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Clinical Pharmacology > Drugs of abuse and toxicity > Flashcards

Drugs of abuse and toxicity Flashcards

1
Q

What is abstinence syndrome?

A

signs and symptoms that occur on withdrawal of a drug in dependent person

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2
Q

What is addiction?

A

compulsive drug-using behavior where the person uses the drug for personal satisfaction

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3
Q

What is a controlled substance?

A

drug deemed to have abuse liability

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4
Q

What is dependence?

A

signs and symptoms opposite of those caused when withdrawn from chronic use or abruptly lowered

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5
Q

What is a designer drug?

A

synthetic derivative of a drug with slightly modified structure but no major change in action

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6
Q

How does dopamine work in regard to addiction?

A

primary role in expression of reward – appears that most addictive drugs affect dopamine in the CNS

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7
Q

What is drug class I and its drugs?

A

no medical use, high addiction potential – flunitrazepam, heroin, LSD, mescaline, PCP, MDA, MDMA, STP, marijuana

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8
Q

What is drug class II and its drugs?

A

medical use and high addiction potential – amphetamines, cocaine, methylphenidate, short acting barbiturates, strong opiods

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9
Q

What is drug class III and its drugs?

A

medical use and moderate abuse potential – anabolic steroids, barbiturates, dronabinol, ketamine, sodium oxybate

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10
Q

What is drug class IV and its drugs?

A

medical use and low abuse potential, benzos, chloral hydrate, mild stimulants, most hypnotics, weak opiods

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11
Q

What are sedative-hypnotics?

A

Benzos (pams and lams), barbiturates (barbitals) and sodium oxybate (GHB), alcohol

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12
Q

What are the effects of sedative-hypnotics?

A

reduce inhibitions, suppress anxiety, produce relaxation – facilitation of GABA effects or enhance brain dopaminergic pathways

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13
Q

What are overdose signs on sedative-hypnotics?

A

slurred speech, drunken behavior, dilated pupils, weak and rapid pulse, clammy skin, shallow respiration, coma, death

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14
Q

What can potentiate the effect of the depressant of sedative-hypnotics?

A

opioid analgesics, antipsychotics, marijuana, drugs with sedatives

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15
Q

How do acute overdoses occur in sedative-hypnotic drugs?

A

depression of medullary, respiratory, and cardiovascular centers

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16
Q

How do you manage a sedative-hypnotic overdose?

A

maintenance of patient airway + ventilatory support
Flumazenil = benzodiazepine antidote but can cause seizures if too fast
not for barbiturates or alcohol

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17
Q

What does withdrawal look like for sedative-hypnotics?

A

anxiety, tremor, n/v, delirium, hallucinations, seizures

long term can have weight loss, tingling/numbing, headache

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18
Q

What is withdrawal treatment for sedative-hypnotics?

A

long activating sedative hypnotic followed by gradual dose reduction and prevent seizures
clonidine or propranolol may be used to suppress this

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19
Q

What can you use to make a patient stop drinking alcohol?

A

naltrexone, acamprosate, disulfuram cause very sick reaction to alcohol

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20
Q

What are the effects of opioids?

A

euphoria –> sedation, rapid tolerance dependence and addiction
po/smoking = milder effects

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21
Q

What are examples of opioids?

A

heroin, morphine, codiene, oxycodone, meperidine, fetanyl

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22
Q

What does an opioid overdose look like?

A

respiratory depression

23
Q

How do you treat an opioid overdose?

A

naloxone and ventilatory support (airway!)

24
Q

What are withdrawal symptoms for opioids?

A

lacrimation, rhinorrhea, yawning, sweating, weakness, goose flesh, n/v, tremors, hyperpnea (rarely fatal)

25
Q

How can you help treat withdrawal from opioids?

A

replacement with pharmacologically similar drug and slow dose reduction, buprenorphine, use of naloxone to make more intense
neonates = special management

26
Q

What do amphetamines do?

A

stimulate, increasing release of dopamine, nore, serotonin

27
Q

What do stimulants cause?

A

euphoria and self-confidence

28
Q

What can chronic meth stimulant use cause?

A

psychotic state with delusions, paranoia, picking

29
Q

What are overdose signs for methamphetamine stimulants?

A

agitation, restlessness, tachycardia, hyperthemia, hyperreflexia, seizures
no antidote

30
Q

What is chronic meth stimulant abuse associated with?

A

necrotizing arteritis

31
Q

What are stimulant withdrawal symptoms?

A

increased appetite, sleepiness, exhaustion, depression

32
Q

What do overdoses look like for cocaine?

A

stimulant too – common fatalities from arrhythmias, seizures, respiratory depressions. No antidote available either

33
Q

What is associated with increased fetal morbidity and mortality?

A

cocaine use in pregnancy

34
Q

How do you handle a poisoning situation?

A

supportive care – airway and blood pressure support, toxicology screenings

35
Q

What are three procedures wildly used to reduce absorption of poisons from GI tract?

A

inducing emesis w/in 1 hr of ingestion*
gastric lavage w/in 1 hr of ingestion*
activated charcoal absorbs poison throughout
*Small intestine not cleared

36
Q

What is the major cause of hepatic failure in the US?

A

acetaminophen toxicity

37
Q

What is the metabolite of acetaminophen toxicity?

A

N-acetyl-p-benzoquinone imine (NAPQI) due to overload of pathway so forced into toxic metabolite

38
Q

What is the antidote for severe APAP toxicity?

A

n-acetylcysteine (NAC)

39
Q

What is methanol in that patients may ingest?

A

windshield and gas line antifreeze, fuel, rapid PO absorption

40
Q

What makes methanol toxic?

A

metabolites – metabolized by alcohol dehydrogenase to form formaldehyde (problem)

41
Q

What happens with methanol and ethylene glycol toxicity?

A

metabolic acidosis, glycoaldehyde, renal injury

42
Q

What are two antidotes for methanol exposure?

A

ethanol and fomepizole, blocking the metabolism of alcohol dehydrogenase

43
Q

What does cyanide do?

A

complete blockade of oxidative phosphorylation critically with cytochrome a3, resulting in loss of ATP synthesis —-> everything ceases to function

44
Q

What are the antidotes for cyanide?

A

nithoidote: sodium nitrite IV and sodium thiosulfate IV
may cause significant HYPOtension, monitor SpO2, give high dose O2

cyanokit -hydroxycobalamin ** very high affinity for cyanide, faster option

45
Q

What drug has a narrow therapeutic index?

A

Digoxin – toxicity resulting from lower cardiac conduction and heightened automaticity

46
Q

What are overdose symptoms of digoxin?

A

unusual blind spots, color mismatch, irregular pulse, tachycardia

47
Q

What is the antidote for a digoxin overdose?

A

digibind, digitalis antidote, digifab

48
Q

What do you give to treat an arsenic exposure?

A

dimercaprol

49
Q

What do you give to treat an iron exposure?

A

deferoxamine

50
Q

What do you give to treat a lead exposure?

A

succimer, EDTA

51
Q

What do you give to treat a mercury exposure?

A

succimer, dimercaprol

52
Q

What is a chelator?

A

binding agent that suppresses chemical activity by forming cheleates – metal toxicity treatment relies on this

53
Q

What is the antidote to warfarin?

A

phytonadione – vitamin K (orally)

54
Q

How does warfarin work?

A

inhibits regeneration of Vitamin K through inhibiting reductase C1 and quinone reductase

Clinical Pharmacology (14 decks)

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