Exam 2 Flashcards
What happens when GABA is suppressed by alcohol?
the flow of chloride increases
What pathways are changed by alcohol?
AMP pathways
What specific neurotransmitters are more likely to be disturbed by alcohol?
GABA and Glutamate
What is a stimulant drug?
increases activity in your brain and nervous system. It also increases the circulation of chemicals such as cortisol and adrenaline in the body.
What does niacinamide adenine determine?
how much alcohol one can metabolize
_ to _ grams of alcohol can be metabolized per hour.
6 to 8 g
In what percent range would you likely have alcohol poisoning?
about 0.3% to 0.4%
Can the rate at which alcohol is metabolized be sped up?
no
Define “off label use”.
a drug that is not FDA approved
What are the 5 steps for treating alcohol dependency (pharmacotherapies)?
- reverse pharmacological effects
- prevent withdrawal
- maintenance of abstinence
- treat coexisting psych disorders and other related issues (depression, bipolar disorder, etc.)
- limit any neural-induced damage
What do reverse pharmacological effects mean?
detox
True or False: The use of caffeine is treated using various forms of therapy and drugs.
False, the use of caffeine is not treated.
What is the treatment of choice for treating alcohol dependency?
mixed approach
How is alcohol intervention handled (4)?
- prevent/treat some withdrawal symptoms
- use drugs to reduce relapse (combined with supportive therapy)
- treat complications
- reduce glutamate release and glutamate receptor regulation
What kind of treatment complications can come from treating alcohol dependency?
sleep issues and depression
How can glutamate receptors be regulated?
mood stabilizers and anticonvulsant
Toluene activates
the central reward systems in the brain
What did the rat study show about inhalants?
The rats showed an increase in stimulation in the hypothalamus as well as an increase in concentration levels. It also showed that there was an increase in depression after there was a crash in energy.
What are the different categories of inhalants?
anesthetics, solvents, office supplies (ex. white put, sharpies, etc.), gases (ex. butane lighters), household aerosol repellents (ex. hairspray, paints, cooking spray, cleaning products, etc.)
What age range is more likely to use and become addicted to inhalants?
mid-adolescents (13 to 15 million Americans)
Vapor is inhaled rapidly and as intoxication increases, the person becomes _.
disoriented
Why do some people die from inhalants?
the inhalants suppress O2
What is it called when a person dies from the usage of inhalants?
Sudden Sniffing Death Syndrome (SSDS)
True or False: It is not known exactly how inhalants work in the body.
True
What type of inhalant produces only light effects?
anesthetics
What is known about inhalant solvents?
they may slow brain activity
What are the effects of chronic use of inhalants?
damage to the liver, kidneys, parietal part of the brain, etc. chronic use can also cause dementia.
How is inhalant addiction treated?
through supportive/talk therapy
What are the “top two drugs of all time” according to Dr. Newell?
caffeine and nicotine
About how many Americans consume caffeine?
~80%
what are some pros to caffeine consumption?
mental alertness, dopaminergic effects, improvement in cognitive (when consumes in moderation) function, attention to detail, and reinforcement
How long does it take caffeine to reach its target?
~40 minutes
How long does the complete absorption of caffeine take?
~2 hours
Does caffeine get to the brain quickly or does it take a long time?
It gets to the brain fairly quickly
What percent of caffeine is left unchanged after it is metabolized?
about 10% is unchanged
What is the range of half-life for caffeine?
2 to 5 hours
What would cause caffeine half-life to be shortened?
smoking
What enzyme metabolizes caffeine?
CYP (1A2) enzyme
What is caffeine metabolized to?
paraxanthine (84%), theobromine (12%), and theophylline (4%)
After the __ metabolizes caffeine, the __ excrete what’s remaining into urine.
liver; kidneys
Which metabolites behave like caffeine?
theophylline and paraxanthine
Which metabolite of caffeine is inactive and can also be used to treat asthma?
theophylline
What may cause toxicity or intolerance to caffeine?
cross metabolism with SSRI’s
Caffeine stimulates the _ system.
nervous
What is a diuretic (also known as “water pills”)?
a drug that increases your frequency of urination to help rid your body of salt (sodium) and water
Caffeine is what type of drug?
a stimulant
Caffeine can be used to treat what?
migraines and narcolepsy
What are some behavioral effects of caffeine?
reduces fatigue, keeps you awake, alertness
How many cups of coffee per day is considered a heavy consumption of caffeine?
about 12 cups or more per day
How many cups of coffee per day is considered lethal? What is it called when you consume this amount or near this amount per day?
100 cups per day; caffeine intoxication
Caffeine adversely affects __ at how many milligrams?
muscle control; about 100 milligrams
What are the primary symptoms for caffeine withdraw?
headaches, increased agitation, and a crash
Caffeine exasperates _ disorder.
anxiety
Caffeinism
a complaint encompassing a variety of unpleasant mental and physical symptoms associated with the consumption of excessive amounts of caffeine; produces CNS and PNS stimulation
What are the symptoms of caffeinism?
restlessness, nervousness, insomnia, increased anxiety, gastrointestinal issues
What issues can caffeinism cause in the PNS?
tachycardia, hypertension, arrhythmias, GI issues
How does caffeine effect panic disorders?
symptoms are exaggerated
Caffeine can increase chances of getting _ disease.
heart
Caffeine can decrease flow as well as pressure in the _.
brain
Caffeine blocks which two adenosine receptors?
A1 and A2A
What happens when caffeine blocks A2A receptors?
the is an increase in dopamine (D2) in the frontal cortex which is where the reward effects of caffeine come from
Adenosine Receptors
neuromodulators; influence the release of neurotransmitters; exerts a depressant effect
What happens when adenosine receptors are blocked?
there will be an increase in the release of neurotransmitters in the brain; the activity of dopamine, acetylcholine, glutamate, and norepinephrine increases
What effects are seen when A1 is blocked by caffeine?
the release of dopamine and glutamate are inhibited, and sometimes acetylcholine is blocked
__ and __ are responsible for reward (pleasurable feeling) and the increase in alertness from caffeine.
dopamine and glutamate
__ accounts for the behavioral affects of caffeine.
acetylcholine
What is the addictive aspect of cigarettes?
nicotine
True or False: There is no medical use for nicotine.
True
In the U.S., when do most people begin smoking/become addicted to cigarettes.
teen years (15 to 16)
Most early cigarette use is related to what?
other drug use and psychoactive issues
Cigarette use in the U.S. has decreased by __ in the last 20 to 30 years.
half
What is the difference between smoking cigarettes, cigars, and pipes.
Cigar and pipe smoke is not inhaled like cigarette smoke
What is the most common way nicotine is consumed?
inhalation via cigarettes
In what way is nicotine used via patches? Why is this used?
Nicotine is used via patches as a slow drip. This is typically used for those who are trying to discontinue the use of cigarettes.
Nicotine is easily absorbed through __.
the lungs and skin
Nicotine smoke= ?
tar
Nicotine rapidly saturates the __.
blood
When nicotine leaves the lungs…
there isn’t as much nicotine in the blood as you’d think.
Cigarettes have different nicotine levels ranging from _ to _.
0.5 mg to 2 mg
~__ % of nicotine is inhaled and absorbed, the rest being absorbed by __.
20; CYP2A6
At what rate is nicotine metabolized?
quickly
What percent of nicotine is metabolized by the liver?
80 to 90%
What is the metabolite of nicotine?
cotinine
A higher level of cotinine is found in what demographic, making them more susceptible to addiction.
Black people
What is the half-life for chronic smokers?
~2 hours
What are the early symptoms of cigarette use?
nausea and feelings of sickness
Nicotine stimulates the __.
thalamus
ADH causes __.
fluid retention
The antidepressant effect of nicotine makes researchers believe what?
smoking is self medication
Teens are more likely to become addicted to/use cigarettes when they have a history of __.
ADHD and conduct disorder (rebellion of authority)
Nicotine reduces __ and __.
muscle tone and weight gain
What are the pros of nicotine?
-releases multiple actions in CNS which increases motor activity
-increases cognitive function
-increase in sensory motor function
-increase in attention/focus
-increase in ability to rapidly process information
Nicotine use can lead to the increase likelihood of __.
panic attacks
locus coeruleus
involved with physiological responses to stress and panic; behavioral arousal
What is the result of frontal lobe activation?
working memory function and mood
There is a strong connection between smoking and __.
adverse childhood abuse
Nicotine activates _ which responsible for _.
ACH; benefits of smoking cigarettes
Nicotinic receptors in the PNS:
cause an increase in blood pressure and heart rate
Why does nicotine cause an increase in blood pressure and heart rate?
because epinephrine is released
Nicotinic receptors in CNS:
are widely distributed throughout the brain; facilitate the release of neurotransmitters (excitatory effect)
Mesolimbic pathway =
addiction pathway
Glutamate and GABA are activated by nicotine. This has led to the debate that it may or may not produce __.
tolerance effects
What are the withdrawal symptoms when smoking/nicotine use is stopped?
-craving for nicotine
-decrease in mood (irritation, anger, aggravation, restlessness)
How long can nicotine/smoking withdrawal symptoms last?
up to a month
Research shows that there is a(n) __ in caffeine use when people decrease or stop the use of cigarettes and/or nicotine.
increase
What is the most toxic/harmful part of cigarettes?
tar
There is an estimate of about __ minutes taken off of lifespan for every __ cigarette that a person smokes.
14; 1
Cigarette use can lead to what type of disease (most often)?
cardiovascular (could also say cancer)
Why does cigarette/nicotine use lead to cardiovascular disease?
Because smoking deprives the heart of less O2 and nicotine increases the amount of work that the cardiovascular system has to do
Nicotine combined with tar can lead to…
heart disease, cardiovascular disease, and cancer
Benzopyrene (Benzo[a]pyrene) (BPD)
major carcinogen in cigarettes
What makes cancer more likely when smoking?
We all have cancer that our bodies fight off so that we do not get sick, but with the combination of nicotine and tar, the cancer suppressor gene is more suppressed. This makes cancer more likely to occur.
What are the various treatments for nicotine addiction?
-“cold turkey” (doesn’t usually last long)
-psychological (relapse prevention, hasn’t worked a lot)
-acupuncture (more common in the 80s)
-replacement therapy
-pharmacotherapy approach
-replace one form of nicotine with another (cigarettes –> patches)
-a fairly successful approach
-drugs
-bupropion (antidepressant) (Zyban in cigarette treating form)
-time release capsules
-A-typical: dopamine involved
-partial nicotine receptors (agonistic)
-vaccine approach (currently in its early stages)
Partial nicotine receptors:
-antagonist
-varenicline (chantics)
-increases chances of stopping smoking (up to 3x more likely)
-more successful than bupropion
What are the side effects of partial nicotine receptors for nicotine addiction treatment?
nausea, GI issues, neuro-psych disturbances, increase in violence and aggression
What form of nicotine addiction treatment is more successful than bupropion?
partial nicotine receptors
What does the vaccine treatments for nicotine addiction treatment target?
NIC-002 and NIC-VAC
What are the features of vaccine therapies for the treatment of nicotine addiction?
-has to be repeated
-intermuscular injections
-if you smoke too much it won’t work
What is the goal of vaccine therapies for the treatment of nicotine addiction?
reduce antibodies and prevent bonding so the drug cannot get through the blood-brain barrier
What will make the vaccine therapies for the treatment of nicotine addiction effective?
only works for smokers with high titer antibodies; only effective if you have enough antibodies
Cocaine is a _.
stimulant/amphetamine
Cocaine comes from __.
the leaves of the coca plant
What are the benefits of the substances from the leaves of the coca plant?
increases alertness, sense of being, and indurance
List the history of the coca plant briefly.
-1855: E.coca isolated
-1860: purified and used as medication
-used as an anesthetic until novocaine was discovered
-1885: no laws in the US against cocaine (was in coca-cola (18mg))
-end of 1800s: we started to recognize its issues
-1914: cocaine was made band (Harrison Act)
-for the next 15 years cocaine use decreased and was replaced with amphetamines
-1960s-1980s (more so the 80s): huge increase in the use of cocaine
What were some causes of the skyrocketed use of cocaine in the 80s?
-the price of amphetamines increased
-became easier to use drugs in general
-bad time for the US (financial issues and such)
-development of crack cocaine (easy, cheap, and very accessible) (“crack baby”)
What are the different ways that cocaine can be used?
smoked, snorted, or injected
The use of cocaine was later replaced by __ in lower socioeconomic communities.
meth
What is used to make meth?
pseudoephedrine
Crack cocaine is insoluble in __ but highly soluble in __.
water; alcohol/ether
What percent of cocaine is made up of the coca plant leaves?
1/2 to 1%
How are the leaves of the coca plant prepared for cocaine?
they’re soaked and mashed up to make a paste and then the paste is treated with an alkaloid
Cocaine paste contains __% of cocaine.
40-80% (75% likely answer for exam)
How long does cocaine show up on blood tests and urine tests?
12 hours; urine: 2 weeks
What is the most common way cocaine is administered?
snorting
When snorted, what percentage of cocaine reaches the blood?
20-30%
How long does it take for cocaine to reach its peak after being snorted?
~30 minutes
Snorting cocaine produces what kind of effect?
euphoric effect (organismic effect)
What is the time of onset for cocaine when smoked?
within seconds
What percent of cocaine reaches the plasma when smoked?
10-30%
When injected, cocaine __ in tissues.
accumulates
What is the half-life of cocaine?
60 minutes
What metabolizes cocaine?
Cytochrome P450 (CYP450)
What is the metabolite of cocaine?
Benzoylecgonine (BE)
What is the mechanism of action for cocaine? (3)
- potent anesthetic
- vasoconstrictor (constricts blood vessels)
- powerful reenforcing stimulant
-this is how you become addicted
What are the neurotransmitters that are effected by cocaine?
-dopamine (addictive nature)
-serotine
-norepinephrine
What are the effects of frequent use of cocaine?
-increases dopamine supply in the brain leading to drug reduced psychosis (psychotic episodes, schizophrenia)
-happens quickly
-not permanent bc when stopped the person returns to normal (unless previous history of mental illness)
How does cocaine affect dopamine, serotonin, and norepinephrine?
Cocaine blocks the transporters of dopamine, serotonin, and norepinephrine, causing increases in extracellular levels of these neurotransmitters.
What is considered a low dose of cocaine?
25-100 mg
What are the effects of cocaine at a low dose?
-hyperactivity
-rapid heartbeat
-restriction of blood vessels
-euphoria
-uncontrollable happiness
-increase in self-awareness (can be a good thing but could also be very bad)
-boastfulness
-suppression of appetite
-delays sleep (insomnia)
-decrease in mental activity
Approximately how long do the effects of a low dose of cocaine last?
~30 minutes but euphoria remains for longer
What happens after the low dose effects of cocaine wear down? what is typically done when this happens?
depression will set in, can lead to trimers and/or seizures (which can be deadly), sexual dysfunction, bad crash; the person will replenish and if they do not they typically have anxiety
What happens with symptoms from cocaine as the dosage increases?
the symptoms will increase as well
What can long-term use of cocaine lead to? Why?
increased chances of stroke, hemorrhage, and heart issues; bc it’s a stimulant and makes the body work overtime
Increasing the dose of cocaine =
toxic symptoms
What are some other symptoms of long-term cocaine use?
-increase in paranoia
-increase in impulse control issues
-hyperactivity
Toxic paranoid psychosis
chronic paranoia and hyperactivity from cocaine use
What is considered toxic dose of cocaine?
1 to 2 mg/kg
At what point does cocaine become morbid?
when it is cross-linked with other drug use and/or previous psych issues
Cocaine being used during pregnancy leads to…
low birth weight
True or False: When cocaine is used during pregnancy, the baby receives more of the drug than the mother.
True
What is the best approach for treating cocaine addiction?
- get the person through withdrawal
- treat issues that may have led to use
True or False: There is no real consensus on how to treat cocaine use.
True
What is the best way to get someone off of cocaine use?
treating comorbidity
What drug can be used to help symptoms of cocaine withdrawal?
Ritalin
Ritalin can restore _.
dopamine malfunction
_ to _ “crack babies” are born each year.
50,000 to 100,000
Pathogenic Agents
-sympathetic neuron system
-“mimic” agents
-epinephrine
Amphetamines produce what kind of affects?
vasoconstriction
-tachycardia
-trimers
-hypertension
-increased restlessness
-increased agitation
-increased alertness
What are the more likely symptoms of amphetamine use?
-increased restlessness
-increased agitation
What was the original use of amphetamines?
treatment of medical issues (still used today)
iatrogenic
relating to drug/amphetamine addiction caused by medical treatment (drug prescription)
-how a lot of people initially become addicted to amphetamines
-benzodiazapean
-opiates
-pain medication
In what ways are amphetamines still used today in medicine?
to treat ADHD and sleep disorders (narcalepsy)
Mechanism of Action for Amphetamines: CNS affects are a result of __.
newly synthesized norepinephrine and dopamine
In the PNS, amphetamines have what effect on norepinephrine and dopamine levels?
Amphetamines increase norepinephrine and dopamine in the PNS
What is the result of dopamine being released from the recumbent?
reward/feel good system
What effect does amphetamine have on dopamine in the synapses? What other drug is this similar to, making it hard to tell the difference between the two?
dopamine is increased and reuptake is blocked; cocaine
What form are amphetamines usually in?
pills
What is considered a “low dose” of amphetamines?
5 to 50 mg but may differ depending on the drug
What are some effects of low dosages of amphetamines?
-increased bp
-increased heart rate
-bronchial muscle relaxes
-metabolites excreated in urine almost entirely
About how long are amphetamines detectable in urine?
48 hours or more
What is considered a “moderate” dosage of amphetamines?
20+ mg (depends on drug)
What are some effects of moderate dosages of amphetamines?
the same as low dosage effects but intensified:
-increased bp
-increased heart rate
-bronchial muscle relaxes
-metabolites excreated in urine almost entirely
What makes higher dosages of amphetamines different from low or moderate dosages (besides the obvious)?
low and moderate dosages are taken orally while higher dosages are more likely to be taken intravenously
What are some effects of moderate dosages of amphetamines?
-repetitious acts
-increase in violence
-increase in paranoia, anxiety, and anorexia
-psychosis (psychotic issues)
-relationship issues
Methamphetamine is known for producing what kind of effects?
psychosis
Brief history of amphetamines:
-1887: amphetamine first synthesized
-Early 1900s: active ingredient isolated
-1918: meth synthesized
-1920s: amphetamines used for meds
-1930s: amphetamines marked as med
-After WWII: used for fatigue and depression
-1960s: we start to see issues with addiction and abuse
-1970s: we realized the issue with amphetamines
-Today: not used as often but still used
-meth has taken over
-amphetamine abuse has increased among young people (college students)
Why have we seen an increase in amphetamine use among young adults (college students)?
more pressure, ppl using it to increase performance
Compare and contrast cocaine and amphetamines:
Cocaine:
-half life= 30 to 50 minutes
-snorted or smoked
-leaves system quicker which in turn makes it have faster effects
-more addictive
-metabolized more quickly
Amphetamines:
-long duration of effect (longer half-life)
Same:
-both are lipid soluble
-both have same risk for overdose
-both stored in the tissues (cross membrane readily)
What is the “drug of choice” in today’s world?
methamphetamine
About what percent of methamphetamine is manufactured at home?
35% or more
Methamphetamine ingredients are readily available, what ingredient can you buy at the store? (Hint: The sale of this ingredient is banned in most states except Oklahoma)
pseudoephedrine
What are the different ways methamphetamine can be used?
vaporized, inhaled, and smoked
-usually crystalized
What is the half-life of methamphetamine?
11 hours
Methamphetamine is excreted through the __.
liver and kidneys
What percent of methamphetamine is excreted unchanged?
40%
When methamphetamine is mixed with __ and __, the risk is increased as well as neurotoxicity.
alcohol and marijuana
In the 1900s, methamphetamine was used to treat what?
ADHD
What percent of crime is related to substance abuse?
60 to 70%
Alcohol is a __ depressant.
CNS
What are the general side effects of methamphetamine use?
-hallucinations
-increase in violence
-decrease inhibition
-more prone to infection
-heart issues
The Thompson and Cohort study shows a link between chronic methamphetamine abuse and ___.
structural brain defects
Chronic methamphetamine abuse leads to:
-decrease in gray matter
-increase white matter (scar replacement)
-tissue of hippocampus becomes loose (loss of memory)
-early onset alzeheimers
The use of amphetamines during pregnancy:
-congenital issues
-preterm labor
-low birth rate
-increase risk of cerebral hemmoriage
-increase risk for anxiety early in age
-increase risk in ADHD
Amphetamine tolerance:
-big tolerance built because of euphoric effects
-compulsive abuse
-physical dependence
-cold turkey
What are the risks of going “cold turkey” from amphetamine?
severe depression and suicidal ideations
Ice:
-smokable form of meth
-crystalized form of meth
-absorption is very fast
What is the half-life for “ice”?
12+ hours
What effect does Ritalin have on serotonin (5HT) and dopamine?
increases it
Nonamphetamines are _ different from methamphetamine.
structurally
What are some different types of nonamphetamines?
-ephedrine
-bath salts
-bupropion
Flakka
-2nd generation synthesized
-smoked
-dopamine and norepinephrine blocker
-increases heart rate and bp
-not easily detected in urine
ADHD is believed to be an imbalance of __.
serotonin and dopamine
Ritalin is believed to balance out __.
dopamine and serotonin
Nonamphetamine effects are similar to the effects of __.
cocaine
Nonamphetamine balances
GABA and glutamate
How is stimulant abuse treated?
-there are no FDA drug treatments
1. reduce withdrawal symptoms
2. reduce craving
How is the craving for a stimulant reduced during stimulant abuse treatment?
-dopamine agonist is used which decreases anxiety and depression
-have to treat comorbid issues
THP
decreases cocaine self-administration and chances of cocaine relapse
