IDT - Drugs of Abuse, Ishmael

Question 1

The Continued, compulsive obsession with obtaining, consuming and experiencing the effects of self-administered drugs

Answer 1

Substance Dependence (addiction)

Question 2

Drugs that have psychoactive properties have a ____________ which makes it __________ to be abused.

Answer 2

Positive reinforcing action

More Likely

Question 3

The return to a drug use after abstinence

Answer 3

Relapse

Question 4

What changes must be made in order to achieve continued recovery?

Answer 4

behavioral, social, psychological and physiologic changes

Question 5

What area of the brain is responsible for the pathway in addiction?

Answer 5

Nucleus accumbens, projections from the Ventral Tegmental area.

Question 6

Why are drugs that block dopamine receptors less likely to be self-administered?

Answer 6

They may have dysphoric effects that people would rather avoid.

Question 7

What are the natural rewards that may be devalued and overriden in addictive pathways?

Answer 7

Food
Water
Sex
Nurturing

Question 8

What is tolerance?

Answer 8

The decrease in pharmacologic response on repeated administration of the drug

Question 9

What is sensitization?

Answer 9

Responses/side effects become stronger than previously anticipated.

Question 10

Classification when administration of the drug is required to maintain normal function and avoid withdrawal syndrome.

Answer 10

Physiologic dependence

Question 11

When a drug dependence is removed from a physically dependent person, this unwanted side effects might occur

Answer 11

Withdrawal syndrome

Question 12

The process of by which an individual that is physically dependent on a drug is withdrawn from it

Answer 12

Detoxification

Question 13

The 7 classes of drugs that have been recognized as obsessively self-administered by humans

Answer 13

Methylxanthines
Nicotine
Alcohol
Marijuana
Stimulants
Opiates
Hallucinogenic/Dissociative drugs

Question 14

Nicotine

• Mechanism
• Effect
• likelihood of dependence

Answer 14

• Binds to Nicotinic Acetylcholine receptors
• Excitatory/Stimulant effect
• Dependence has a genetic component

Question 15

Pharmacologic treatment strategies for smoking cessation

Answer 15

NRT 
- patches, gum, e-cig etc 
- Reduces withdrawal by changing behavior 
Anti Depressants (no SSRIs)
- Bupropion
- Nortriptyline
Varenicline
 - Chantix, selective partial agonist

Question 16

Varenicline (Chantix)

• Target
• Efficacy

Answer 16

Selective alpha4beta2 nicotinic receptor partial agonist

Causes sufficient dopamine release to reduce cravings/withdrawal but prevents full activation of receptor.

Question 17

Why can Nicotine be so addicting?

Answer 17

Nicotinic receptors within the VTA and impact dopamine release in the nucleus accumbens

(mixes behavioral, cognitive and psychological signals)

Question 18

How do Buproprion and Nortrtiptyline differ in their mechanism of action for smoking cessation

Answer 18

Buproprion targets NET and DAT

Nortriptyline (NET < SERT ««< DAT)

Question 19

The observed phenomenon where the pharmacologic effect of alcohol having greater effect while rising than falling, even though blood ethanol concentration is the same.

Answer 19

The Acute Tolerance
or
Mellanby Effect

Question 20

Effects of Alcohol on CNS

Answer 20

slurred speech
motor incoordination
impaired judgement
uninhibited behavior
increased self-confidence
sedation
relief of anxiety
increased pain threshold

Question 21

What is the first thing you lose during consumption of alcohol?

Answer 21

Cognitive functions, as the neuronal populations are more sensitive

Question 22

Describe the Asian Glow

Answer 22

Asian populations lack aldehyde dehydrogenase or have a mutation which allows the alcohol’s aldehyde intermediate to build up and cause dysphoric effects.

Question 23

Disulfiram

Answer 23

An inhibitor of aldehyde dehdryogenase, supposed to make people sick when they drink in order to ween bad drinking behaviors

Question 24

Alcohol withdrawal symptoms

Answer 24

Tremors (Shakes)
Increased BP
Rapid Breathing
Sweating/Nausea
Alcohol Hallucinations
Seizures
Delirium Tremens

Question 25

What class of medications can be used to lessen alcohol withdrawal symptoms

Answer 25

Benzodiazepenes OTC - vitamins (thiamine, magnesium)

Question 26

What is the main psychoactive ingredient in marijuana?

Answer 26

delta9-tetrahydrocanabinol

Question 27

Why is marijuana not associated with severe withdrawal?

Answer 27

Not high enough dose to overload reward pathway and cause dependency

Question 28

When did the Oregon Medical Marijuana Act get passed

Answer 28

Dec 1998; Approved for recreational use in Oregon in 2015

Question 29

What debilitating medical conditions may be prescribed marijuana?

Answer 29

``` Agitation related to Alzheimer Cachexia Cancer Glaucoma HIV/Aids Nausea PTSD Severe Pain Seizures Persistent muscle spasms ```

Question 30

How do endogenous cannabinoids modulate NT release

Answer 30

They decrease calcium ions by binding at CB receptors on the presynpatic neuron

Question 31

Medicinal marijuana use vs | Recreational marijuana use

Answer 31

Medicinal - Symptom relief | Recreational - Pleasure

Question 32

What routes of administration are often used for consumption of marijuana

Answer 32

Smoking Oral (edibles) Vaporizing

Question 33

What route of marijuana consumption allows allows rapid and predictable bioavailabiity and allows for self-titration?

Answer 33

Smoking the Ganj

Question 34

What is CUD?

Answer 34

Cannabis Use disorder - pattern of substance abuse that leads to clinically significant impairment - Social, occupational and recreational activities reduced in favor of drug - tolerance, withdrawal may develop, causing behavioral and physical effects, persistence in spite of negative consequences just like other drugs

Question 35

What medication was used to treat morphine addiction in 1884?

Answer 35

Cocaine

Question 36

What legitimate medical use can cocaine be used for?

Answer 36

Local anesthetic and vasoconstriction (use dependent Na+ channel blocker) - Upper respiratory tract - ear - nose - throat

Question 37

Cocaine's mechanism of action

Answer 37

Binds to and blocks the Dopamine, SR and NE transporters, enhancing DA levels especially in the nucleus accumbens

Question 38

What conditions can amphetamines be used to treat?

Answer 38

ADHD Narcolepsy Obesity

Question 39

What is the primary effects of CNS stimulants?

Answer 39

Increased Alertness Increased locomotor activity Stereotype behavior, Euphoria, excitement, overconfidence and anorexia

Question 40

What are the chances of developing dependence with amphetamine meds?

Answer 40

High, rapid, as it creates euphoria and is needed to avoid the unpleasant ftigue and depression that follows

Question 41

What is the affect on dopamine transport by amphetamines?

Answer 41

Creates a "Reverse Transport", because amphetamines act as substrates of NET, SERT, DAt and VMAT, they may deplete the pH gradient in vesicles and cause efflux of endogenous neurotransmitters.

Question 42

What do Cocaine and SSRI's/SNRI's have in common?

Answer 42

They are both non-transported inhibitors, binding to the receptor but not being actively transported themselves.

Question 43

What are the 3 types of ADHD?

Answer 43

Inattentive Hyperactive-impulsive Combined

Question 44

In individuals that have been diagnosed with ADHD, what is the likelihood of dependence or abuse?

Answer 44

Much lower, and is considered safe, with no convincing evidence it may lead to this.

Question 45

What is the effect of stimulants in treatment of ADHD?

Answer 45

Tends to reduce the hyperactivity, impulsiveness and works to improve the ability to focus.

Question 46

How is Atomoxetine unique from other CNS stimulants?

Answer 46

It targets the NE transporter and inhibits its function rather than acting as a stimulant, so it has low abuse liability