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Pharmacology > Drugs of Abuse > Flashcards

Drugs of Abuse Flashcards

1
Q

What are some of the criteria for substance abuse disorders?

A
  • Tolerance
  • Withdrawal
  • Usage of large amounts
  • Normal activities are given up
  • Continued use despite knowledge of problems
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2
Q

Withdrawal

A

Signs that emerge when the use of the drug is stopped which will go away when the drug is resumed

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3
Q

Tolerance

A

Decreased effect with repeated use of drug and increased need for larger doses for the same effect

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4
Q

What pathway is activated by all drugs of dependence?

A

Ventral Tegemental Area of nucleus accumbens which results in the release of dopamine

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5
Q

Besides lack of the agonist, what is another mechanism that can cause withdrawal?

A

Antagonism of the receptor that the drug normally binds to

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6
Q

What are the psychostimulants?

A

Cocaine and amphetamines

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7
Q

Cocaine Uses

A

Powerful CNS stimulant and appetite suppressant as well as a topical anesthetic.

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8
Q

Cocaine MOA

A

Inhibits the action of dopamine transporters in the presynaptic terminals - the levels of DOPA in the presynaptic cleft will increase

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9
Q

Amphetamines MOA

A

Inhibit the action of VMAT2 so DOPA cannot be placed in the vesicles leading to a high level of “free” DOPA that can reverse the DOPA transporter - increased DOPA in the presynaptic cleft

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10
Q

What are the effects of psychostimulants?

A
  • Increased energy
  • Decreased fatigue
  • Decreased appetite
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11
Q

What is the fastest mechanism to feel “high” from cocaine?

A

IV

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12
Q

Where is cocaine metabolized?

A

Hepatic metabolism

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13
Q

What is the problem of combining cocaine with ethanol?

A

Forms cocaethylene which leads to a longer duration of action and an increased cardiotoxic effect

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14
Q

What is a unique risk of psychostimulant abuse?

A

Increased risk of rare autoimmune disorders like lupus and Stevens Johnson

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15
Q

Cocaine OD Signs

A
  • Cardiac Arrhythmia
  • Tachycardia
  • Dilated pupils
  • HTN
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16
Q

What is the treatment for cocaine withdrawal?

A
  • Bromocriptine

- Lorazapam

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17
Q

Opioid MOA

A

Inhibition of GABA interneurons leading to the disinhibition of the mesolimbic DOPA system - increased DOPA in the nucleus accumbens is ultimate result

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18
Q

Opioid OD Signs

A
  • Unconsciousness
  • Respiratory depression
  • Pulmonary edema
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19
Q

Is there cross tolerance to opioids?

A

Yes. Tolerance to one will cause tolerance to another opoid.

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20
Q

What is the metabolism of heroin?

A

Heroin -> 6-monoacetylmorphine -> morphine

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21
Q

Opioid Withdrawal Symptoms

A
  • Lacrimation
  • Rhinorrhea
  • Yawning
  • Piloerection
  • Involuntary movement
22
Q

What is the treatment for opioid addiction and withdrawal?

A

Methadone or busprenophine

23
Q

What is the treatment for opioid OD?

A

Naloxone

24
Q

What is the treatment for opioid dependence?

A

Naltrexone

25
Q

Naloxone MOA

A

mu-opioid competitive antagonist with very high affinity and short half life to displace heroin - heroin is longer acting though and symptoms can return so monitoring is required

26
Q

Naltrexone MOA

A

mu-opioid competitive antagonist with long half life that makes heroin administration no longer rewarding

27
Q

Methadone MOA

A

mu-opioid agonist with long half life that prevents withdrawal symptoms

28
Q

Buprenorphine MOA

A

Partial mu-opioid agonist that has less potential for respiratory depression

29
Q

What is suboxone?

A

4:1 mix of buprenorphine and naloxone

30
Q

Cannabinoid MOA

A

THC inhibits GABA interneurons via CB1 which leads to increased DOPA in the nucleus accumbens

31
Q

What are the symptoms of cannabinoid use?

A
  • Increased appetite
  • Redness of the eyes
  • Relaxation
  • Decreased pressure in the eyes
32
Q

Cannabinoid SE

A
  • Panic
  • Amotivational syndrome
  • Personality changes
33
Q

Type B Alcohol Dependence

A

Earlier onset at less than 25 yrs and is more severe

34
Q

Type A Alcohol Dependence

A

Later onset of greater than 25 yrs and has a slower disease progression

35
Q

What is the effect of alcohol on neural circuits?

A

Increases the effects of GABA and inhibition of glutamate - chronic use leads to reduction of the GABA receptors and upregulation of glutamate receptors

36
Q

What is the result of sudden reduction in alcohol intake from a chronic user?

A

Abrupt increase in glutamate action due to the release from inhibition

37
Q

What drugs are used to treat alcohol withdrawal?

A

Benzodiazepine

38
Q

Alcohol Withdrawal Symptoms

A
  • Seizures
  • Alcoholic hallucinations
  • Delirium tremens
  • Hyperarousal
39
Q

Delirium Tremens

A

Uncontrollable tremors of the extremities with autonomic instability

40
Q

Besides alcohol withdrawal, what else can cause delirium tremens?

A

Benzodiazepine withdrawal

41
Q

What are the treatments for alcohol dependence?

A
  • Disulfiram
  • Naltrexone
  • Acamprosate
42
Q

Disulfiram Indications

A

Alcohol Aversion Therapy

43
Q

Acamprosate MOA

A

Restores balance between excitation and inhibition - but true mechanism is unknown

44
Q

Disulfiram MOA

A

Inhibits aldehyde dehydrogenase that results in nausea and vomiting if alcohol is taken - decreases desire to drink

45
Q

What mutation is protective against alcohol dependence?

A

Often in Asians due to ALDH2*2 mutation

46
Q

Acamprosate Contraindications

A

Severe Renal Disease

47
Q

What is the treatment for benzodiazepine withdrawal?

A

Diazepam - has a long half-life and it will be tapered off over time

48
Q

What is used for treatment of nicotine addiction?

A

Varenicitine - partial agonist that binds nicotine ACh receptors which relieves cravings and binds with greater activity than nicotine which decreases the reward from smoking

49
Q

What is the molecular target of the hallucinogens?

A

Serotonin receptors - 5HT2A

50
Q

Do hallucinogens cause addiction?

A

No

Pharmacology (74 decks)

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