Exam 5 lecture 7

Question 1

describe current trends in stimulant overdose deaths

Answer 1

All increasing.

Question 2

What parts of the brain are activated by stimulants

Answer 2

VTA and Nucc Acc (emotion, fear, reward, planning, memory, learning)

Question 3

Nicotine MOA

Answer 3

Acts on acetylcholinergic receptor by causing inflow of Na and outflow of K, causing action potential.

Question 4

What determines how many molecules of Ach bind to receptor

Answer 4

Heterogenity of subunits

Question 5

why does nicotine bind to Ach receptor?

Answer 5

Nictotine is structurally similar to Ach

Question 6

What are the structural similarities and differences of nicotine and acetylcholine

Answer 6

Both have charged amine groups and hydrogen bond acceptor groups

Nicotine is membrane penetrable at physiological PH (weak base)

Nicotine is also not degraded by by acetylcholinesterase

Question 7

What effect does nicotine not being degraded by acetylcholinesterase have

Answer 7

longer duration of action of nicotine (more potent)

Question 8

Rank addictive probability, cocaine, nicotinem heroine

Answer 8

Nicotine
heroin
cocain

Question 9

Drug therapy used to treat nicotine dependence

Answer 9

partial agonist (varenicline)

Question 10

What are things to know about partial agonist drugs used for quitting nicotine

Answer 10

Highly addictive. Partial agonists increase quit rate

Question 11

Why is pseudoephedrine BTC

Answer 11

Can be converted to Meth fairly easily

Question 12

What are some commonly abused psychostimulants

Answer 12

MDMA
Meth
Ritalin
cocaine

Question 13

What is Fenethyline? Use?

Answer 13

Amphetamine + theophylline

Wide spread use in arabian peninsula
ADHD

Question 14

MOA of cocaine

Answer 14

antagonist of amine transprters
DAT SERT NERT

Question 15

Rank the receptors cocaine will have most effect on

Answer 15

Dat>SERT>NERT

Question 16

MOA of methamphetamines/bathsalts

Answer 16

Competitive reuptake
Block DA reuptake

Push out DA from vesicle and induces reverse transport

Question 17

What are the clinical effects of methamohetamine abuse

Answer 17

neurologic- delirium, tremor
psych-anxiety, panaroia, delusions, hallucinations
ENT- profuse dental decay
cardiovascular- tachycardia, hypertension, vasospasms
skin- diaphoresis

Question 18

describe what is seen in brain scan of meth abuser

Answer 18

DA receptor in normal brain has high concentration.

Meth abusers will have a down regulation of dopamine receptors. Receptor downregulation believed to mediate withdrawal sx

Question 19

is dopamine downregulation evidence of a broken brain

Answer 19

No, recovery of of DA receptors shows ability to return to homeostasis

Question 20

Do addictive drugs increase brain dopamine

Answer 20

decrease in C-raclopride binding reflect increase synaptic ventral striatal dopamine levels.

Question 21

Can low dose psychostimulants increase productivity?

Answer 21

This off label use is not well supported by research and can progress to stimulant use disorder

Question 22

What is sympathomimetic toxidrome? symptoms? EXAM

Answer 22

MATHS
M-Mydriasis
A- agitation, arrhythmia, angina
T- tachycardia
H-Hypertension, Hyperthermia
S- Seizure, sweating

Question 23

Management of sympathomimetic toxidrome

Answer 23

1. treat agitation, HTN and seizures with BZDs
2. Avoid pure BB due to unopposed alpha antagonism

Question 24

What are things to know about sympathomimetic syndrome

Answer 24

HTN usually responds to sedation
hyperthermia denotes poor prognosis

Question 25

Differentiate between Hemp and marijuana

Answer 25

Legal to federally grow and distribute hemp Illegal for marijuana Hemp contains- 0.3% of less THC Marijuana contains 15-20% Cannabis is schedule I substance

Question 26

Difference of delta 8 and 9

Answer 26

Delta 9 and delta 8 only differ in placement of double bond. Delta 8 only has 25% of the psychoactive activity of Delta 9

Question 27

What is more potent, synthetic or natural marijuana

Answer 27

Synthetic

Question 28

why is hemp grown

Answer 28

Textile, agroculture etc

Question 29

Acute cannabis intoxication effects

Answer 29

Perceptual- Temporal slowing, auditory, visual or depersonalization Physical- tachycardia, hypotension, dry mouth, increased appetite Affective- Euphoria, Anxiety, disinhibition, emotional lability Cognitive- suspicious or paranoid ideation, impaired judgement, impaired rxn time

Question 30

What is the endocannaboid system? What is it comprised of? exam

Answer 30

RECEPTORS- CB1 and CB2 LIGANDS- Anandemide and 2 AG TRANSPORTER- EMT endocannabinoid membrane transporter ENZYMES- Fatty acid amide hydrolase, monoglycerol lipase

Question 31

What do endocannabinoids and phytocannabinoids do?

Answer 31

They are RETROGRADE REGULATORS of neurotransmission inhibiting release of GABA and glutamine

Question 32

What is the difference between THC and CB1R?

Answer 32

THC is a partial agonist at CV1R where as synthetic cannabinoids are full agonists.

Question 33

What expression is higher in brain? CB1 or CB2?

Answer 33

CB1 expression is higher than CB2 in brain.

Question 34

Where dies CB2 exist?

Answer 34

Glia

Question 35

Do people get respiratory depression when exposed to large doses of THC? Why?

Answer 35

No, low levels of receptors exist in brainstem

Question 36

What expression is seen as higher in periphery? CB1 or CB2

Answer 36

CB2 is seen to be higher in periphery than CB1

Question 37

Where is CB2 found in periphery? CB1?

Answer 37

CB2- lymphocytes (B cells, T cells) CB1- Liver (upregulated in liver fibrosis)

Question 38

What are some FDA approved Cannabinoid drugs? What are they used for?

Answer 38

Marinol- synthetic delta 9 THC in sesame oil, schedule III, counter loss of appetite Nabilone- THC mimetic, schedule II, anti emetic and chronic pain

Question 39

What are some challenges with medical marijuana use?

Answer 39

Lack of quality control Absence of adequately designed studies for assessing efficacy and ADR Growing influence of tobacco and alcohol companies in industry

Question 40

How has percentage concentration of CBD and THC changed over time?

Answer 40

Marked increase

Question 41

Is cannabis use associated with mental health disorders?

Answer 41

- extremely difficult to prove and controversial -growing evidence for association with several disorders, cause and effect not established.

Question 42

Risk factors and pathways to psychosis with cannabis use

Answer 42

Age of onset and potency appear to be key determinants

Question 43

What are the diagnostic criteria of cannabinoid hyperemesis syndrome

Answer 43

cycling vomit/nausea presentation after prolonged excessive use of cannabis Relief by sustained cessation

Question 44

Treatment of cannabinoid hyperemesis

Answer 44

Cannabis cessation BZDs Haloperidol Capscasin cream on abdomen

Question 45

MOA of capscasin in cannabinoid hyperemesis syndrome

Answer 45

1. substance P activates NK1R to induce vomiting 2. Activation of TRPV-1 by heat or capscasin leads to depletion of substance P 3. Chronic cannabis use causes desensitization and downregulation of TRPV1