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Spring 2024 Therapeutics 3 > Final Substance Use Disorder > Flashcards

Final Substance Use Disorder Flashcards

1
Q

What are the 3 main categories that drugs of abuse fall under?

A

Stimulants
Depressants
Psychedelics

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2
Q

What does Schedule I mean?

A

These drugs have No Medical Use

-high abuse potential, safety not guaranteed

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3
Q

What are some examples of Schedule I drugs?

A

Marijuana, THC, LSD

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4
Q

What dose Schedule II mean?

A

Have a medical use but high abuse potential

-large risk of dependence

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5
Q

What are some examples of Schedule II drugs?

A

Cocaine, PCP

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6
Q

What does Schedule III mean?

A

Have a medical use, MODERATE abuse and dependence

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7
Q

What are some examples of Schedule III drugs?

A

Marinol (THC in oil capsule) -delta 9 THC

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8
Q

What does Schedule IV mean?

A

Medical potential, LOW abuse potential

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9
Q

What does Schedule V mean?

A

Lowest risk of abuse

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10
Q

What is the difference between Delta 9 THC and Delta 8 THC?

A

Cannabis has a thousand different bioactive molecules in it (all related to delta 9)

Delta 9 THC is the major active ingredient in marijuana

Delta 8 is slightly less potent at receptors

The Department of Agriculture Farm Bill states that some Delta 8 THC is derived from hemp which makes this molecule legal

(hemp derived molecules are legal but cannabis derived molecules are illegal)

*Note, the function between these two molecules is very very similar and therefore this does not really make sense

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11
Q

Which abuse substances act directly on G Protein-Coupled Receptors?

A

Opioids
LSD/ Mushrooms
Marijuana/ K2/ Spice
Gamma Hydroxy Butyric Acid
Caffeine

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12
Q

What receptors are targeted by marijuana, K2, and spice?

A

Cannabinoid receptors (CB1)

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13
Q

What substances of abuse act INDIRECTLY on G protein-coupled receptors?

A

Cocaine, Amphetamine
MDM/Ecstasy
Alcohol

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14
Q

How does Cocaine and Amphetamine create its abuse potential?

A

Block the dopamine transporter which blocks dopamine reuptake and allows dopamine to accumulate

-Indirectly causes overactivation of dopamine receptors

works on dopamine transporters

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15
Q

Which substances of abuse work on ion channels?

A

Nicotine
PCP, Ketamine
Benzodiazepines, Barbiturates

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16
Q

What receptors are targeted by nicotine and what is its function?

A

Acetylcholine receptors
-agonist

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17
Q

What receptors are targeted by PCP, ketamine and what is their function?

A

NMDA receptors
-antagonist

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18
Q

What receptor is targeted by benzodiazepines and barbiturates and what is their function?

A

GABA A receptors

Positive allosteric modulators

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19
Q

What part of the brain is in charge of decision making and impulsivity?

A

Frontal Cortex

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20
Q

What part of the brain is responsible for pleasure?

A

Nucleus accumbens

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21
Q

What part of the brain is responsible for reward/value?

A

Striatum

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22
Q

What part of the brain is the source of dopamine?

A

VTA

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23
Q

What is the dopamine hypothesis of addiction?

A

Pleasurable events release dopamine

*Dopamine is important for assigning value to reward prediction error

*Value provides the drug with an incentive salience (learning occurs in the brain around reward) ex: expecting a red apple to taste better than a green apple

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24
Q

True or False: Dopamine is required for reward learning

A

False

-dissociation between liking (direct effect) and wanting (motivation)
-“you don’t always like what you want”

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25
Q

How is dopamine involved in “liking”?

A

Dopamine does not encode liking, but is involved in making reward predictions and learning from outcome/error

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26
Q

what is the Glutamate Hypothesis of Addiction?

A

Glutamate can increase dopamine activity in the nucleus accumbens (NAcc)

Glutamate projects to the VTA (ventral tegmental area)

Destruction of this pathway reduces cocaine/morphine reward

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27
Q

What is Long Term Potentiation (LTP)?

A

Persistent increase in synaptic strength following intense stimulation

-Drug use induces long term changes in neuronal plasticity

-Increased glutamate AMPA receptors on surface which are making a signal more robust (easier to activate neurons)

-Rewarding substances like cocaine trigger LTP causing patients to have a memory associated with the exposure

Rewarding substances cause relative increase in glutamatergic AMPA receptors

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28
Q

What is drug abuse?

A

Use of a drug for a nontherapeutic effect

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29
Q

What is drug misuse?

A

Inappropriate, illegal, or excessive use of a prescription or nonprescription drug

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30
Q

What are the 11 Substance Abuse Criteria?

A
  1. Taking drug in larger amounts or for longer than prescribed
  2. Unable to stop taking
  3. Preoccupied with substance (spending lots of time around it)
  4. Cravings
  5. Distracted because of use and not keeping up daily tasks
  6. Continuing to use even when problems in relationships occur
  7. Giving up other activities because of use
  8. Using even when it creates danger
  9. Using against your own better judgement
  10. Tolerance (needing more)
  11. Withdrawal symptoms
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31
Q

How many substance use criteria must a person fit to be considered “Mild”?

A

2-3

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32
Q

How many substance use criteria must a person fit to be considered “Moderate”?

A

4-5

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33
Q

How many substance use criteria must a person fit to be considered “Severe”?

A

> 6

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34
Q

What are the 3 types of withdrawal symptoms?

A

Emotional Withdrawal Symptoms
Physical Withdrawal Symptoms
Dangerous Withdrawal Symptoms

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35
Q

What are some physical withdrawal symptoms?

A

Goose bumps (cold turkey)
Muscle spasms (kicking the habit)

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36
Q

Which substances are associate with dangerous withdrawal symptoms?

A

Alcohol

Tranquilizers

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37
Q

What are possible dangerous withdrawal symptoms?

A

Grand mal seizures

Delirium tremens (DTs)

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38
Q

What type of dependence is responsible for addiction (physical or psychological)?

A

Psychological dependence

*can occur even in absence of withdrawal

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39
Q

What is negative reinforcement?

A

Reward from escaping a negative/painful stimulus (such as withdrawal)

**NOT the same as punishment

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40
Q

What is positive reinforcement?

A

User feels pleasure/satisfaction

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41
Q

What is the function of psychostimulants?

A

Activate the CNS resulting in alertness, excitation, and elevated mood

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42
Q

What are commonly abused stimulants?

A

Methamphetamine
Ecstasy
Crack
Cocaine
Nicotine

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43
Q

Where does nicotine work on the dopamine receptor?

A

Ventral Tegmental Area

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44
Q

Where do stimulants work on the dopamine receptor?

A

Increase dopamine in synapses between the ventral tegmental area and nucleus accumbens

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45
Q

Which neurotransmitter is nicotine structurally similar to?

A

Acetylcholine

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46
Q

What differentiates the function of nicotine from acetylcholine?

A

Nicotine is not degraded by acetylcholinesterase!

-Therefore nicotine has a longer half-life than acetylcholine and a longer duration of action (more potent)

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47
Q

What is the most addictive stimulant?

A

Tobacco

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48
Q

What is the MOA of varenicline (Chantix)?

A

Partial agonist

-stimulates enough dopamine release to prevent withdrawal but not enough to cause addiction

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49
Q

Fenethylline is a combination of which to drugs?

A

Amphetamine
Theophylline

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50
Q

Arrange the neurotransmitter transporters in order of MOST to LEAST potent

A

M:
DAT
SERT
NERT
L:

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51
Q

What is the MOA of cocaine?

A

Cocaine blocks the dopamine transporter and prevents reuptake

-Dopamine is in the synaptic cleft longer and causes more stimulation of the receptor

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52
Q

What is the MOA of Meth, Ecstasy (XTC), and Bath Salts?

A
  1. Act mostly by simple competition, structurally similar enough that they compete for the reuptake inhibitor. This is how they reduce reuptake (do not inhibit, just compete)
  2. Can stimulate more release of dopamine out of the vesicles into the synaptic cleft
    (push out dopamine from vesicles)
53
Q

What receptor is affected by Meth, Ecstasy, and Bath Salts and what affect do they have on it?

A

Activate the Trace Amine-Associated Receptor (TAAR1)

induce reverse transport
(becomes efflux transporter and forces dopamine out)

54
Q

What are the side effects of meth?

A

Neurologic: Delirium, Tremor

Psych: Anxiety, Paranoia, Hallucinations, Delusions

ENT: Dental Decay

CV: Tachycardia, Hypertension, Vasospasm

Skin: Diaphoresis (sweat)

55
Q

True or False: The use of stimulants for cognitive enhancement has not been well supported by research

56
Q

What are the symptoms of sympathomimetic toxidrome (signs of people who are abusing substances)?

A

MATHS

M: Mydriasis (dilated pupil)
A: Agitation, Arrhythmia, Angina
T: Tachycardia
H: Hypertension, Hyperthermia
S: Seizure, Sweating

57
Q

How do we treat agitation, HTN, and seizures associated with substance abuse?

A

Benzodiazepines

58
Q

Which drugs should be avoided in patients suspected to be abusing stimulants?

A

Beta Blockers

(due to unopposed alpha agonism)

59
Q

Which symptom in a patient presenting with sympathomimetic toxicity denotes a poor prognosis?

A

Hyperthermia

60
Q

What are psychedelics?

A

Agents that produce non-ordinary and variable forms of conscious experiences

(changes in mood, thought, and distorted perceptual sensations)

61
Q

Why has the term “hallucinogen” fallen out of favor?

A

These drugs rarely produce frank hallucinations at commonly used doses

62
Q

What is a delusion?

A

A fixed, false belief that is unresponsive to logic

*Paranoia is a common manifestation

(ex: a man comes to a homeless shelter convinced he arrived in a black ops helicopter)

63
Q

What is a hallucination?

A

A false perception arising from internal stimuli

-Creates a false reality

(ex: there are bears floating around the ceiling)

64
Q

What is an illusion?

A

A misperception of external stimuli

-Distorts reality

(ex: mistaking a man for a bear)

65
Q

What are the 2 drug categories of psychedelics?

A

Classical Psychedelics

Dissociative Psychedelics

66
Q

What are the classical psychedelics?

A

Derivatives of phenethylamine

Derivatives of tyramine

67
Q

What are the dissociative psychedelics?

A

Phencyclidine
Ketamine
Muscimol

68
Q

What is the naturally occurring psychedelic found in magic mushrooms?

A

Psilocybin (pro-drug of psilocin)

69
Q

Mescaline combines the action of which two drugs?

70
Q

What is special about Phenethylamine?

A

It has both stimulant and psychedelic properties

*more hallucinogenic than stimulatory

71
Q

Most classical psychedelics are agonists of which receptor?

72
Q

Which psychedelic stimulates 5-HT release and is the exception to the normal 5-HT agonist property of psychedelics?

73
Q

How do psychedelics impact the CNS?

A

Increase global integration
(areas of the brain talk to each other more than normal)

74
Q

What is anxious ego-dissolution?

A

A thought disorder leading to a bad psychedelic trip (unpleasant state)

75
Q

True or False: Psychedelics have no addictive potential

76
Q

What are the potential therapeutic uses of psychedelics?

A

Cancer-related psychological distress
PTSD
Depression
Substance use disorder (alcohol)

77
Q

What are the shortcomings of psychedelic clinical trials?

A

Small sample size (90% excluded)

Inadequate controls

Hard to determine proper control group

Selection bias (for people with experience using psychedelics)

78
Q

Dissociative psychedelics act at which receptor?

A

Antagonists of NMDA receptors (glutamate)

79
Q

What other effects can NMDA receptor antagonists have besides psychedelic?

A

Anesthesia

Analgesia

80
Q

Which enantiomer of ketamine is more active?

81
Q

What % of high schoolers abuse dextromethorphan (DXM)?

82
Q

How does dosing of dextromethorphan vary based on if it is used for cough suppression or to induce a high?

A

Cough suppression: <60mg

High: 100-600mg

83
Q

Is phencyclidine (PCP) more or less potent than ketamine?

A

More potent

84
Q

Besides being an NMDA receptor antagonist, what other mechanism of action does phencyclidine (PCP) have?

A

D2 receptor agonist

85
Q

What is a concerning affect associated with phencyclidine (PCP)?

A

Self-mutilation without recognition (dissociation with analgesia)

86
Q

What is the MOA of muscimol?

A

Agonist of GABA A

*this drug comes from mushrooms but is not magic mushrooms

87
Q

What are alkyl nitrites?

A

Sold as “poppers” (inhalants that release nitrous oxide causing smooth muscle relaxation)

88
Q

Which drugs have the highest abuse potential among gay men?

A

Alkyl Nitrite inhalants

(because of enhanced erections, relax anal sphincter)

89
Q

What is the greatest risk associated with alkyl nitrite inhalants?

A

Methemoglobinemia

90
Q

How does the physical form of volatile solvents change?

A

Volatile solvents are liquid at room temperature and evaporate when exposed to air

91
Q

What are common volatile solvents?

A

Toluene (glue, thinners, cement, spray paint)

Acetone (nail polish, model glue, rubber cement)

Benzene (cleaning fluid, rubber cement, tire repair)

Butane (cigarette lighter, hair spray, spray paint)

92
Q

Which drugs have the highest frequency of use among adolescents, especially in isolated communities?

A

Volatile solvents

93
Q

What are the clinical effects of high dose volatile solvents?

A

CNS depression
Slurred speech
Disorientation
Weakness
Sedation

94
Q

What are the risks of inhalant abuse?

A

(inhaling a solvent causes less room for oxygen, symptoms result from this)

Asphyxiation
Suffocation (plastic bag)
Convulsions or Seizures
Coma
Choking
Fatal Injury

95
Q

What is the number of inhalant fatalities in the US each year?

A

100-200 minimum

96
Q

What is sudden sniffing death syndrome?

A

Development of fatal arrhythmias within minutes of inhalation

97
Q

Alcohol elimination follows what kind of kinetics?

A

Zero order

*at or above 10-20 mg/dl
*no way to speed up metabolism

98
Q

In alcohol metabolism, only high alcohol concentrations involves which enzyme?

99
Q

What is glucuronidation in relation to alcohol?

A

Test used to monitor alcohol consumption

*too sensitive for most needed purposes
*tests for ethyl glucuronide which has a long half-life
*can test alcohol use for days

100
Q

Alcohol is metabolized by which enzyme?

A

Alcohol dehydrogenase

101
Q

True or False: Men express HIGHER levels of Alcohol Dehydrogenase (ADH)

102
Q

What drug is used for alcohol poisonings?

A

Fomepizole (Antizol)

103
Q

What is the MOA Fomepizole (Antizol)?

A

Alcohol Dehydrogenase (ADH) inhibitor

-slows formation of formaldehyde and toxic metabolites
-lives has more time to metabolize metabolites further

104
Q

Alcohol metabolism produces what compound?

A

Acetaldehyde

*when metabolism stops here this causes a hangover

105
Q

Acetaldehyde produced from alcohol metabolism is metabolized by what enzyme?

A

Aldehyde dehydrogenase

(ALDH1B1 and ALDH2)

106
Q

Which gene is the reason why some people flush more or cannot drink alcohol?

107
Q

What does being heterozygous for ALDH2*2 mean?

A

-Have reduced metabolic activity

-Flushing and increased skin temperature upon drinking

-Can still consume alcohol just build up more acetaldehyde and more side effects

108
Q

What does being homozygous for ALDH2*2 mean?

A

CANNOT DRINK ALCOHOL IT IS TOXIC

-unable to metabolize acetaldehyde

109
Q

What is Disulfiram used for?

A

(Antabuse)

-Used for alcohol abuse
-If person drinks alcohol while taking this medication they will get sick
*Effects last up to 14 days

110
Q

What 2 ligand-gated ion channels are targeted by alcohol?

A

GABA A

NMDA

111
Q

What is the most common side effect of acute drinking?

A

Vasodilation

112
Q

Moderate alcohol drinking can have what positive effect?

A

Reduced risk of coronary disease

113
Q

Heavy/chronic alcohol use affects which organ?

114
Q

High doses of alcohol can have what effect on thermoregulation?

A

Hypothermia

115
Q

Alcohol has what effects in the GI tract?

A

Secretagogue
-increases acid secretion

-can cause either appetite stimulation (low dose) or depression (high dose)

116
Q

What affect does alcohol have on the liver?

A

Increases fat metabolism

Fatty liver leads to cirrhosis

-Can cause: ascites, edema, and effusions

117
Q

Where can alcohol cause cancer in the body?

A

Along the route of ingestion
(mouth, larynx, esophagus, stomach)

Liver

118
Q

What is the drug interaction between alcohol and acetaminophen?

A

Increases toxic metabolites of acetaminophen (Ex: NAPQI)

119
Q

What are the 3 approved treatments for alcoholism?

A

-Disulfiram (Antabuse)

-Acamprosate (Campral)

-Naltrexone (Revia)

120
Q

Patients with which gene mutation respond better to Naltrexone?

A

118G

(SNP in mu opioid receptor)

121
Q

When is a person with a substance use disorder considered “recovered”?

A

NEVER
-always recovering, never recovered

122
Q

What is the legal blood alcohol concentration in most states?

A

80 mg/dL

(0.08mg%)

123
Q

What are 2 severe side effect of alcohol withdrawal and after how much timet do they occur?

A

Grand mal seizures (1-2 days)

Delirium tremens (3-5 days)

124
Q

AT what CIWA score do we medicate for alcohol withdrawal?

A

8 or higher

125
Q

Which vitamin should be substituted in alcohol withdrawal patients?

126
Q

Which antiseizure medication is not useful in alcohol withdrawal?

127
Q

Thiamine deficiency can cause what disease?

A

Wernicke’s encephalopathy

128
Q

When should thiamine be given in patients with alcohol withdrawal?

A

Before dextrose-containing fluids

Spring 2024 Therapeutics 3 (24 decks)

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