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Year 4 - Toxicology > Lecture 13 - Drug Abuse & Addiction > Flashcards

Lecture 13 - Drug Abuse & Addiction Flashcards

1
Q

Really hard to die from an OD of ______ alone

A

benzos

*become dangerous when mixed with other CNS depressants

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2
Q

When would anti-depressants have addiction potential? (i.e. what receptor would they have to hit?)

A

dopamine

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3
Q

What are benzo’s first line for?

A

really only first line for status epilepticus

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4
Q

What other drugs have abuse potential?

A
  • Z drugs

- Gabapentin

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5
Q

_____ has opioid effect in massive doses

A

loperamide

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6
Q

______ can have a dissociative effect at high doses as well

A

gravol

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7
Q

By itself, _____ is not toxic

A

gravol

*again, it’s when it’s mixed with other CNS depressants (ex. alcohol) when it becomes dangerous

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8
Q

What drugs have abuse potential?

A
  • marijuana
  • pain relievers
  • inhalants
  • tranquilizers (benzos)
  • hallucinogens
  • stimulants (ADHD meds)
  • cocaine
  • sedatives
  • heroin
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9
Q

What are some sources for the Rx drugs that are being abused?

A
  • 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
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10
Q

What is speedball?

A

heroin & cocaine

depressant then stimulant

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11
Q

Who is more likely to prescribed CNS depressants?

A

older women

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12
Q

2 main reasons why people use drugs ?

A 
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
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13
Q

Is addiction more likely with physical or emotional pain relief?

A

emotional

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14
Q

Why do we as pharmacists care about drug mis use?

A
  • drug interactions
  • patients are uneducated and they are dangerous
  • they are not studied in quantities or mixtures that they are being used in
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15
Q

What is addiction?

A

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

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16
Q

Describe 2 types of addiction

A

1) Ingestion
- drugs or alcohol

2) Process
- gambilng, shopping, sex, internet

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17
Q

What are our natural rewards? (that are important for survival or ourselves and our species)

A
  • food
  • sex
  • love or babies?
  • water
  • lmao see page 4
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18
Q

Describe impulsive stage

A
  • binge intoxication
  • pleasurable effects
  • abstinence - neutral affect
  • reward craving
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19
Q

Describe compulsive stage

A
  • prolonged intoxication
  • relief
  • protracted abstinence - negative affect
  • reliefe craving
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20
Q

What circuits are involved in drug abuse and addiction?

A
  • inhibitory control
  • reward/salience
  • motivation/drive
  • memory/learning
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21
Q

how is inhibitory control, reward and drive changed in an addicted brain vs. non-addicted brain

A

In the addicted brain:

  • inhibitory control is minimized
  • reward and drive are bigger
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22
Q

Why should we care?

A

DRUG INTERACTIONS MAN

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23
Q

Why don’t we see medication or alcohol problems?

A
  • attitudes
  • beliefs
  • denial
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24
Q

When can drug interactions result?

A
  • Mixing 2 or more medications
  • Mixing medications and illicit drugs
  • Mixing multiple illicit substances

*Medications include prescription, OTC, and herbal/alternative products

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25
Q

What people are at risk for drug interactions?

A
  • 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
26
Q

What else might increase risk?

A
  • 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)
27
Q

What can result from a DI ?

A
  • 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
28
Q

Drugs that can act at the same receptor cause an ______ effect

A

additive

29
Q

Drugs that act at different receptors can cause _______ effect

A

synergistic

30
Q

2 drugs that oppose each other cause ______ effect

A

antagonistic

31
Q

Cannabis may increase the effect of ________

A

hallucinogen

32
Q

Stimulants and hallucinogens increase risk of ______ ______

A

serotonin syndrome

33
Q

How do hallucinogens and depressants interact?

A

hallucinogens may mask or enhance the depressant’s effects

34
Q

Describe interaction for:

Cannabis and hallucinogens

A

cannabis may increase the hallucinogen’s effects

35
Q

Describe interaction for:

stimulants and cannabis

A

increased heart rate

36
Q

Describe interaction for:

cannabis and depressants

A

cannabis can increase the depressants effects

37
Q

Describe interaction for:

stimulants and depressants

A

stimulants may mask the depressant’s effects

38
Q

Describe interaction for:

alcohol and cocaine

A

creates a potent and long-lasting metabolite (coca-ethylene)

39
Q

Describe interaction for:

alcohol and tobacco

A

increased risk of cancer - risk from smoking x risk from drinking

40
Q

Describe interaction for:

Cannabis and cocaine

A

cannabis increases vasodilation so increases absorption of cocaine from snorting

41
Q

Describe interaction for:

alcohol and cannabis

A

alcohol may increase absorption of THC

42
Q

Describe interaction for:

tobacco and cannabis

A

additive lung damage if smoked

43
Q

Describe interaction for:

amphetamines and cocaine

A

cocaine inhibits enzymes that metabolize MDMA

44
Q

Describe interaction for:

amphetamines and alcohol

A

alcohol increases MDMA levels, increases risk of dehydration & OD

45
Q

Describe interaction for:

amphetamines and tobacco

A

additive stimulant effects

46
Q

_____ increases it’s own metabolism

A

alcohol

47
Q

_____ decreases effects of many antipsychotics

A

smoking

48
Q

Give some examples of things that the average person needs to be aware of

A
  • 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
49
Q

Describe:

Ginkgo biloba

A

may increase bleeding, including in the brain

50
Q

Describe:

St. John’s wort

A

interacts with many anti-depressants, especially the SSRI type

51
Q

Describe:

Ephedra or “herbal ecstasy”

A
  • interacts with other stimulants - additive/synergistic

- possibly fatal!

52
Q

Describe:

Kava Kava

A
  • adds to the sedative effect of other drugs

- may have serious effects with parkinson drugs or anti-psychotic meds

53
Q

Describe the dopamine pathways

A
  • movement
  • pleasure
  • behaviour/reward
  • euphoria
54
Q

What drugs target dopamine pathways?

A

Stimulant street drugs

  • amphetamine/meth
  • cocaine/crack
55
Q

Describe the serotonin pathways

A
  • body temperature
  • cognitive function
  • regulation of emotions (i.e. panic & anxiety)
  • regulate appetite/satiety
  • sleep/wake cycle
  • sexual functioning
  • in excess: serotonin syndrome
56
Q

What drugs target serotonin pathways?

A
  • ecstasy

- classic hallucinogens (LSD)

57
Q

Describe the noradrenergic pathways

A
  • “fight, flight, or freeze” response

- state of “readiness”: increased HR, BP, blood diverted from skin to skeletal muscle, peripheral blood vessels contract

58
Q

What drugs target noradrenergic pathways?

A
  • amphetamine/meth

- cocaine/crack

59
Q

Describe the GABA pathways

A
  • Major “calming” transmitter in the brain
  • Decrease anxiety
  • Relaxation
  • In excess: sedation, coma, death
60
Q

What drugs target GABA pathways?

A
  • benzo’s
  • barbiturates
  • alcohol
61
Q

Describe opiate receptors

A
  • physical and psychological analgesia
  • euphoria
  • sleepy-relaxed-coma
  • triggers DA release
  • dependence
62
Q

What drugs target opiate receptors?

A
  • opioids obviously
  • heroin
  • morphine

Year 4 - Toxicology (24 decks)

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