Exam 3 Flashcards
Opiates - Common Types
Opium, Codiene (syrup), Morphine, Herion
Opiates- three primary effects
Analgesic - relieves pain.
Antitussive - relieves cough.
Constipation - firms the stool
Opiates: Side effects
- Drowsiness, mental clouding
- Respiratory depression
- Nausea, vomiting, & constipation
- Inability to urinate
- Drop in blood pressure
- Abuse potential
Opiates: withdrawal symptoms
- Craving for drugs, anxiety.
- Yawning, perspiration, runny nose, tears.
- Pupil dilatation, goose bumps, muscle twitches, muscle aches, hot & cold flashes, anorexia.
- Increased intensity of above, insomnia, raised BP, fever, faster pulse, nausea.
- Increased intensity of above, curled-up position, vomiting, diarrhea, increased blood sugar, & “kicking the habit”.
Opiates: Oxycontin
Popularity soared in the late 90s. Users grind up the tablets & snort the powder, or mix it with water & inject it like heroin.
Opiates: Krokodil (Desomorphine)
A derivative of morphine (1932-US) that has sedative and analgesic effects 8-10x stronger than morphine. Fast onset and short duration, little nausea or respiratory depression compared to morphine. Often highly impure, scale-like appearance of skin. High is similar to heroin, but lasts 1-1.5 hours instead of 4-8 hours.
Opiates: Tramadol (Ultram)
(1994 in US) A centrally acting synthetic analgesic used to treat moderate to moderately severe pain. Agonist that induces serotonin release, and inhibits the reuptake of norephinephrine. Several states have elected to make it a Schedule IV drug.
Opiates: Tapentadol
A new synthetic atypical opioid. Made to mimic the agonistic properties of tramadol’s metabolite, M1. Schedule II, potency is somewhere between tramadol & morphine, closest chemical relative of tramadol.
Commonly Used Opiates
Heroin (smack), Morphine, Methadone, Meperidine, Hydromorphone, Oxycodone, Propoxyphene, Codeine, Loperamide, Diphenoxylate, Opium tincture
Etc. - tylenol w/ codiene, percocet, tylox, vicodin
NSAID Classification
Salicylates - includes: Aspirin, Acetaminophen (Tylenol)
Others - Ibuprofen (Advil, Motrin), Naproxen (Aleve), Ketoprofen (Orudis KT)
Naproxen (Aleve)
Single dose lasts for 8-12 hours, used for patients with persistant pain. Available as prescription since 1976 & became available OTC in 1994.
NSAID Physiological Effects
- Analgesia - Works for somatic rather than visceral pain.
- Antipyretic - Reduces fever. (<101°F)
- Anti-inflammatory - Reduces swelling (except acetaminophen). Need high, sustained doses for this effect.
NSAID: Common Side Effects
- Aspirin- Gastrointestinal irritation, bleeding, ulcer aggravation, interference with clotting; prolongs bleeding, chronic high doses cause tinnitus & hearing loss. Reyes Syndrome <15
- Acetaminophen-acute high doses or chronic exposure can cause severe damage to liver and kidney
- Ibuprofen (& newer NSAIDS)-similar to aspirin but less severe gastrointestinal and blood symptoms, damage in elderly or those with existing kidney disease.
Reye’s Syndrome
Potentially fatal complication of colds, flu or chicken pox in children. Believed to be caused by salicylate. Swelling of the brain and liver.
Amphetamines: History
1887- Synthesized
1927- effects are discovered: reduced fatigue, increased alertness, & a sense of confident euphoria.
1932- Marketed as Benzedrine in an OTC inhaler for nasal congestion. Abused.
193- Available by prescription as a pill. Used to treat narcolepsy and hyperactivity
1940- Was widely used to reduce fatigue in soldiers (still is & note: Provigil). Both dextroamphetamine (Dexedrine) & methamphetamine (Methedrine) became readily available
1971-All potent amphetamine-like compounds in nasal inhalers were withdrawn from the market.
Methamphetamine I
Especially strong amphetamine with a high abuse potential.
Currently, 3-6% of U.S. adolescents use it annually.
Due to ease of production, it is often clandestinely manufactured.
Toxic chemicals in these labs pose a threat to residents, neighbors, & the environment.
Methamphetamine I: Names and Administration
Speed or crystal: swallowed or sniffed
Crank: injected
Ice: smoked
Amphetamine Approved Uses
Narcolepsy
Short term weight reduction
Hyperkinetic Behavior (ADD/ADHD)
ADHD Facts
≈11% of children 4-17 years of age (or 6.4 million) have been diagnosed with ADHD as of 2011. Rates of diagnosis have been increasing by about 3-5%/year since 1997. Is 2-3x more common in boys than girls.
About 30-50% of people diagnosed in childhood continue to have symptoms into adulthood & between 2-5% of adults have it. Stimulant medication is used as treatment, therapeutic doses are administered.
ADHD Medications: Trade and Generic
Adderall; amphetamine (& XR - eXended Release)
Dexedrine and Dextrosta; dextroamphetamine
Vyvanse; lisdexamfetamine
Concerta and Ritalin; methylphenidate (long acting)
Metadate; methylphenidate (& ER=Extended Release)
Daytrana; methylphenidate (a patch)
Focalin; dexmethylphenidate
Cylert; pemoline
Strattera; atomextine
ADHD - Medication Side Effects
-Irritability, anorexia, insomnia, tics, psychotic symptoms, & hypertension.
Most common side effect of long term concern is growth suppression. Recommend stopping dosage during weekend & summer holidays if possible.
ADHD Meds: Effects on Neurotransmission
- Are NE agonists (act as if they are NE)
- Stimulates release of monoamines (E, NE, Seratonin)
- Inhibit MAO
- Block catecholamine reuptake
Nasal Decongestants: Generic and Brand name
ephedrine; Primatene metaraminol; Aramine naphazoline; Privine oxymetazoline; Afrin, Dristan phenylephrine; Neo-Synephrine phenylpropanolamine; Contac, Dimetapp, etc. pseudoephedrine; Sudafed, Comtrex, etc. tetrahydozoline; Visine, Tyzine, etc.
Appetite Suppressants: Generic and Brand name
diethylpropion; Tenuate fenfluramine; Pondimin mazindol; Sanorex phendimetrazine; Bondril, Plegine, Preludin phenylpropanolamine; Acutrim, Dexatrim
Cocaine History 1
2500 B.C.: Coca chewing (South America) Believed to be a gift from God.
1855: Cocaine first extracted from coca leaves.
1870: Vin Mariani, 6 mg/oz of wine. Exported Vin Mariani contained 7.2 mg/oz.
1884: Use as a local anesthetic in eye surgery. Also came to be used for toothache & in cigarettes.
1886: Coca-Cola- cocaine laced syrup & caffeine.
1901: Coca-Cola removed coca from their formula.
1905: Snorting cocaine becomes popular.
1910: First cases of nasal damage from cocaine snorting are seen in hospitals.
1912: U.S. government reports 5,000 cocaine related fatalities in one year.
1914: Cocaine banned in the U.S.
1976: Freebase cocaine first developed.
1980’s: Popularity rose. Cost decreased during this decade.
Coca Chewing
Aymaras & Quechuas of Bolivia, Peru & other Andean countries. Used to alleviate pain. Chewing is done softly to break the cell membranes, and the bolus formed is kept in the mouth lining. Lllijta is added, made of several types of vegetal ashes & stimulates the action of the alkaloids in the leaf.
Anesthetic effect on the mucosa next to the bolus, & the mouth/throat. Miners & farmers may chew 2-4 times/day when work is hard.
Smoking Description
Coca paste, freebase cocaine, & crack: smoked in glass pipes. Cocaine smokers achieve maximum effects, 1-2 min after inhalation. Similar to iv administration, the effects of inhaled cocaine last 30 min.
Xanthine Family
Caffeine or trimethylxanthine.
Theophyline - Found in tea.
Theobromine - Found in chocolate.
Xanthine: Behavioral Effects
- Low doses enhance mental alertness & reduce fatigue.
- High doses impair performance (restlessness, nervousness, irritability, insomnia, diuresis, muscle twitching, tremors, rambling thoughts/speech, & stomach complaints & headaches).
- May effect introverts/extroverts differently, effects children more.
- Reduces boredom.
Caffeine Withdrawal
Cold turkey is problematic. Easing back over a few days minimizes the problem. The symptoms reach a peak after a day or two & taper off within a week.
Caffeine: Physiological Effects
Diuretic, increases basal metabolic rate, alleviates some types of headache pain, stimulates gastric acid & pepsin secretion, dilates bronchi of the lungs
At high doses it may increase heart rate & BP.
Lethal Dose: 30-80 cups
>500 mg - panic, chills, nausea, clumsiness
5 to 10 gms - seizures, respiratory failure, & death
Six overdose deaths have been reported (1976).
Khat (Cot)
Shrub native to E. Africa & Southern Arabia. Chewed, smoked, brewed, or mixed with soft drinks or alcohol. Similar to amphtamines but less potent effects. No physical dependence or tolerance. Leaves <48 hrs old are preferred, it can be preserved by freezing. Contains cathinone & cathine. Cathinone is 10x more potent than cathine & is only present in fresh leaves.
Bath Salts
Designer drugs containing substituted cathinones. Most varieties contain methylenedioxypyrovalerone (MPDV), mephedrone & pyrovalerone. Side effects– intense paranoia, hyperthermia & hallucinations.
-Over 6,100 emergencies involving bath salts were reported by poison-control centers in 2011, up from 303 cases in 2010 (Daily Beast).
CAT or Methcathinone
Structural analogue of methamphetamine & cathinone, made illegal in 1993. Most commonly snorted, can be taken orally (by mixing it with a beverage) or diluted in water & injected iv. Has abuse potential equivalent to methamphetamine & produces amphetamine-like effects.
Nicotine: Physiological Effects
Stimulates: central dopamine release, cardiovascular system
Stimulates & then inhibits salivary & bronchial secretions
Increases respiration
Inhibits feelings of hunger
IS THE LEADING PREVENTABLE CAUSE OF DEATH IN THE U.S.!!
Composition of Tobacco Smoke:
A top-secret list of 700 additives to cigarettes pinpoints several hazardous substances. These are some examples:
- Nicotine sulfate.
- Ethyl 2 furoate.
- Sclareol.
- Ammonia.
- Freon.
- Maltitol.
- Methoprene.
Nicotine: Effect on the face
Blood supply to the vessels is diminished, damage from elements result in premature aging of the face. Fine wrinkles, sagging. Dry, leathery look to the face
State Deaths - 2010
7,717 WI deaths were associated with tobacco use.
- 6,966 people died from illnesses directly related to smoking, constituting 15% of all annual deaths.
- Another 751 people died from illnesses & fires indirectly related to smoking.
Second hand Smoke Effects: Children
- Ear infections
- More frequent & severe asthma attacks
- Respiratory symptoms (e.g., coughing, sneezing) & infections (i.e., bronchitis, pneumonia)
- Greater risk for SIDS
Second hand Smoke Effects: Adults
Causes deaths annually among nonsmokers:
≈3,400 lung cancer
≈46,000 heart disease
Nicotine: Chantix
Varenicline is a nicotinic receptor partial agonist. It both reduces cravings for & decreases the pleasurable effects of cigarettes.
-Side effects can include upset stomach, insomnia, headache, & psychological problems.
10 Tips to Succeed in Quitting
- Choose a quit date & stick to it.
- Remember that first few days will be the hardest.
- Change habits associated w/ smoking (e.g., substitute morning cig w/ OJ).
- Tell people you know that you are quitting.
- Drink lots of water & brush your teeth frequently.
- Never carry a lighter with you & remove ashtrays.
- Spend time with people who don’t smoke.
- Keep a supply of cigarette substitute (gum, candy).
- When you get the urge, try taking a few deep breaths. Hold the last, then exhale slowly, & tell yourself you have just had a cigarette.
- Think about the money you are saving.
OTC Drug Classes Approved by FDA
Acne medications, analgesics & anti-inflammatories, antacids, antidiarrheals, antihistamines & allergy products, antimicrobials, antiperspirants
Bronchodilators & antiasthmatics
Cold remedies, contraceptives & vaginal products
Dandruff & athlete’s feet, dentifrices & dental products
Emetics & antiemetics, laxatives, ophthalmics
Stimulants, sleep aids, sunburn treatments & sunscreens
Vitamins & minerals
Note: others include antitussives, hemorrhoid products, & smart drugs.
Most Frequently Used Categories:
Category and % adults who use
Pain relievers (internal); 47 Vitamins; 46 Skin products; 30 Antacids; 23 Laxatives ; 21 Eye medications; 14 Pain relievers (external) ; 13 Antihistamines; 9 Cough suppressants; 9
OTC Categories Summary
- Analgesics - internal (NSAIDs) & external (counter irritants).
- Cold, Allergy, & Cough Remedies
- Sleep Aids - typically antihistamines.
- Stimulants - caffeine & sympathomimetics.
- Gastrointestinal Medications – Stomach (antacids) & bowels (laxatives, anti-diarrhea).
- Diet Aids - Sympathomimetics, benzocaine & methyl cellulose.
- Skin Products - acne, sun, & first aid products.
Cold, Allergy, & Cough Remedies Types
- Decongestants - reduce nasal congestion. Includes sympathomimetics (pills/sprays) & antihistamines.
- Antitussives - reduce cough.
- Expectorants - reduce mucous.
Future OTC trends: Herbal medicines
Comfrey – anti-inflammatory & antibacterial
Saw Palmetto - urological problems
Echinacea - colds & to enhance the immune system
Feverfew - migraine headaches
St. John’s Wart - depression
Gingko Biloba - dementia
Ginseng - tonic
OTC Drugs that were Prescriptions
NSAIDS - Ibuprofen, naproxen & ketoprofen
First aid ointment - Bactine, Cortaid (hydrocortisone)
Treatment for vaginal yeast infections - Gyne-Lotrimin, Mycelex (clotrimazole), Monistat (miconazole)
Antihistamines - Actifed (triprolidine), Benadryl & Sominex (diphenhydramine), Coricidin Nasal Mist (oxymetazoline), Dramamine II (meclazine), Dimetane, Dimetapp (brompheniramine), OcuClear (oxymetazoline)
Anxiolytics
Used to treat anxiety disorders. Benzodiazepine Structures Half-Iives of Various Benzodiazepines Antianxiety Drugs (Variety & Dose) Rohypnol
Antianxiety Drugs
Benzodiazepines
Chlordiazepoxide; Librium
Diazepam; Valium
Oxazepam; Serax
Clorazepate; Tranxene
Proparzediols
Meprobamate; Equanil, Miltown
Tybamate; Tybatran
Antihistamines
Hydroxyzine; Atarax, Vistaril
Diphenhydramine; Benadryl
Tricyclic Antidepressants
Doxepin; Sinequan
b-Adrenergic antagonists (or beta blockers)
Propranolol; Inderal
Nonbarbiturate, Nonbenzodiazepines
Ethinamate; Valmid
Buspirone; BuSparRohypnol
Or flunitrazepam, a benzodiazepine not legally available in the U.S. but prescribed in other countries for insomnia & anesthesia.
- Produces amnesia, muscle relaxation, & slowing of psychomotor performance. Sedation occurs 20-30 mins after administration of a 2mg tablet & lasts 8 hrs. Also, it is synergistic with alcohol.
- It is another of the “date rape” drugs.
MAO lnhibitors
Exs. Parnate (Tranylcypromine), Marplan (Isocarboxazid), & Nardil (Phenelzine), etc.
Inhibits enzyme that breaks down monoamines (DA, NE, 5HT).
In addition to fatigue, dizziness & constipation, they can cause deadly surges in BP if taken with certain foods.
Tricyclics
Increase DA, NE, & 5HT. Narrow margins of safety & effectiveness. Common side effects include grogginess, headache, constipation & weight gain. Examples: Imipramine Tofranil, Antipress Amitriptyline Amitril, Elavil Desipramine Norpramine Nortriptyline Aventyl, Pamelor Doxepin Sinequan Protriptyline Vivactil Amoxapine Asendin Trimipramine Surmontil
SSRI’s
Specific Serotonin Reuptake Inhibitors. Enhance the effect of 5-HT by blocking its reabsorption.
Typically take ≈1-4 weeks to have an effect.
Exs. Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram), Lexipro (escitalopram), etc.
Safer than the older antidepressants & easier to tolerate. Can cause nausea, diarrhea & decreased sexual function.
Atypical; Newest drugs - SNRIs
Exs. Effexor (venlafaxine), Wellbutrin (bupropion), Pristique (desvenlafaxine), etc.
Enhance both 5HT & NE.
Side effects similar to SSRIs.
With the broader effect, these drugs may help some depressed patients who don’t respond to the simpler SSRI’s.
Wellbutrin is called Zyban when used to treat nicotine addiction.
Augmentation pharmacotherapy
refers to the addition of drugs that are not standard antidepressants in order to enhance the effect of the antidepressant.
Abilify
A partial dopamine agonist & atypical antipsychotic with additional antidepressant properties that is used in the treatment of schizophrenia, bipolar disorder, & clinical depression.
It received FDA approval for use as an adjunct for major depressive disorder in 2007.
Bipolar Disorder
Person’s mood swings from depression to excessive excitement. May show some or all of the following symptoms: Aggressiveness, elation, fast urgent talking, frantic physical activity, grandiose, unrealistic ideas & little need for sleep.
Eskalith (Lithium) - is a common treatment.
Maintenance therapy diminishes intensity of subsequent episodes.
Effective within 1-3 weeks. Dose needs to be gauged carefully.
History: antipsychotics
In the 1950’s a drug called chlorpromazine (CPZ, thorazine) came to be used for the treatment of schizophrenia. Prior to these drugs, violent patients were physically restrained or heavily sedated (among other procedures). In particular, thought disturbances, hallucinations, & delusions tend to subside with continued administration of the drug.
Antipsychotic: Motor Side Effects
Parkinsonian Symptoms
Difficulty in initiating voluntary movements, muscular rigidity, stooped posture, & tremors. More likely in older patients.
Tardive Dyskinesia
Involuntary movements of the mouth, as well as writhing movements of the hands, trunk, etc. Usually only occurs after chronic treatment & may get worse after withdrawal. Some symptoms are permanent.
Akathisia
A compulsive restlessness or desire to move, along with abnormal muscle sensations. More likely in younger patients.
Antipsychotic: Side Effects
Photosensitivity, Orthostatic hypotension, dry mouth, dilated pupils, weight gain, various hormonal abnormalities. Additional allergic reactions (relatively rare) include liver & blood problems.
Representative Antipsychotics
Phenothiazines
Chlorpromazine; Thorazine
Prochlorperazine; Compazine
Trifluoperazine; Stelazine
Fluphenazine; Prolixin
Thioridazine; Mellaril
Non-Phenothiazines
Haloperidol; Haldol
Thiothixene; Navane
Loxapine; Loxitane
Clozapine; Clozaril“Meth Mouth”
Dry mouth, poor oral hygiene, increased consumption of sugary drinks, & teeth clenching/grinding.
Salicylates
Aspirin-like drugs
NSAIDS
Nonsteroidal anti-inflammatory drugs
Antipyretics
drugs that reduce fevers
Expectorants
Substances that stimulate mucus secretion and diminish mucus viscosity
Analgesics
Drugs that relieve pain without affecting consciousness
Opioid
Relating to drugs that are derived from opium
Speed balling
Combining heroin and cocaine
Mainline
To inject a drug of abuse intravenously
Narcotics and narcotic related drugs
Opioids (ie heroin, morphine, codeine, oxycodone)
Dextromethorphan, clonadine, naloxone/naltrexone
Uppers
CNS stimulants
Behavioral stereotypy
Meaningless repetition of a single activity
Precursor chemicals
Chemicals used to produce a drug
Run
Intense use of a stimulant, consisting of multiple administration over a period of days
Tweaking
Repeated administration of methamphetamine to maintain the high
Hyperpyrexia
Elevated body temperature
Performance enhancers
Drugs taken to increase physical or mental endurance to embellish one’s performance
Adulterated
Contaminating substances are mixed in to dilute the drugs
Freebasing
Conversion of cocaine into its alkaline form for smoking
Crack
Already processed and inexpensive “freebased” cocaine, ready for smoking
Nicotine
Colorless, highly volatile liquid alkaloid
Snuff dipping
Placing a pinch of tobacco between the gums and the cheek
Environmental tobacco smoke
Term for secondhand smoke
