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Therapeutics > Exam 5 lecture 8 > Flashcards

Exam 5 lecture 8 Flashcards

1
Q

What are delusions

A

Delusions are fixed false beliefs unresponsive to logic. Paranoia is a common manifestation. Paranoia is a common manifestation.

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2
Q

Whar are hallucinations

A

False perception arising from internal stimuli
Creates false reality

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3
Q

What are illusions

A

Misperception of external stimuli
Distorts reality

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4
Q

What are the different typs of psychadelics?

A

Classical psychadelics (derivatives of tyramine and phenethylamine)
Dissociative psychadelics (Phencycladine, ketamine, muscimol)

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5
Q

What are some drugs that are derivatives of phenethylamine

A

MDMA
Mescaline
MDA

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6
Q

What are some drugs that are derivatives of tryptamine

A

LSD, DMT, Ibogaine, 5-MeO- DiPT

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7
Q

What are some naturally occuring psychadelic drugs

A
  • dimethyl triptamine (DMT)
    ayahuasca leaves

-5-me ODMT
colorado river toad

-Psilocybin
Mushrooms

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8
Q

Mescaline combines mechanism of what two drugs

A

MDMA and LSD

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9
Q

Phenethylamine MOA

A

Amphetamine like (increases release of 5HT> Da)

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10
Q

Most classical psychadelics are agonists of

A

5HT-2A receptor

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11
Q

pre treatment of 5HT-2A antagonists has what effect on hallucinogen

A

blocks psychadelic effects (except MDMA)

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12
Q

global integration and psychadelics?

A

psychadelics increase global integration in CNS, increasing interconnectedness of different sites on brain

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13
Q

What are the 3 components of an LSD trip

A
  1. visionary restructuralization (hallucinations)
  2. Oceanic boundlessness (Highly pleaserable state of self dissolution)
  3. anxious-ego dissolution- though disorder leading to unpleasant state (bad trip)
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14
Q

what are the classes of adverse effects associated with psychadelics

A

short term physiologic
acute dysphoric reaction
psychotic reaction

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15
Q

short term physiologic adverse effects of psychadelics

A

tachycardia
hypertension
tremors
dry mouth
nausea
hyperthermia

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16
Q

acute dysphoric reaction adverse effects of psychadelics

A

Terrifying thoughts
Fear of insanity
Fear of losing control
Fear of death

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17
Q

Psychotic reaction adverse effects of psychadelic use

A
  • flashbacks
    -enduring changes in personality
    -exacerbate underlying psychotic disorder
  • instigate psychotic disorder
    -rate of psychosis after LSD
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18
Q

What are some potential uses of psychadelics? What are some short comings of clinical trials?

A

Depression, PTSD, alcohol use disorder, substance use disodrder

potential short comings include- small sample size, lack of inadequate controls, what is proper control group, selection bias

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19
Q

Difference in MOA of classic psychadelics and dissociative psychadelics

A

Dissociative psychadelics act as antagonists of NMDA receptors

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20
Q

What are the two types of glutamate receptors?

A

Ionotropic (iGluR)
Metabotropic (MgluR

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21
Q

What are the names of the ions in ionotropi can metabotropic glutamate receptors

A

Ionotropic- NMDA, AMPA, Kainate (fast acting and excitatory)
Metabotropic- group 1 (slow excitatory), Group 2 and 3 (slow and inhibitory)

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22
Q

are NMDAR pre or post synaptic?

A

post (can also bind glycine)

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23
Q

What are some prominent NMDA receptor antagonists

A

ionotropic glutamate receptor
Ketamine (special K)
Dextromethorphan (DXM)

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24
Q

What are ionotropic glutamate receptors used for?

A

NMDA receptor antagonist used for anesthetic and analgesic effects

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25
Which variant of ketamine is more active (racemic)
S
26
What is dextromethorphan usually abused by? doses for cough suppression vs dosing for high
4% of highschoolers <60 mg are doses for cough suppression 100-600 mg induce hugh
27
How does phencycladine (PCP) act? side effects?
NMDA antagonist more potent than ketamine also a dopamine D2 receptor agonist self mutilation could be a side effect
28
Describe the pharmacology of muscimol
Agonist of GABAa channels and can also induce dissociative psychadelic effects
29
What are the different ways inhalants can be misused
volatile solvents (toulene, glue, kerosene, gasoline) Aerosol, gases, spray Nitrates and nitrous oxide Hydrocarbons and ketones
30
How do alkyl nitrates work and why are they abused?
Nitric oxide results in smooth muscle relaxation, commonly sold as poppers Relaxes anal sphincter and lead to prolonged erections Highest abuse among gay men
31
State the volatile solvents, what they are and who is more likely to abuse them
volatile solvents are liquid at RT and evaporate when exposed to air Toluene- glue, spray paont acetone- nail polish remover, rubber cement, model glue Benzene- clwaning fluids, rubber cements, tire tube repair kit Butane- hair spray, spray paint, lighters Highest frequency of use amont adolescents living in isolated communities
32
What is the most characterized of the volatile solvents
Toluene
33
List the risks of inhalant abuse
asphyxiations- from repeated inhalation, displaces oxygen in lungs suffocation- from blocking air from re entering lungs convulsions/seizures- from abnormal electric discharges in brain coma- brain shutting down almost all vital functions choking- on vomit fatal injuries- from operating machinery
34
explain sudden sniffing death syndrome
development of fatal arrythmias within minutes of inhalation
35
Where is Alcohol absorbed? When does it peak in body? What does this absorption cause?
10% stomach, rest in intestine peaks in 30-90 minutes (slowed by food) Alcohol increases acid release (GERD, Ulcers)
36
Why can men handle alc better than women
skill diff (58% water content for men, 48% in women so we dilute it better)
37
Alcohol elimination follows what order kinetics
Zero order
38
What are the two enzymes involved in alcohol metabolism
Alcohol dehydrogenase (ADH) Aldehyde dehydrogenase (ALDH)
39
Where is alcohol metabolized? when does microsomal ethanol oxidizing system occur?
90% liver MEOS only at high alcohol concentration
40
What enzyme is involved in MEOS oxidizing alcohol
CYP2E1
41
Where is ADH found? What antagonizes ADH? What effect does this antagonization have?
ADH is found in liver, brain and stomach (men express higher levels) Fomepizol (antizol) is an ADH inhibitor It slows formation of formaldehyde and toxic metabolites so liver has more time to metabolize toxic effects
42
What is aldehyde metabolized by>
aldehyde dehydrogenase (ALDH)
43
what are the isoenzymes under ALDH? What are the important for?
ALDH1B1 and ALDH2
44
What effect do we see in the real world regarding ALDH2?
50% of asians only have ALDH2.
45
Describe heterozygous and homozygous ALDH2
heterozygous- reduced metabolic activity, flushing and increased skin temp, CAN STILL CONSUME ALC homozygous- Deficient in ability to metabolize acetaldehyde, neurotoxic, strong hangover
46
What is an irreversible inhibitor targetting ALDS
Disulfram (antabuse)
47
What are some places alcohol acts on in the body?
Ligand gated ion channels Neurotransmitter release
48
What are some ligand gated ion channels that are affected by alcohol
GABA a receptors (allosteric activator of inhibitory mechanisms) NMDA receptor (inhibitor)
49
What are some neurotransmitters released by alcohol
Opioids (enkephalins) increase CNS and blood ACTH levels Serotonin, norepinephrine
50
What are the pharmacological actions of different levels of alcohol
low- CNS stimulation intermediate- CNS depression High- coma-death
51
what are the cardiovascular effects induced by alcohol
acute use- vasodilation, reduced BP, increased HR Moderate use- reduced risk of coronary heart disease (increases HDL) Heavy/chronic use- cardiomyopathy
52
What are some physiological effects of alcohol consumption
Thermoregulation- hypothermia GI effects- EtOH is a secretagogue (increases HCL secretion)
53
Long term adverse effects of alcohol consumption
Liver- fatty liver leading to cirrhosis is common among abusers Cancer- along route of ingestion (mouth, larynx, esophagus, stomach)
54
What are some important drug drug interactions with alcohol
CNS depressants aldehyde dehydrogenase inhibitors Acetaminophen Aspirin
55
What are some CNS depressants to be wary of with alcohol
Opioids antipsychotics sedative/hypnotics
56
What are aldehyde dehydrogenase inhibitors that could interact with alcohol
Disulfram Antimicrobials (metronidazole) sulfonylureas
57
Why is alcohol use with acetaminophen bad?
Increases toxic metabolite (NAPQI) alcohol upregulates CYP2E1
58
Why is aspirin contraindicated with alcohol
Increased GI bleeding risk
59
What to do for acute intoxication management of alcohol
Prevent respiratory depression
60
Withdrawal symptoms of alcohol
Anxiety, insomnia, seizures (tonic-clonic), delirium tremens
61
What are the FDA approved treatments for alcohol withdrawal
Disulfram (antabuse) Acamprosate Naltrexone
62
What receptors does disulfram act on? what does it cause
Acts as Aldehyde dehydrogenase inhibitor causes flushing, throbbing headache, N/V, sweating patients should be alcohol free for 24 hours before starting
63
What receptor does acamprosate act on?
NMDA receptor antagonist/GABA agonist
64
What receptor does naltrexone act on
Opioid receptor
65
What patients is naltrexone most useful in?
patients with an SNP in Mu opioid receptor gene 118G patients respond better to naltrexone
66
prevalence of 188G
most in asians, least in Aa and latino
67
Three important off-label drugs used for treatment of alcoholism? What enzyme do they act on?
-Topiramate (Topamax): Inhibits glutamate signaling, enhances GABA signaling -Baclofen (Baclofen): Stimulates GABA B receptors -Varenicline (Chantix): nicotinic acetylcholine receptor partial agonist

Therapeutics (38 decks)

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