Drugs to Treat Addiction

Question 1

When are schedule I drugs prescribed

Answer 1

No approved medical use in the US at this time

Question 2

List some schedule I drugs

Answer 2

Heroin
Psilocybin
MDMA
LSD
Marijuana

Question 3

How are scheduled drugs placed in schedule II through V?

Answer 3

Schedule II = highest potential for abuse, psychological or physical dependence

Schedule V = those risks still exist, but lowest

Question 4

List some schedule II drugs

Answer 4

Most pure opioid agonists
Amphetamine, cocaine
Barbiturate pentobarbital

Question 5

What schedule drug is THC?

Answer 5

III

Question 6

What schedule drug is ketamine

Answer 6

III

Question 7

What schedule drug are benzodiazepines

Answer 7

IV

Question 8

What schedule drug is zolpidem (Ambien)

Answer 8

IV

Question 9

Definition of drug abuse

Answer 9

Use not in accordance with medical or social norms

Question 10

Definition of substance use disorder

Answer 10

Continued use of drug despite significant use related problems

Question 11

Definition of drug tolerance

Answer 11

Higher dose of drug is required to elicit the same response

Question 12

Definition of cross tolerance

Answer 12

Tolerance to one drug confers tolerance to another
(I.e. opioids)

Question 13

Definition of psychologic drug dependence

Answer 13

Subjective need for a psychoactive drug

Question 14

Definition of physiologic dependence

Answer 14

State in which a physical abstinence syndrome will occur upon drug D/C

Question 15

Definition of withdrawal syndrome

Answer 15

Signs and symptoms that occur in a physiologically dependent person upon drug d/c

Question 16

List some effects of chronic alcohol use

Answer 16

CNS dysfunction
heart failure
Respiratory depression
Liver disease
Gastritis
Esophageal varies
Pancreatitis
Cancer risk
Teratogenesis
(Others as well!)

Question 17

What is the pattern of alcohol metabolism?

Answer 17

Zero order kinetics
(Set amount metabolism per hour, not set % metabolism per hour)

Question 18

Major drug class with cross tolerance with alcohol

Answer 18

Benzodiazepines

Question 19

As tolerance to alcohol develops, tolerance does not develop to _____

Answer 19

Respiratory depression

Question 20

Severe s/s alcohol withdrawal?

Answer 20

Cramps, vomiting, hallucinations, seizures, tachycardia, HTN, hyperthermia

Can be life threatening

Question 21

Treatment of alcohol OD

Answer 21

Supportive
(Resp support, hemodynamic support, manage fluids/electrolytes/glucose)

Question 22

Pharmacological treatment of acute alcohol withdrawal

Answer 22

Benzodiazepines!
Adjunct = antiseizure meds, a2 agonists, beta blockers

Question 23

List three meds used in alcohol abstinence. Which is the most effective?

Answer 23

Disulfiram
Naltrexone- most effective
Acamprosate

Question 24

How does disulfiram work?

Answer 24

Inhibits alcohol dehydrogenase, thus toxic levels of acetaldehyde accumulate

This causes negative reactions if etoh is consumed

Question 25

Disulfiram with etoh can cause:

Answer 25

Nausea, vomiting Sweating Weakness, blurred vision Hypotension —> CV collapse Resp depression Death (This is due to acetaldehyde accumulation)

Question 26

How does naltrexone work?

Answer 26

Pure opioid antagonist that blocks the pleasurable effects of EtOH (decreased dopamine release)

Question 27

How does acamprosate work

Answer 27

Decreases desire to drink (since it decreases subclinical withdrawal symptoms, likely through NMDA actions)

Question 28

At doses ingested in smoking, what are the effects of nicotine?

Answer 28

Agonism at SNS/PSNS ganglia and adrenal medulla - vasoconstriction - tachycardia - vomiting - CNS stimulation

Question 29

With tolerance to nicotine, a person does not develop tolerance to _____

Answer 29

CV effects

Question 30

S/s nicotine withdrawal

Answer 30

Anxiety & irritability Impaired concentration Increased appetite, weight gain

Question 31

How does nicotine replacement therapy work in smoking abstinence

Answer 31

Pharmacological nicotine doesn’t result in as much pleasure but avoids the withdrawal symptoms. Then we can slowly decrease nicotine dose

Question 32

How does bupropion work in smoking abstinence?

Answer 32

Reduces cravings and some other w/d symptoms d/t cns stimulation

Question 33

How does varencline work in smoking cessation?

Answer 33

Partially agonizes nicotine receptors- allows for pleasurable effects but prevents pleasurable effects from nicotine from occurring

Question 34

Which drug is most effective in smoking cessation?

Answer 34

Varenicline

Question 35

Three drugs used in the treatment of opioid abstinence

Answer 35

Methadone Buprenorphine Naltrexone

Question 36

How does methadone work in opioid abstinence

Answer 36

Less euphoria and increases tolerance to street opioid (thus the street opioid won’t cause euphoria either)

Question 37

How does buprenorphine work in opioid abstinence?

Answer 37

Alleviates cravings but since there is a ceiling to resp depression, it’s safer

Question 38

How does naltrexone work in opioid abstinence?

Answer 38

Blocks euphoria if opioids are used

Question 39

Antidote for benzodiazepines

Answer 39

Flumazenil