Medical Marijuana Flashcards
Where are most CB1 receptors located?
- Brain (mostly in CNS)
- Adipocytes
- Hepatocytes
- Musculoskeletal tissues
Where are most CB2 receptors located?
Peripheral organs especially cells associated with the immune system
What effect does THC have on CB receptors?
Psychoactive effects
1. Primarily binds to CB1 receptors
2. Partial agonist at CB1 and CB2 receptors
What effects does CBD have on CB receptors?
Anti-psychoactive that controls high
1. Partial agonist or CB2 receptors and non-cannabinoid receptors
What are terpenes?
Influence the aroma and effect of specific cultivars for different medical conditions
How is cannabis distributed?
90% protein bound, 10% unbound and can bind to CB1 receptors
How is cannabis eliminated?
30% in urine
70% in feces
What is the metabolism of cannabis?
CYP2C9 (major)
CYP3A4 (major)
What is the active metabolite of delta 9 THC?
11-OH-THC
What is a typical dose on THC?
2.5-10mg
What delivery systems are there for THC?
- Smoking/vapor
- SL, buccal
- Topical
- Rectal/vaginal
What are short-term SEs of THC?
- Coughing, dry mouth/throat
- Red, irritated eyes
- Dizziness
- Tachycardia, hypotension, palpitations
- Confusion, anxiety
- Nausea
What are long-term SEs with THC?
- Bronchitis in long-term smokers
- Cognitive defects with heavy, longterm consumption
- Cannabis hyperemesis syndrome
What disease states is THC a concern in?
- Schizophrenia,bipolar, severe depression
- Heart disease, HTN
- ANGINA, ARRHYTHMIAS, hx of stroke
What are symptoms of THC dependence?
- Excessive, daily use of cannabis
- Tolerance that requires increased dosing to achieve effects
- compulsion to use cannabis whenever available/ offered
- use results in failure to fulfill obligations
- activities given up or reduced because of cannabis use
- use in hazardous situations
What drugs does cannabis potentiate the effects of?
- alcohol
- benzodiazepines
- opioids
What are drug interactions with cannabis?
- inhibit P-glycoproteins efflux pumps
- effect drugs with narrow therapeutic index (warfarin, phenytoin, dabigatran, digoxin, and tacrolimus)
What medications increase the effects of cannabis?
- Clarithromycin/Erythromycin
- Fluconazole, Itraconazole, Ketoconazole
- verapimil, diltiazem, amiodarone
- Ritonavir, Atazanavir
What medications decrease the effects of cannabis?
- phenobarbital, phenytoin, carbamazepine
- Rifampin, rifabutin
- st johns wart
- Ritonavir
What medications do cannabinoids increase clearance of?
- Olanzapine
- Theophylline
What is the onset of inhaled cannabis?
peak:5-10 min
What is the onset and peak of buccal cannabis?
onset: 5-15 min
peak: 45 min-2h
What is the onset and peak of oral cannabis?
onset: 30min-2h
peak: 2-7 h
What is the FDA approved indication for Cannabidol (EPIDIOLEX)?
to treat seizures associated with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex in patients 1 year and older
What are SEs with Cannabidol?
- somnolence
- decreased apetite
- diarrhea
- fatigue
- malaise
- rash
What is the FDA approved indication for dronabinol (MARINOL, SYNDROS)?
anorexia in patients with AIDs, CINV, and moderate-severe obstructive sleep apnea
What is the difference between MARINOL and SYNDROS?
syndros- schedule 2
marinol- schedule 3
What are SEs with dronabinol?
- euphoria/antiemetic
- appetite stimulant
- hypotension
- cannabinoid hyperemesis syndrome
