Drugs to Treat Addiction Flashcards
When are schedule I drugs prescribed
No approved medical use in the US at this time
List some schedule I drugs
Heroin
Psilocybin
MDMA
LSD
Marijuana
How are scheduled drugs placed in schedule II through V?
Schedule II = highest potential for abuse, psychological or physical dependence
Schedule V = those risks still exist, but lowest
List some schedule II drugs
Most pure opioid agonists
Amphetamine, cocaine
Barbiturate pentobarbital
What schedule drug is THC?
III
What schedule drug is ketamine
III
What schedule drug are benzodiazepines
IV
What schedule drug is zolpidem (Ambien)
IV
Definition of drug abuse
Use not in accordance with medical or social norms
Definition of substance use disorder
Continued use of drug despite significant use related problems
Definition of drug tolerance
Higher dose of drug is required to elicit the same response
Definition of cross tolerance
Tolerance to one drug confers tolerance to another
(I.e. opioids)
Definition of psychologic drug dependence
Subjective need for a psychoactive drug
Definition of physiologic dependence
State in which a physical abstinence syndrome will occur upon drug D/C
Definition of withdrawal syndrome
Signs and symptoms that occur in a physiologically dependent person upon drug d/c
List some effects of chronic alcohol use
CNS dysfunction
heart failure
Respiratory depression
Liver disease
Gastritis
Esophageal varies
Pancreatitis
Cancer risk
Teratogenesis
(Others as well!)
What is the pattern of alcohol metabolism?
Zero order kinetics
(Set amount metabolism per hour, not set % metabolism per hour)
Major drug class with cross tolerance with alcohol
Benzodiazepines
As tolerance to alcohol develops, tolerance does not develop to _____
Respiratory depression
Severe s/s alcohol withdrawal?
Cramps, vomiting, hallucinations, seizures, tachycardia, HTN, hyperthermia
Can be life threatening
Treatment of alcohol OD
Supportive
(Resp support, hemodynamic support, manage fluids/electrolytes/glucose)
Pharmacological treatment of acute alcohol withdrawal
Benzodiazepines!
Adjunct = antiseizure meds, a2 agonists, beta blockers
List three meds used in alcohol abstinence. Which is the most effective?
Disulfiram
Naltrexone- most effective
Acamprosate
How does disulfiram work?
Inhibits alcohol dehydrogenase, thus toxic levels of acetaldehyde accumulate
This causes negative reactions if etoh is consumed
Disulfiram with etoh can cause:
Nausea, vomiting
Sweating
Weakness, blurred vision
Hypotension —> CV collapse
Resp depression
Death
(This is due to acetaldehyde accumulation)
How does naltrexone work?
Pure opioid antagonist that blocks the pleasurable effects of EtOH (decreased dopamine release)
How does acamprosate work
Decreases desire to drink (since it decreases subclinical withdrawal symptoms, likely through NMDA actions)
At doses ingested in smoking, what are the effects of nicotine?
Agonism at SNS/PSNS ganglia and adrenal medulla
- vasoconstriction
- tachycardia
- vomiting
- CNS stimulation
With tolerance to nicotine, a person does not develop tolerance to _____
CV effects
S/s nicotine withdrawal
Anxiety & irritability
Impaired concentration
Increased appetite, weight gain
How does nicotine replacement therapy work in smoking abstinence
Pharmacological nicotine doesn’t result in as much pleasure but avoids the withdrawal symptoms.
Then we can slowly decrease nicotine dose
How does bupropion work in smoking abstinence?
Reduces cravings and some other w/d symptoms d/t cns stimulation
How does varencline work in smoking cessation?
Partially agonizes nicotine receptors- allows for pleasurable effects but prevents pleasurable effects from nicotine from occurring
Which drug is most effective in smoking cessation?
Varenicline
Three drugs used in the treatment of opioid abstinence
Methadone
Buprenorphine
Naltrexone
How does methadone work in opioid abstinence
Less euphoria and increases tolerance to street opioid (thus the street opioid won’t cause euphoria either)
How does buprenorphine work in opioid abstinence?
Alleviates cravings but since there is a ceiling to resp depression, it’s safer
How does naltrexone work in opioid abstinence?
Blocks euphoria if opioids are used
Antidote for benzodiazepines
Flumazenil
