II Pharm IV Flashcards
What are the most abused drugs in all age groups?
Alcohol and tobacco
4 Factors that increase potential for abuse:
Potency
Rapid onset
Inexpensive
Easy to obtain/distribute
What are “potential” pts?
call office seeking pain meds w/o being seen
In order to give a script:
2 things
pt of record
dental need
Why is a drug “scheduled”
Potential for abuse
Drugs that are used in a manner/amount inconsistent w/ med or social pattern of culture
Drug Abuse
When a drug necessitates continued administration to prevent withdrawal:
Physical dependence
Physical dependence is addiction
False
*chronically dependent opiates for pain = physical dependence but not an addict
You can be physically dependent on a drug and not be addicted to the drug:
True
*but addicts are usually physically dependent
Perceived need or craving for a drug:
Psychological dependence
What is the primary reason for relapse:
Psychological dependence
3 signs of addiction:
Compulsive drug-seeking behavior
Continued use despite serious consequences
ALWAYS psychological dependence (so relapse common)
Physiologic tolerance or psychological dependence short of addiction:
Habituation
4 behaviors associated w/ addiction:
Anal retentive
OCD
Controlling
Manipulative
T/F
Habituation will ALWAYS lead to addiction or dependency
True
With repeated dosing, drug must be increased to produce same effect:
Tolerance
What kind of tolerance to Psychoactive drugs produce?
Central tolerance
*definite decrease in the response of brain tissue to constantly increasing amounts of drug
Is tolerance the same as Metabolic Tolerance?
NO
*it is central tolerance - would need accelerated metabolic rate - not really a factor w/ most psychoactives
Behavior of others associated with user that results in continued drug abuse:
Enabling
The state of being free of drugs:
Abstinence Syndrome
Using opiates for sleeping aid would be considered what?
Misuse
T/F
Nicotine/EtOH are considered “gateway” drugs
True
If pt has Hx of drug abuse, what must you watch out for?
3 things can’t use w/ these pts:
Relapsing disease
opiates, benzodiazepines, nitrous oxides
*ANY substance that can promote relapse
A primary, chronic, progressive, relapsing disease process with genetic, psychosocial, and environmental factors influencing its development and manifestations:
Chemical Dependency
When comparing drugs in the same group, the time required to produce physical dependence is shortest with a rapidly metabolized drug.
True
The time course of withdrawal rxns is related to the half-life of the drug
True
How do we Tx abuse:
3 things
counseling
education
self-help groups
*but person must WANT help
The leading cause of ER visits and accidental overdose among kids (esp in AZ)
Access to stored meds
3 considerations for Drugs and Children:
Increased mem. permeability
Dosing based on weight
Half adult dose
Poison Prevention Act 1970:`
prescriptions must have Child-resistant containers
2 psychological trends in children seeking drugs:
Appearance:
If anxiety - seek downers
Low self esteem - uppers
Appear drunk/intoxicated
Kids are abusing prescription drugs more than cocaine, heroin, hallucinogens, and Ecstasy combined
True
*prescription drugs more popular than recreational drugs
What causes more overdoses in adolescents than cocaine and heroin combined?
Opiates (hydrocodone w/ acetaminophen especially)
2 reasons inhalants are abused:
Huffing/Sniffing very easy
Accessible (markers, glue, white out)
What is difluoroethane?
Why important for Dentistry?
Can lead to what?
Inhalant - halogenated hydrocarbons
Increase heart muscle sensitivity to Epinephrine
Sudden Death
Inhalants known as poppers, snappers?
Amyl nitrite
Butyl nitrite
Whippets are:
Nitrous oxide
T/F
Kids abuse prescription drugs more than street drugs and this is known as “pharming”
True
5 signs of inhalants
*produce similar effects as anesthetics
Intoxication
Slurred speech
Inability to coordinate movements
Euphoria
Dizziness
What is the most abused drug among children?
Vicoden
5 causes of death due to inhalants:
Hepatotoxicity
Suffocation
Resp depression
Sudden sniffing death
Cardiac death (difluoroethane)
What is in Robitussin
Dextromethorphan
What does Dextromethorphan do at low dose?
High dose?
What drug is it similar to and where does it act?
Antitussive
Hallucinogenic
Morphine, centrally
Robotripping involves drinking ____oz’s of DXM (Robitussin) until nausea causes you to ____ and ______
4 ounces
vomit, hallucinate
A lot of cold meds are _______ and considered ________
This means they can’t be used in people that have ______
Adrenergic Agonists
Vasoconstrictors
Hypertension
What cold med doesn’t have Acetominophen but still contains DXM (dextromethorphan)?
Coricidin HBP
What is Coricidin’s street name?
Skittles
T/F
Alcohol use is on the rise, including binge drinking
False
*continues to decline
Alcohol use is decreasing except for what demographic?
College age girls
Roofie:
Rohyponol
Why are women more susceptible to alcohol poisoning?
Don’t make as much Alcohol Dehydrogenase as men
As of _____, cigarette use reached an all-time low due to peer disapproval
2014
More popular among teens: cigarettes or e-cigs?
e-cigs
The FDA regulates e-cigs
True
but, legislation just passed
In 1998 ____% students had tried tobacco
In 2014 ___%
56%
23%
The greatest decline of illicig drug use has been with what drug?
Synthetic marijuana
K-2, spice
Most students recognize synthetic marijuana as a dangerous class of drug:
False
Amphetamine-like stimulant found naturally in the Khat plant:
Bath salts
less than 1% student use
The use of exctasy, salvia, and shrooms have declined
True
10 illicit drugs that have remained unchanged in use:
heroin
crack
meth
ritalin/adderall
LSD
Inhalants
Powder cocaine
tranquilizers
sedatives
anabolic steroids
What receptor does ecstasy bind to in the brain?
NMDA receptors
Most teens get their drugs from a friend/relative
True
3,4 methylenedioxypyrovalerone (MDPV):
aka, drone, meph, meow meow, methylone
Bath Salts
Substance abuse disorders are expected to double by 2020 and the Tx admission for substance abuse has doubled since 1992
True
*baby boomers
1/3 Baby Boomers use Rec. drugs
True
Elderly adults w/ substance abuse put themselves at risk for what 3 things?
Cancer
Infections
Infectious diseases
Newest demographic for HIV
Women over 65
Adults over 65, increasing use of what?
Alcohol
5 diseases Elderly Smokers will die from:
COPD
Heart disease
Stroke
Cancer
Alzheimer’s
Most commonly used recreational drug?
Marijuana
The proportion of older adults seeking Tx for substance abuse is increasing compared to younger adults
True
Alcohol/Rec. drug dependency often come about by what 3 things?
Chronic pain use - initial
Psychological probs - sleeping, anxiety, depression
Loneliness, boredom
4 Recreational and OTC meds abused by older adults:
Opioids
Benzodiazepines
Alcohol
Sleeping preparations
4 substances abused by older adults:
Rx and OTC meds
Alcohol/tobacco
Marijuana
Cocaine/Heroine (diminished after 60)
Most commonly abused CNS depressants?
2 other classes used fairly commonly:
Opioid analgesics
benzodiazepines, barbiturates
What are the 2 most commonly abused CNS stimulants?
Amphetamines
Methylphenidate
5 Examples of depressants:
Alcohol
Benzodiazepines
Opioids
Inhalants
Nitrous oxide
The most frequently abused drug:
Alcohol
Alcohol is oxidized to what in the liver?
Acetaldehyde
Acetaldehyde is metabolized to what?
Excreted where?
CO2 and water
lungs/urine
6 cancers linked to Acetaldehyde:
Oral
Pharyngeal
Gastric
Pancreatic
Liver
Bladder
Alcohol is eliminated from the body via _____ kinetics
What is the rate?
Zero-order
1g/hour
4 signs alcohol intoxication?
Dilated pupils
Slurred speech
Nystagmus (involuntary eye movement)
Incoordination
3 severe, centrally mediated signs of intoxication:
seizures
coma
death
4 physiologic considerations of Alcohol Use in older adults:
Decreased body water/body mass (higher conc. alcohol)
Decline liver/kidney
Malnutrition/Weight loss
Injuries/Falls
4 reasons the Elderly are more sensitive to Alcohol:
*this is why older people develop problems with alcohol even if drinking habits have not changed
Metabolize more slowly
Stays in body longer
Decrease body water
Lower body’s tolerance
Alcohol induced changes in the Elderly Brain that is often misdiagnosed as dimentia:
Biological Brain Disorder
Biological Brian Disorder: withdrawal, Seizures, Organic hallucinations, Psychosis, Dementia, and _______
Delirium tremens (DT’s)
4 consequences of Chronic Alcoholism in the Elderly:
Systemic (neuropathies)
Fatigue/weight loss
Existing conditions worsen (HTN, diabetes, etc)
Psychological (isolation, depression, anxiety, suicide)
Mixing alcohol with what can cause GI bleeding?
Aspirin/NSAIDS
Alcohol plus what can cause liver damage?
Acetaminophen
Cold/allergy meds + antihistamines + alcohol = 4 things
Drowsiness
Impaired judgement
Reaction time
Decreased coordination
CNS drugs + alcohol = 5 things
Sleepiness
Poor coordination
Dyspnea
Tachycardia
Memory problems
Alcohol withdrawal occurs in stages and includes what 4 things?
Paranoid behavior
Disorientation
Grand mal seizures
DT’s (delirium tremens), shaky tremor movements
Chronic signs of alcoholism, watch what 4 things:
Bleeding
Oropharyngeal cancer
Liver cancer
Peripheral neuropathy
Mothers that drink:
Fetal Alcohol Syndrome
2 features of Fetal Alcohol Syndrome:
Intellectual disabilities
Craniofacial probs
What drug inhibits the metabolism of Aldehyde Dehydrogenase, increasing serum levels of Acetaldehyde?
disulfiram (Antabuse )
disulfiram is used for what?
Tx alcoholism
If you drink while taking disulfiram you will _____
vomit
Other than alcohol, what is a contraindication when taking disulfiram (Antabuse)
Alcohol containing mouth rinses
For an Alcoholic, 5 Dental Tx Considerations:
Poor OH
Bilateral Parotid gland enlargement
Liver failure (bleeding)
Ascites
Difficulty metabolizing drugs
7 oral complications of Alcoholism
*must know
Glossitis
No Tongue Papillae
Angular Cheilitis
Fungal infections
Bleeding
Oral cancer (squamous cell)
leukoplakia, ulceration of lateral borders of tongue
If you’re Tx an alcoholic, examine the tongue carefully for what?
Precancerous lesions
4 abused opioids:
Heroin
Methadone
Morphine
Oxydodone
*oxycontin widely abused by dentists
Why are opioids typically abused?
Produce complete satiation for all drives of body
*only in absence of pain