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DTII Exam 2 > Egleton: Drug Abuse > Flashcards

Egleton: Drug Abuse Flashcards

1
Q

Cause of pleasure sensation

A

Mesolimbic tract

Dopamine

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2
Q

Cause of craving

A

PFC

Hippocampus

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3
Q

Cause of withdrawal

A

Hypothalamus

Brain stem

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4
Q

Meds with Direct effect

A

Cocaine

Amphetamine

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5
Q

Meds with Indirect effect (disinhibition)

A 
Nicotine
Alcohol
Opioids
Benzos
Cannabinoids
PCP
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6
Q

Severity of addiction depends on what

A

Dose and Duration

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7
Q

Opioids: MoA

A

Stimulate opioid receptors in mesolimbic reward circuit
Inhibit GABAergic transmission
Increased Nucleus accumbens Dopamine release
Induce Euphoria, then tranquility and drowsiness

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8
Q

Opioids: overdose

A 
Decreased respiratory rate
Decreased bowel sound
Constricted pupils
Dereased tidal volume
Depressed mental status
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9
Q

Opioids: treatment

A

Ventilation

Naloxone (IV/IM)

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10
Q

Opioids: maitenance

A 
Methadone maintenance (gold standard) {reduce craving and withdrawal}
Buprenorphine (partial Mu agonist, Kappa antagonist) {induce withdrawal abstinence}
Naltrexone (antagonist) {prevent relapse}
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11
Q

Opioids: withdrawal

A

Pupil dilation
Yawning
Increased bowel sounds
Hypotension (by diarrhea and vomiting){loss of volume}

Dysphoria, Restlessness
Rhinorreha, Lacrimation
Myalgias, Arthralgias
Nausea, Vomiting, Abdominal cramping, Diarrhea
Hypersensitivity to pain
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12
Q

Oxycodone

A 
Hillbilly heroin
Delayed release formulation
Longest actign pain reliever on market
Cheap
Combination with Acetaminophen> potential Liver problem
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13
Q

Heroin

A

Diacetylmorphine metabolized to 6-monoacetylmorphine then Morphine
High BBB penetration
Effects by 6-monoacetylmorphine and Morphine
Urine test detects 6-monoacetylmorphine specific heroin metabolites

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14
Q

Cheese heroin

A

Mixture of Black tar heroin and Tylenol PM

{liver damage!}

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15
Q

Krokodil

A

The living dead
Russian addicts
Leaves scaly skin akin to crocodile’s

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16
Q

Benzodiazepines {BDZ}

A

Generally safe in overdose {unless with Alcohol/ depressants}
Sedative/ cause CNS depression with normal vital sign
Antidote= Flumazenil
Abrupt withdrawal= Tremor, Anxiety, Perceptual disturbance, Dysphoria, Psychosis, Seiuzures
Treated with Diazepam (IV)

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17
Q

Flunitrazepam

A

Roofie drug

Date rape drug (added to drinks)

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18
Q

Barbituates

A

Sedative
Can lead to respiratory depression and death
No antidote

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19
Q

Propofol

A

In anesthesia
Short power naps for Anesthesiologists
Short term effects: Mild euphoria, Hallucination, Disinhibition
Long term effects: Addiction

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20
Q

Gamma-hydroxybutyrate

A

Sedative
Date rape drug (put into drinks)
CNS depressant, Increase release of endogenous opioids
ADR: Drowsiness, Dizziness, Nausea/ Vomiting
Toxicity: Amnesia, Seizures, Cardiopulmonary depression, Coma, Death

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21
Q

Alcohol

A

Stimulate both GABA and Opioid transmission
Antidote= Naltrexone
Antabuse= Disulfiram

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22
Q

Amphetamines

A

Directly increase levels of Dopamine in Nucleus accumbens
Metamphetamine is the most effective (BBB crossing)
Meth is better at it.

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23
Q

Amphetamines: MoA

A 
Increase neurotransmission in central NE, DA and 5-HT system by their release
Low dose: NE released more
Moderate dose: NE and DA released
High dose: NE, DA, 5-HT released 
{NE>DA>5-HT}
Blockade of reuptake of NE, DA, 5-HT
Inhibition of MAO
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24
Q

Meth

A

Increase attention, Concentration, Focus, Talkativeness
Good for ADHD
Increase vigilance, Wakefulness
Decrease fatigue, Appetite
Increased mood, Elation, Euphoria, Self confidence, Psychomotor stimulation

Popular in college campus

Oral, nasal, IV
Rapid onset, Prolonged symptoms

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25
Q

Meth: ADR

A

{Like Schizophrenia}
Acute: Restlessness, Anxiety, Insomnia, Agitation, Aggressiveness, High dose= Convulsions
Chronic: Paranoid schizophrenia-like state, Delusions, Hallucinations
CV: Palpitations, Arrhythmias, Hypertension, Anginal pain, Circulatory collapse
GI: Anorexia, Nausea/Vomiting, Abdominal cramps, Diarrhea
Others: Meth mites, Meth mouth, etc
Headaches, chills, sweating, Fulminant hyperthermnia, DIC, Rhabdomyoslysis, Renal failure, Hepataotoxicity

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26
Q

Meth: Tolerance

A

With chronic use

Withdrawal symptoms of Mental depression, Fatigue, Hunger

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27
Q

Meth: Overdose

A 
CNS stimulation (Agitation, Delirium, Acute psychosis)
Tachycardia
Hypertension
Dilated pupils
Diaphoresis
Hyperthermia
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28
Q

Meth overdose treatment, avoid what

A

Beta blockers

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29
Q

Meth overdose treatment: meds

A 
Benzodiazepine (Lorazepam, Diazepam)
Antipsychotics (Chlorpromazine, Haloperidol, Droperidol, Ziprasidone)
Stabilize airways and CV function
Activated charcoal
Control seizure
Modify urine pH
30
Q

Meth: Withdrwal

A

Mental depression
Fatigue
Ravenous hunger

31
Q

MDMA:MoA

A

Amphetamine derivative
Indirect serotonergic agonist
{Increase 5-HT release, Block reuptakes}

32
Q

MDMA: action

A 
Prolonged effect up to 1wk
Sympathomimetic and Psychotomimetic
Increased Euphoria, Empathy
Enhances pleasure
Heightens sexuality
Expands consciousness
Positive change in self-image
33
Q

MDMA toxicity

A 
{Problem if dehydrated}
Narrow margin of safety
Cardiac arrhythmias
Hyperthermia
Convulsions
Rhabdomyolysis
renal failure
Fatalities
Psychosis

Depression (after long term use)
Chronic use= Hepatic damage

34
Q

Cocaine: MoA

A

Blocks reuptake of NE, DA, 5-HT
Blocks Na channel
{Act as local anesthetics for eye/nasal surgeries}
Increase concentration of excitatory AA (Glutamate, Aspartate) in Nucleus accumbens

35
Q

Cocaine: CNS stimulation

A

Increase mental awareness, Euphoria
Feeling of well being, Increaed self confidence
Hallucinations, Delusion, Pranoia
Reduction of fatigue
Restlessness, Irritability, Anxiety, Sleeplessness, Mood swings

36
Q

Cause of cocaine craving

A

Chronic cocaine intake= DA depletion by breakdown

37
Q

Cocaine: withdrawal

A

Fatigue, Depression, Sleep disturbance, Increased appetite

38
Q

Cocaine metabolites

A

Active metabolite:
Cocaethylene (formed only in presence of alcohol via transesterifcication, 17%)
{Crosses BBB, block reuptake, as potent as cocaine}

Inactive metabolites:
Benzoylecgonine (spontaneous hydrolysis, 50%)
Ecgonine (plasma/ liver pseudocholinesterase 40-50%)
Norcocaine (liver P450 induced demethylation, 5%)

39
Q

Cocaine: overdose toxicity

A

Cardiac failure (rapid elevation of blood pressure= stroke, irregular heartbeat, cardiac arrest}

Delirium, Violent behavior
Weak and irregular pulse
Tonic-clonic seizures
Malignamnt encephalopathy

40
Q

Cocaine: treatment

A

Agitation: Benzodiazepine (Diazepam, Lorazepam}
Hypertension: Benzodiazepine, Phentolamine
MI: Aspirin, Nitroglycerin, Phentolamine
{No Beta blockers for Hypertension and MI}

Bromocriptine: DA agonist, reduces craving of drug?

41
Q

Cocaine: prolonged use

A

Addiction and Physical dependence

Malnutrition, Weight loss, Sexual problems, Mental confusion, Anxiety

42
Q

Cocaine babies

A

Hyperactivity, tension, Muscle stiffness, Poor reflexes, Delayed motor development

43
Q

Levamisole

A

Anthelminthic drug used by vets in Mexico
MAOI and COMT inhibitory action

Induce Neutropenia, Agranulocytosis

44
Q

Crack

A

Free base form of Cocaine

“Crack lips” due to hot pipe

45
Q

Bath salts

A

Designer drugs
Metphedrone, MDPV, Methylone
{Cathionones= similar to Amphetamine}

46
Q

Bath salts: MoA

A

Similar to Amphetamine {transporter inhibition}
Not as potent
Induce Feeling of empathy, Stimulation, Alertness, Euphoria, Mood lift, Appreciation of music/ Awareness of senses

47
Q

Bath salts: ADR

A

Similar to Amphetamine’s

48
Q

Bath salts: treatment

A 
{Similar to Amphetamine's}
Benzodiazepine (Lorazepam, Diazepam)
Antipsychotics (Chlorpromazine, Haloperidol, Droperidol, Ziprasidone)
Stabilize airways and CV function
Activated charcoal
Control seizure
Modify urine pH
49
Q

Khat

A

East Africa, Arabian-Peninsula
From Catha edulis (flowering shrub’s shoots/ leaves)
Cathinone= active chemical
Structurally similar to Amphetamine, similar potency
90 min of action
ADR/ Withdrawal same as Amphetamine’s

50
Q

Nicotine

A 
From Nicotiana plant
Lipid soluble
Tertiary amine
Rapidly absorbed/ distributed
Cotinine= metabolite
Tars in cigarette smoke accelerates metabolism of other drug

Used for smoking cessation therapy

51
Q

Nicotine: MoA

A

Activate Cholinergic nicotinic receptors (CNS, PNS)
Initially stimulate>then block receptor
Inhibit MAO= activate DA neurotransmission (dependence)
Stimulate NE/DA release

Promote mild euhpria
Increase Arousal and Concentration
Improve memory
Suppress appetite

52
Q

Nicotine pharmacokinetics

A 
Absorption: lung, GI, skin
Cross placental membrane
Secreted in milk
Metabolized in Lung/ Liver= Cotinine is the metabolite
Urinary excretion
53
Q

Nicotine: ADR

A

Irritability, Tremors, GI cramps, Diarrhea, Increased HP and BP

54
Q

Nicotine: Toxicity

A

Central respiratory paralysis

Hypotension from Medullary paralysis

55
Q

Nicotine: withdrawal

A

Irritation, Anxiety, Restlessness, Frustration, Difficulty concentrating, Headache, Insomnia

Peak 1-2 days after quitting
Decrease over weeks

56
Q

Caffeine: Use

A

Treat idiopathic apnea of premature neonates {Caffeine citrate}
Acute Circulatory failure
Diuretics
Treat Spinal puncture headaches (Caffeine sodium benzoate}
Adjuvant for Analgesics

57
Q

Caffeine: MoA

A

Methylxanthine
Translocation of extracellular Ca2+
Inhibit PDE> Increase cAMP, cGMP
Blockade of Adenosine receptors {induce wakefulness}

58
Q

Caffeine: Effects

A

Decrease fatigue
Increase mental alertness
{100-200mg}

Increase anxiety and tremor (1.5g)

Increase spinal cord stimulation (2-5g)
Cardiac arrhythmias (Lethal dose= 10g)
59
Q

Why are kids hyper on Halloween nights?

A

Dark chocolates got caffeine, yo!

60
Q

Caffeine: other effects

A

Mild diuretics
Positive inotropic/ chronotropic effects at high dose
Increase secretion of gastric HCl
Insomnia, Anxiety, Agitation at moderate doses
Emesis and Convulsions at high doses

61
Q

LSD (Lysergic acid diethylamide)

A

5-HT1/2 agonist
Hallucinations with brilliant color {Visual hallucination}
Mood alteration

62
Q

LSD: ADR

A 
Hyperreflexia
Nausea
Muscle weakness
Increased HP, BP
Mydriasis
Flashbacks (days-1yr)

Not drug of abuse

63
Q

LSD: treatment

A

Haloperidol (block hallucinations {Neuroleptic therapy}

64
Q

Ketamine and Phencyclidine (PCP)

A

Glutamate action antagonist
Anticholinergic

Cause dissociative anesthesia

65
Q

Ketamine and Phencyclidine (PCP): ADR

A 
Extremity numbness
Staggered gait
Slurred speech
Muscular rigidity
Increase BP/ HR
Nausea/Vomiting
Violent behaviors
Suicidal
Seizures
66
Q

Hallucinogenic mushrooms

A

“Shroom”
Psilobycin, Psilocin
20min-6hr effects

Dilated pupils, Confusion, Vertigo
Exhilaration, Laughter, Hallucinations
Tachycardia, Hypertension
Nausea/ Vomiting

67
Q

Hallucinogenic mushrooms: Treatment

A

Activated charcoal

Diazepam

68
Q

Peyote

A

By Apache, Navajo, and Plains Tribes
Used in Native American Church rituals, Legal for them

Peyote= small, spineless cactus
Contain Phenethylamine alkaloids (Mescaline)

Similar to LSD, but not as potent

69
Q

Marijuana

A

THC (delta9-tetrahydrocannabinol) metabolized to 11-OH-delta9-THC

Receptors in Basal ganglia, Hippocampus, Cerebellum

Euphoria followed by Drowsiness/ Relaxation
Impairs short-term memory and mental activity
Visual hallucinations
Delusions
Increased HR

Munchies
Tolerance, Withdrawal Addiction possible
Lipophilic

70
Q

Dronabinol

A

THC (Tetrahydrocannibinol)
Treat severe nausea and pain by AIDS/ Cancer
Appetite stimulant
“Medical marijuana”

Marijuana vs Hashish-Hash oil

Lipophilic

71
Q

NBome

A

5HT2A agonist

Agitation, Hallucinations
Tachycardia, Hypertension

Treat with Benzodiazepine (IV)
Prolonged periods of aggressive behavior

72
Q

Inhalants

A

Volatile solvents
Aerosols
Gases
Nitrites

Tend to have burned mouth{b/c of solvent on their mouth and high prevalence of smoking}

Axonopathies, Hepatotoxicity, Cardiotoxicity
Alcohol high
Euphoria, Delusion, Sedation, Hallucinations

DTII Exam 2 (4 decks)

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