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Psychology- Pharm > Drugs of Abuse, Tolerance and Dependence > Flashcards

Drugs of Abuse, Tolerance and Dependence Flashcards

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1
Q

Differentiate mild from severe substance abuse

A

Mild: 2-3 symptoms
Severe: 5+ symptoms

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2
Q

Which pathway is activated by all drugs of dependence? What is the end results of activation?

A

VTA-nucleus accumbens pathway —> dopamine release

VTA= ventral tegmental area

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3
Q

What is responsible for the inhibition of dopamine release from the ventral tegmental area?

A

GABA-ergic inhibitory interneurons.

Drugs that affect these interneurons can cause dependence

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4
Q

What is cocaine’s MOA?

A

Cocaine inhibits the dopamine reuptake transporter –> increased dopamine in synaptic cleft

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5
Q

What is the MOA of amphetamines?

A

Amphetamines inhibits the vesicular monoamine transporter responsible for packing dopamine into the secretory vesicles –> increased dopamine in pre-synaptic clefts –> leakage of dopamine into presynaptic cleft

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6
Q

What aspects of cocaine are altered by route of administration?

A

Onset, magnitude and duration depend on the route of administration

Users prefer IV administration –> surge

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7
Q

Where is cocaine metabolized?

A

Liver- by cholinesterases.

Inactive metabolite is detectable in urine for up to 8 days

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8
Q

What is the problem of mixing cocaine and ethanol?

A

Cocaine in the presence of ethanol is transesterified resulting in cocaethylene, which produces more euphoria and has a longer duration of action.

It is more cardiotoxic than cocaine alone

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9
Q

People who take cocaine are at a higher risk for developing what type diseases?

A

Autoimmune diseases or connective tissue diseases such as lupus, Goodpasture’s syndrome, SJS

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10
Q

What is the deadly symptom of cocaine?

A

Cardiac arrhythmias

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11
Q

Name two drugs that may be used for the treatment of acute withdrawal from cocaine

A

Bromocriptine

Benzodiazepines (mostly lorazepam because it’s less toxic to the liver)

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12
Q

What are the treatment strategies for long term addiction?

A

No FDA approved pharmacological therapies

Cognitive-Behavioral Therapies- functional analysis and coping skills

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13
Q

Name the 4 most common opiods

A

Heroin
Morphine
Codeine
Oxycodone

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14
Q

What is the general MOA of opioids?

A

They cause inhibition of mesolimbic dopamine by acting on mu receptors located on GABAergic interneurons

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15
Q

Do tolerance and dependence occur with heroin use?

A

Yes, both –> increased in quantities taking

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16
Q

What are the dangerous symptoms associated with heroin overdose?

A

Respiratory depression and pulmonary edema

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17
Q

Describe the “cross-tolerance” phenomenon of opioids

A

Development of tolerance to one opioid leads to tolerance of other opioids

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18
Q

Why does heroin last longer than morphine?

A

Heroin is metabolized to 6-monoacetylmorphine, which is then metabolized further to morphine.

Double the trouble, double the fun.

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19
Q

Is heroin withdrawal life-threatening?

A

No, although it is profoundly painful

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20
Q

How soon will heroin withdrawal symptoms set in?

A

12 hours after last dose.

Last between 5-7 days, although some effects can linger

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21
Q

Name 5 withdrawal symptoms specific to opioids

A 
Lacrimation
Rhinorrhea
Yawning
Piloerection/gooseflesh
Involuntary movement (kicking the habit!)
22
Q

What is the treatment for opioid overdose?

A

Naloxone- mu receptor antagonist

23
Q

What drug is used for the treatment of opioid addiction/dependence?

A

Naltrexone- mu opioid receptor antagonist

24
Q

Name two drugs used for the treatment of opioid withdrawal symptoms/maintenance

A

Methadone- mu receptor opioid agonist

Buprenorphine- partial mu receptor opioid agonist

25
Q

What is a contraindication for the use of naltrexone?

A

Liver failure

26
Q

Why does naltrexone work for the treatment of opioid addiction?

A

Because heroin self-administration is no longer rewarding- heroin does not out-compete the antagonistic binding

27
Q

Why does methadone work for opioid withdrawal?

A

Because the half-life is so long, that people don’t feel “high” when they take it

28
Q

Why was suboxone formulated?

A

Suboxone (buprenorphine/naloxone) was formulated so that if people tried to inject the drug, they would not feel high at all, and the blocking effects of naloxone would lead to withdrawal symptoms

29
Q

How does THC work?

A

THC inhibits GABAergic interneurons in the ventral tegmental area leading to increased levels of dopamine in the nucleus accumbens

30
Q

Name the receptor recently discovered in the MOA of marajuana

A

CB1

31
Q

What is the age of onset for Type B alcohol dependence?

A

<25 (early onset)

32
Q

Which type of alcohol dependence is more severe?

A

Type B

33
Q

What other mental health problems are associated with Type B alcohol dependence?

A

Personality disorders and criminality

34
Q

How does alcohol affect GABA?

A

Increases effects of GABA

35
Q

How does alcohol affect glutamate?

A

Inhibits the effects of glutamate

36
Q

How does alcohol affect the GABAergic and NDMA receptors?

A

Reduce levels of GABA-ergic receptors
Increase levels of NMDA receptor

Sudden decrease in chronic alcohol consumption leads to overactivation of the NMDA receptor

NMDA sensitization, GABA desensitization

37
Q

How does alcohol withdrawal lead to sudden death?

A

NMDA system has been oversensitized (firing like crazy because there is no GABA)

Withdrawal leads to overactivation of NMDA and sudden death

38
Q

What are the 4 stages of alcohol dependence treatment?

A
  1. Identification
  2. Detox/withdrawal
  3. Rehab
  4. Aftercare
39
Q

Why are benzodiazepines given for alcohol withdrawal symptoms?

A

They are indirect agonists for GABA receptors

40
Q

Why is lorazepam often prescribed for the treatment of alcohol withdrawal symptoms?

A

Because it is not metabolized by the liver, and most alcoholic have a messed up liver

41
Q

Describe the minor alcohol withdrawal symptoms

A

Seen: 6-36 hours after the last drink

Hyperarousal, anxiety, GI upset, sweating, palpitations, insomnia, nausea…

42
Q

Describe the seizure stage of alcohol withdrawal symptoms

A

6-48 hours after last drink: tonic-clonic seizures –> status epilepticus

Can be life threatening

43
Q

When do auditory hallucinations occur as a part of alcohol withdrawal?

A

12-48 hours after the last drink

44
Q

When does delirium tremens occur?

A

48-96 hours after last drink. Can last up to 5 days

45
Q

What are the life-threatening features of delirium tremens?

A

autonomic instability- fever, tachycardia, hypertension, diaphoresis)…

46
Q

What are the three drugs approved for the treatment of alcohol dependence?

A

D-Disulfiram
N- Naltrexone
A- Acamprosate

47
Q

How does disulfiram work for the treatment of alcohol dependence?

A

Disulfiram blocks the conversion of acetaldehyde (which gives hangover symptoms) to acetate.

Therefore acetaldehyde builds up and makes you feel sick

Alcohol aversion therapy

48
Q

What genetic variant do asian people have that slows down the metabolism of acetaldehyde?

A

ALDH2*2

49
Q

How does naltrexone work to treat alcohol dependence?

A

Blocks release of opioid release to nucleus accumbens, decreases alcohol cravings

50
Q

Which is the best drug available for alcohol treatment? How does it work?

A

Acamprosate

MOA unknown, but leads to increased balance of neurotransmitters

51
Q

Which are the two most common hallucinogens?

A

LSD, mescaline

52
Q

What is the receptor of LSD?

A

5HT-2A in the cortex

Psychology- Pharm (7 decks)

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