Drugs of Abuse

Question 1

Pharmacotherapies for Alcohol Addiction

Answer 1

Naltrexone, Acamprosate, Disulfiram, Topiramate

Question 2

Pharmacotherapies for Opioid Addiction

Answer 2

Methadone, Buprenorphine, Naltrexone, Naloxone

Question 3

Pharmacotherapies for Nicotine Addiction

Answer 3

• Nicotine Replacement Therapy (NRT)
• Bupropion (Zyban)
• Varenicline (Chantix)
• Combined with Behavioral Treatment

Question 4

Pharmacotherapies for Misc.

Answer 4

Bromocriptine

Question 5

Amphetamines - MoA

Answer 5

 Increases release of DA
• Reverses DA transport through the DAT

Adderall, Ritalin (methylphenidate)

Question 6

Amphetamines - Uses

Answer 6

Narcolepsy & ADHD

Question 7

Amphetamines - Side Effects

Answer 7

 CNS effects: Alertness, euphoria, excitement
• Appetite suppression
• Aggression, paranoia, delusions

 Peripheral effects
• Increased blood pressure
• Cardiac toxicity - pulmonary edema and heart
failure via extensive cardiac stimulation

Question 8

Methamphetamine (ICE, crystal meth)

Answer 8

 May produce amphetamine psychosis
 Adverse effects: weight loss, pale skin, body odor,
hyperthermia, dental problems, ‘meth bugs’,
seizures, organ damage, stroke, heart attack
 Chronic use may cause permanent damage to
noradrenergic and serotonergic neurons
 Long-term personality changes common
 Rapid physical and psychological dependence
 “Craving” in abstinence is intense

 Withdrawal - may be severe and last a long time

Question 9

Cocaine

Answer 9

 Mechanism: Inhibits DA reuptake
 Craving can be severe
 Physical and psychological dependence

 CNS stimulation
• alertness, euphoria, anxiety, hyperactivity
 Peripheral effects
• tachycardia, vasoconstriction, hypertension
• bronchodilation, hyperpyrexia

 Medical: local anesthetic, vasoconstrictor

Question 10

Chronic Cocaine Use

Answer 10

 Reduction in overall brain activity
 Anxiety, insomnia, paranoia, hallucinations, repetitive
behaviors
 “Cocaine bugs”
 Nasal congestion and perforated nasal septum
 Intense physiological dependence -
dysphoria/craving when drug levels drop
 Withdrawal - can be severe
 Overdose (toxicity)
• Ventricular tachycardia and fibrillation
• Stroke or cerebral hemorrhage
• Seizures

Question 11

Treatment of Cocaine Addiction

Answer 11

 Pharmacological treatment

• bromocriptine – decreases craving for cocaine

Question 12

Nicotine - MoA

Answer 12

 Activates nicotinic receptors in the CNS and
periphery
 Increases 5-HT and DA release

Question 13

Nicotine - CNS Effects

Answer 13

mild euphoria, increased arousal, appetite suppression

Question 14

Nicotine - Pharmacokinetics

Answer 14

Rapidly absorbed; ½ life of 30 min

 Metabolized by CYP450s; Induces CYP450s

Question 15

Nicotine - Withdrawal

Answer 15

difficult, can last months

Question 16

MDMA “Ecstasy”

Answer 16

 Increases 5-HT activity by blocking reuptake and
stimulating 5-HT receptors
 Produces feelings of peacefulness, empathy,
closeness and trust
 May be followed by confusion, depression, anxiety,
paranoia
 Increases blood pressure and heart rate
 Hyperthermia, dehydration, kidney failures can lead
to fatalities
 Persistent memory loss may occur

Question 17

Marijuana - MoA

Answer 17

 delta-9-tetrahydrocannabinol (THC)
 Smoked or eaten; quickly absorbed
 Very lipophilic, long half life

• stimulates presynaptic CB1
  receptors to inhibit transmitter (ACh) release

Question 18

Marijuana - Effects

Answer 18

 Produces state of mild euphoria, well being, altered
sense of time, difficulty concentrating, introspection,
tranquility
 No physical dependence; psychological dependence
possible

Question 19

Marijuana - Adverse Effects

Answer 19

 Anxiety, decreased memory, impaired cognitive
functioning
 Amotivational syndrome
 Cannabinoid hyperemesis - cyclic vomiting syndrome
 Bronchial irritation, risk of cancer
 Decreased ovulation and testosterone/sperm
production
 Low birth weight and fetal malformations

Question 20

LSD & Mescaline & Psilocybin

Answer 20

 Lysergic acid diethylamide (LSD)
 Acts on 5-HT receptors in the brain
 Euphoria, visual hallucinations
 Altered sense of time and reality
 “bad trips”; flashbacks
 May increase BP and heart rate, flushing, dilated
pupils
 Synesthesia–one sensory modality assumes the
characteristics of another (colors can be heard or
sounds may be seen)
 Don’t cause dependence, don’t stimulate DA
pathways

Question 21

PCP, Ketamine, and GHB

Answer 21

 PCP (angel dust), ketamine–NMDA receptor
antagonists
 GHB–GABA receptor weak agonist
 Developed as general dissociative anesthetics
 Sensation of dissociation or “floating”
 PCP and ketamine may cause analgesia
accompanied by aggression
 May produce amnesia and personality changes
 PCP often produces psychosis, treat with haloperidol
in ER
 Ketamine and GHB used as “date rape” drugs
 Increases blood pressure; May cause coma with non-
reactive pupils

Question 22

Inhalants

Answer 22

 Recreational exposure to chemical vapors (Huffing)
 Household cleaners, solvents, nitrates, ketones,
hydrocarbons
 Produces sense of euphoria
 Mechanism unknown; may alter ionotropic receptors
and increase DA
 Toxicity occurs in many organs; lesions in brain’s
white matter

Question 23

Nitrous Oxide

Answer 23

 Rapid, short acting pleasurable effects
 Peripheral neuropathy with chronic use
 Overdose can be fatal
 Frequently abused by dentists

Question 24

Amyl and Butyl Nitrite

Answer 24

 Smooth muscle relaxants
 Euphoria, light headedness, blurred vision,
headache, nausea, hypotension, tachycardia