Lecture 13 - Drug Abuse & Addiction Flashcards
Really hard to die from an OD of ______ alone
benzos
*become dangerous when mixed with other CNS depressants
When would anti-depressants have addiction potential? (i.e. what receptor would they have to hit?)
dopamine
What are benzo’s first line for?
really only first line for status epilepticus
What other drugs have abuse potential?
- Z drugs
- Gabapentin
_____ has opioid effect in massive doses
loperamide
______ can have a dissociative effect at high doses as well
gravol
By itself, _____ is not toxic
gravol
*again, it’s when it’s mixed with other CNS depressants (ex. alcohol) when it becomes dangerous
What drugs have abuse potential?
- marijuana
- pain relievers
- inhalants
- tranquilizers (benzos)
- hallucinogens
- stimulants (ADHD meds)
- cocaine
- sedatives
- heroin
What are some sources for the Rx drugs that are being abused?
- got them from a friend or relative for free
- bought from a friend or relative
- Rx’s from 1 doctor
- Bought from drug dealer or stranger
- Took from a friend or relative without asking
- Rx’s from more than 1 doctor
- bought on internet
What is speedball?
heroin & cocaine
depressant then stimulant
Who is more likely to prescribed CNS depressants?
older women
2 main reasons why people use drugs ?
1) To feel good To have novel: -feelings -sensations -experiences AND to share them
2) To feel better To lessen: -anxiety -worries -fears -depression -hopelessness
Is addiction more likely with physical or emotional pain relief?
emotional
Why do we as pharmacists care about drug mis use?
- drug interactions
- patients are uneducated and they are dangerous
- they are not studied in quantities or mixtures that they are being used in
What is addiction?
Addiction is a persistent, compulsive dependence on a behaviour or substance despite recurrence of negative consequences.
Addiction is a primary, chronic condition involving brain reward, motivation, memory and related circuitry.
*when an unhealthy relationship with the drug develops
Describe 2 types of addiction
1) Ingestion
- drugs or alcohol
2) Process
- gambilng, shopping, sex, internet
What are our natural rewards? (that are important for survival or ourselves and our species)
- food
- sex
- love or babies?
- water
- lmao see page 4
Describe impulsive stage
- binge intoxication
- pleasurable effects
- abstinence - neutral affect
- reward craving
Describe compulsive stage
- prolonged intoxication
- relief
- protracted abstinence - negative affect
- reliefe craving
What circuits are involved in drug abuse and addiction?
- inhibitory control
- reward/salience
- motivation/drive
- memory/learning
how is inhibitory control, reward and drive changed in an addicted brain vs. non-addicted brain
In the addicted brain:
- inhibitory control is minimized
- reward and drive are bigger
Why should we care?
DRUG INTERACTIONS MAN
Why don’t we see medication or alcohol problems?
- attitudes
- beliefs
- denial
When can drug interactions result?
- Mixing 2 or more medications
- Mixing medications and illicit drugs
- Mixing multiple illicit substances
*Medications include prescription, OTC, and herbal/alternative products
What people are at risk for drug interactions?
- many people with mental health issues also use/misuse/abuse illicit substances
- co-occuring clients may be on multiple medications to manage their conditions
- the most serious
What else might increase risk?
- Dose of drugs taken
- Genetics (i.e. poor or fast metabolizers)
- Diet/nutritional status
- Reduced liver or kidney fcn
- Increased age
- “poly pharmacy”
- poly-substance abuse
- co-morbidity (any health condition)
What can result from a DI ?
- the effects of either drug may be enhanced
- the effect of the medication may be reduced
- the effect of the illicit drug may be reduced
- a new/unpredictable effect might occur
- a beneficial effect?
- nothing
Drugs that can act at the same receptor cause an ______ effect
additive
Drugs that act at different receptors can cause _______ effect
synergistic
2 drugs that oppose each other cause ______ effect
antagonistic
Cannabis may increase the effect of ________
hallucinogen
Stimulants and hallucinogens increase risk of ______ ______
serotonin syndrome
How do hallucinogens and depressants interact?
hallucinogens may mask or enhance the depressant’s effects
Describe interaction for:
Cannabis and hallucinogens
cannabis may increase the hallucinogen’s effects
Describe interaction for:
stimulants and cannabis
increased heart rate
Describe interaction for:
cannabis and depressants
cannabis can increase the depressants effects
Describe interaction for:
stimulants and depressants
stimulants may mask the depressant’s effects
Describe interaction for:
alcohol and cocaine
creates a potent and long-lasting metabolite (coca-ethylene)
Describe interaction for:
alcohol and tobacco
increased risk of cancer - risk from smoking x risk from drinking
Describe interaction for:
Cannabis and cocaine
cannabis increases vasodilation so increases absorption of cocaine from snorting
Describe interaction for:
alcohol and cannabis
alcohol may increase absorption of THC
Describe interaction for:
tobacco and cannabis
additive lung damage if smoked
Describe interaction for:
amphetamines and cocaine
cocaine inhibits enzymes that metabolize MDMA
Describe interaction for:
amphetamines and alcohol
alcohol increases MDMA levels, increases risk of dehydration & OD
Describe interaction for:
amphetamines and tobacco
additive stimulant effects
_____ increases it’s own metabolism
alcohol
_____ decreases effects of many antipsychotics
smoking
Give some examples of things that the average person needs to be aware of
- tylenol & alcohol
- extended release pills and alcohol
- DM, alcohol & codeine
- diphenhydramine(Benadryl), dimenhydrinate (gravol), scopolamine (Transform V)
- interactions can also occur with medical conditions and other prescription medications
Describe:
Ginkgo biloba
may increase bleeding, including in the brain
Describe:
St. John’s wort
interacts with many anti-depressants, especially the SSRI type
Describe:
Ephedra or “herbal ecstasy”
- interacts with other stimulants - additive/synergistic
- possibly fatal!
Describe:
Kava Kava
- adds to the sedative effect of other drugs
- may have serious effects with parkinson drugs or anti-psychotic meds
Describe the dopamine pathways
- movement
- pleasure
- behaviour/reward
- euphoria
What drugs target dopamine pathways?
Stimulant street drugs
- amphetamine/meth
- cocaine/crack
Describe the serotonin pathways
- body temperature
- cognitive function
- regulation of emotions (i.e. panic & anxiety)
- regulate appetite/satiety
- sleep/wake cycle
- sexual functioning
- in excess: serotonin syndrome
What drugs target serotonin pathways?
- ecstasy
- classic hallucinogens (LSD)
Describe the noradrenergic pathways
- “fight, flight, or freeze” response
- state of “readiness”: increased HR, BP, blood diverted from skin to skeletal muscle, peripheral blood vessels contract
What drugs target noradrenergic pathways?
- amphetamine/meth
- cocaine/crack
Describe the GABA pathways
- Major “calming” transmitter in the brain
- Decrease anxiety
- Relaxation
- In excess: sedation, coma, death
What drugs target GABA pathways?
- benzo’s
- barbiturates
- alcohol
Describe opiate receptors
- physical and psychological analgesia
- euphoria
- sleepy-relaxed-coma
- triggers DA release
- dependence
What drugs target opiate receptors?
- opioids obviously
- heroin
- morphine
