Medical Cannabis Flashcards
Three species of Cannabis
- sativa (Taller, high THC)
- indica (Shorter plant, higher CBD, used for sleep)
- ruderalis
Uses for Cannabis
Fiber, food (seeds are highly nutritious), religion
* Medicinal
* Recreational
Endogenous cannabinoids include: _____
Anandamide (THC mimics this)
2-AG (2-Arachidonoylglycerol) (CBD
mimics this)
CB1 vs. CB 2 receptors
- CB 1 Receptors: present in all chordates (brain, lungs, vascular system, muscles, reproductive
organs, immune system, liver, bone marrow,
pancreas) - CB 2 Receptors: found in: spleen, bones, skin, immune system, liver, bone marrow, pancreas
____ is a CB1 and CB2 agonist
THC
PHARMACOLOGY (FOR THC)
- Causes psychoactive effects
- Can decrease nausea/vomiting associated with
chemotherapy - Improves appetite (studied in HIV patients)
- Reduces pain, especially neuropathic (usually in
combination with some amount of CBD) - Reduces muscle spasticity (usually with CBD)
THC and CBD inhibit _____, so can increase the availability of drugs metabolized by this system, e.g. sertraline (Zoloft)
CYP3A4
Medications impacted by THC and CBD inhibition of CYP2C9
fluoxetine (Prozac): increasing the availability
Warfarin: Increases bleeding times
Substantial evidence Indications for cannabis recommending
- Chronic pain
- Chemotherapy induced nausea/vomiting
- Spasticity with multiple sclerosis
- Lennox-Gastaut and Dravet seizure syndromes
Cannabis shows moderate evidence for _____
sleep disturbance
Cannabis shows limited evidence for:
- Appetite and weight gain
- PTSD (symptom control)
- Social anxiety
No evidence in Cannabis is shown for:
- Cancer
- Epilepsy (exception being the Lennox-Gastaut and
Dravet syndromes) - ALS, Huntington’s, Parkinson’s
- Irritable bowel syndrome
- Opiate addiction
Contraindications for Cannabis recommending:
- Pregnancy and lactation (adverse neurodevelopmental effects on fetus/infant)
- Heart disease (angina due to tachycardia and hypotension due to THC)
- Relative contraindication for those <21 years old
- Smoking or vaping in patients with COPD and asthma
Risk with oral cannabis administration
patient will not wait enough time to feel effect of dosage and may repeat doses resulting in excessive medication.
Driving/Safety Sensitive Operations with Cannabis:
- Avoid for 4 hrs after inhalation
- Avoid for 6 hrs after oral ingestion
- Avoid for 8 hrs if euphoria was experienced
- Specific jobs (aviation) – no use within 28 days
