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PHAR 100 > Module 2 > Flashcards

Module 2 Flashcards

1
Q

substance use disorders (SUD)

A

defined and clinically diagnosed by a number of criteria

if an individual meets two of the criteria they have mild SUD, more = more severe

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2
Q

substance use disorder (SUD) criteria

A
  • social impairment
  • risky use
  • impaired control
  • withdrawal
  • tolerance
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3
Q

social impairment

A

individual fails to fulfill major roles (work, school, home) and/or has persistent social or interpersonal problems

social, occupational, recreational actives may be given up

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4
Q

risky use

A

individuals may use substances in physically hazardous situations or use the substance despite physiological/psychological problems caused by use

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5
Q

impaired control

A

individual have persistent craving for substance

addiction

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6
Q

withdrawal

A

after stopping use individual experience withdrawal syndrome

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7
Q

tolerance

A

individual develops tolerance to the substance

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8
Q

addiction

A

impaired control associated with SUD manifested as emotional and mental preoccupation with drugs effects and a persistent craving for the drug regardless of consequences

can be other stimuli

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9
Q

dopamine hypothesis

A

commonly misused drugs increase dopamine in reward system

neurotransmitter systems involved in misuse by dopamine is key component

drugs associated with addiction cause an exaggerated increase in dopamine altering communication in brain

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10
Q

characteristics of addiction drugs

A
  • increase dopamine
  • produce novelty
  • reduce anxiety
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11
Q

drugs increasing dopamine

A

CNS stimulates
- cocaine
- amphetamines
- nicotine
- caffeine

opioids
- morphine
- heroin
- oxycodone

alcohol and cannabis

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12
Q

drugs produce novelty

A

novel feeling produced in person (new emotion of sensation)

lysergic acid diethylamide (LSD) and ecstasy (MSMA)

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13
Q

drugs reduce anxiety

A

CNS depressants
- benzodiazepines
- barbiturates

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14
Q

drug withdrawal

A

abnormal physiological state

severity of withdrawal syndrome increases with the speed of drug withdrawal (biological processes that accommodated the presence of drug do not have time to reverse themselves)

fear of withdrawal adds to continuing drug taking behaviour

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15
Q

stimulates withdrawal symptoms

A
  • sleepiness
  • muscle pain
  • anxiety
  • tremors
  • low mood
  • suicidal ideations (some)
  • cardiovascular problems (some)
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16
Q

opioid withdrawal symptoms

A
  • sweating
  • muscle aches
  • agitation
  • diarrhea
  • abdominal cramping
  • vomiting
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17
Q

drug tolerance

A

state in which repeated administration of a given dose of a drug has progressively less pharmacological effect

or

a state in which the dose of a drug must be increased to obtain the same magnitude of pharmacological effects produced by the original dose

is reversible upon drug discontinuation

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18
Q

cross tolerance

A

the resistance or tolerance of a drug because of the resistance of tolerance to a pharmacologically similar drug

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19
Q

factors influencing substance use disorders (SUD)

A
  • genetic factors
  • pre existing disorders
  • environmental factors
  • developmental factors
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20
Q

genetic factors, SUD

A

can predispose an individual to SUD

mutations in dopaminergic pathways to brain increase risk

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21
Q

pre existing disorders, SUD

A

major affective disorder (depression, bipolar), anxiety disorder or schizophrenia at higher risk of SUD

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22
Q

environmental factors, SUD

A

exposure to environments that promote drug use, family dynamic, trauma, social/work groups alter risks

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23
Q

developmental factors, SUD

A

more vulnerable during certain developmental timeframes

adolescence and early adulthood association with initiation of SUD

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23
Q

stigma of SUD

A

people with SUD are judged by others without knowing anything about the individual

can lead to isolation and low self esteem

individuals don’t receive medical or social help needed

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23
Q

harm reduction

A

approach that seeks to reduce/prevent negative consequences of substance use and improve health without stigma and without necessarily requiring the person to stop using the substance

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24
Q

health harms

A

goal is to decrease morbidity (disease, infection) and mortality (overdose)

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25
Q

societal harms

A

goal is to decrease lost productivity, apprehension of children and criminal activity

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26
Q

prescription use vs misuse

A

SUD can occur with medications used as prescribed or misuse of substances

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27
Q

misuse definition

A

using drugs in ways or amounts other than what was prescribed or against social norms

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28
Q

potential misuse of a drug

A
  • nature of the drug
  • route of administration
  • amount/frequency of use
  • availability
  • inherent harmfulness
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29
Q

nature of drug, misuse

A

drugs are natural reinforcers

pleasurable effects produced increase probability of use

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30
Q

route of administration, misuse

A

drugs administered by routed with rapid absorption hence rapid effects have greater potential of misuse

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31
Q

amount/frequency of use, misuse

A

greater dose and frequency, greater the potential for tolerance, withdrawal and addiction, thus misuse

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32
Q

availability, misuse

A

availability of drug in society determines potential misuse

more widespread, higher likelihood of misuse

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33
Q

inherent harmfulness, misuse

A

potential of the drug to cause harm

if perceived to be a serious risk to life and health, likeliness of use is lessened

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34
Q

amphetamines and cocaine drug type

A

classes of CNS stimulant drugs

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35
Q

amphetamines

A

widely misused and is a controlled substance in Canada

drug class that includes:
- amphetamine
- dextroamphetamine
- methamphetamine

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36
Q

amphetamine related compounds

A

methlypenidate (ritalin) - used to treatt ADHD

MDMA (ecstasy) - derivative of methamphetamine

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37
Q

MDMA (ecstasy) effects

A

creates a feeling of intimacy and empathy while improving intellectual capacities

neurotoxic, causes neuronal damage and death

long lasting, if not permanent effect

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38
Q

chemistry of amphetamines

A

synthetic organic compound

structure is similar to endogenous neurotransmitters norepinephrine and dopamine

synthesized readily resulting in illicit manufacturing

purity of illicit substances is variable, can contain side products of the chemical reaction, unreacted chemicals and cutting/filler agents (starch, baking soda) which can be dangerous

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39
Q

pharmacology of amphetamines

A

increase amount of dopamine or norepinephrine in the synaptic cleft

they are substrates for dopamine transporters which clears dopamine out of the synaptic cleft

compete with dopamine and end up in the presynaptic nerve

in the nerve they block vesicular monoamine transporters which bring dopamine into vesicles to be packaged and released when nerve impulses arrive

leads to a build up in free dopamine in the neuron which forces it to travel through the dopamine transporters in the reverse direction (into synaptic cleft)

increases CNS excitation

same actions for norepinephrine but with norepinephrine transporters

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40
Q

pharmacology of ecstacy

A

similar to amphetamines but has preferential effect on serotonin containing neurons and causes release of serotonin

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41
Q

amphetamines CNS effect

A

decreased threshold for transmitting sensory input to the cerebral cortex, thus CNS excitation

euphoria and reward feeling

temperature regulation and feeding centre modifications leading to appetite suppression

increased aggressive behaviour and mood swings

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42
Q

excitation symptoms

A
  • overstimulation
  • restlessness
  • dizziness
  • mild confusion
  • tremor

rare cases
- panic and psychosis

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43
Q

effects associated with increased CNS excitation

A
  • increased alertness
  • feeling of power
  • reduced fatigue
  • increased responsiveness
  • increased heart rate and blood pressure
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44
Q

short term effects of amphetamines

A

non CNS tissue effects
- chest pain or heart attack
- cardiovascular collapse (high doses)
- increased respiratory rate

overdose can result in
- seizure
- high fever
- stroke

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45
Q

cardiovascular collapse

A

severely low blood pressure resulting in heart failing to pump blood around the body

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46
Q

long term effects of amphetamines

A
  • chronic sleeping problems
  • poor appetite
  • anxiety, repetitive behaviour, psychoses, aggressive behaviour
  • elevated blood pressure and abnormal cardiac rhythm
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47
Q

amphetamine concurrent drug use

A

other drugs used to antagonize various toxic effects of amphetamines (CNS depressants/stimulants)

can lead to drug to drug interactions, misuse of additional drugs and potential SUDs

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48
Q

therapeutic use of amphetamines

A

narcolepsy - chronic sleep disorder

ADHD - hyperactivity, impulsivity and/or difficulty controlling or refocusing attention

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49
Q

amphetamines potential for misuse

A

high since they produce powerful euphoria

water soluble salts forms of the drug allow for large doses that are readily injectable, resulting in rapid and intense response

50
Q

amphetamines potential for SUD

A

tolerance develops to effects (does not develop to therapeutic effects or drug induced psychosis)

cessation results in withdrawal

addiction occurs

51
Q

cocaine

A

local anesthetic and CNS stimulate

classified as a narcotic

52
Q

pharmacology of cocaine

A

similar to amphetamines in its acute effects and toxicity patterns

has a shorter duration of action (less than an hour, amphetamines 12 hours)

commonly sniffed or smoked (amphetamines intravenously)

53
Q

mechanisms of cocaine

A

causes generalized CNS stimulation in dose dependent manner (more = more stimulation)

inhibits the active re uptake of primarily dopamine and serotonin into the presynaptic neuron

increase concentration of neurotransmitters in synaptic cleft thus increasing activation of post synaptic neuron receptors

54
Q

therapeutic use of cocaine

A

used as a local anesthetic for the mouth and throat

rarely used tho since other options are better

55
Q

effects of long term use of cocaine

A
  • toxic psychosis (paranoia)
  • hallucinations or sensations of insects crawling under the skin
  • impaired sexual function
  • permanent brain damage and impairment of neuronal function may occur
  • high blood pressure and an irregular heart rhythm
  • changes to the nasal mucosa as the drug is sniffed
56
Q

cocaine potential for misuse

A

has the highest misuse liabilities amongst all drugs (powerful euphoria)

57
Q

pharmacokinetics of nicotine

A

absorption, particles inhaled > rapidly absorbed (GI tract, oral mucosa, across skin)

distribution, throughout body > rapid access to brain

metabolism, rapidly metabolized in liver

excretion, urine (half life is about 2 hours)

58
Q

mechanism of action of nicotine

A

stimulates nicotinic receptors at synapses > increases psychomotor activity, cognitive function, attention and memory

effect in CNS mediated by nicotinic receptors mediated release of CNS neurotransmitters dopamine and serotonin

58
Q

effect of large doses of nicotine

A

causes agitation, tremors, seizures

59
Q

therapeutic use of nicotine

A

smoking cessation program

administered as chewing gum, transdermal patches or buccal spray (maintain blood nicotine levels)

59
Q

short term effect in regular smoker

A

mild euphoria, enhances arousal, increased ability to concentrate, sense of relaxation

may cause small increase in heart rate, blood pressure, suppress appetite

60
Q

short term effect in non regular smoker

A

dizziness, headache, nausea, vomiting, abdominal cramps

smoke can cause coughing or gagging

61
Q

long term effects of smoking - cardiovascular

A

cardiovascular disease linked to nicotine

respiratory and carcinogenic effects related to products of combustion (not nicotine)

nicotine and carbon monoxide reduce capacity of red blood cells to carry oxygen, increase incidence of atherosclerosis and formation of thrombi

62
Q

tobacco smoke chemicals

A

nicotine, carbon monoxide, carcinogenic aromatic hydrocarbons, tars, other products of combustion

63
Q

what is atheroscleorisis

A

narrowing and hardening of arteries due to plaque buildup

64
Q

what are thrombi

A

blood clots

65
Q

long term effects of smoking - lungs

A

linked to lung disease (smokers syndrome)

increase risk of emphysema and other forms of chronic obstructive lung disease

66
Q

smoker syndrome

A

characterize by difficulty in breathing, wheezing, chest pain, congested lung and increased lung infection

67
Q

long term effects of smoking - cancer

A

cancer risk is associated with smoking (cigarette smoke)

cancer of lung, oral cavity, throat, bladder and uterus

68
Q

passive smoke

A

second hand smoke associated with increased risk of cardiovascular disease and cancer

69
Q

passive smoke in children

A

increase risk of bronchitis, pneumonia, asthma and sudden infant death syndrome

70
Q

smoking during pregnancy

A

has adverse effects on developing fetus

risk of fetus being to small or being born preterm

effects reverse if stop smoking early in pregnancy

passive smoke increase chance of low birth weight neonate (decreased oxygen to fetus)

71
Q

nicotine potential misuse and SUD

A

tolerance - smokers will smoke to keep nicotine blood levels at certain range (30-40mL)

withdrawal - number of symptoms

addiction - extreme urge to smoke

72
Q

smoking cessation programs

A

involve counselling and pharmacological support (nicotine replacement programs)

73
Q

caffeine

A

found in drinks and in over the counter stimulants analgesics and diuretics

increase mental performance and motor activity while decreasing drowsiness and fatigue

74
Q

what are diuretics

A

substances that increase urine production and excretion of water from body through kidneys

75
Q

lethal dose of caffeine

A

10g for average adult (50 cups of medium strength coffee)

76
Q

absorption of caffeine

A

orally, rapidly and completely absorbed

blood levels of caffeine are significant 30 minutes after and peak 2 hours after ingestion

77
Q

distribution of caffeine

A

distributes to all parts of the body and freely crosses into the brain and placenta

78
Q

metabolism of caffeine

A

genetics determine rate of metabolize and excretion (slow or fast)

79
Q

elimination of caffeine

A

half life various amount individuals (2.5-10 hours)

80
Q

mechanism of action without caffeine

A

in the brain activation of receptors (adenosine receptors) stimulate GABAergic neurons that inhibit dopamine release

81
Q

mechanism of action of caffeine

A

competitively blocks adenosine receptors in brain

when blocked, neurons released from adenosine inhibition decreasing GABA activation, thus increasing dopamine

effect is stimulation of CNS

81
Q

short term effects of caffeine - CNS

A

produce mild mood elevations and reduce fatigue

small increase in performance may exist

flow of thought may be clearer and more rapid

when taken by abstainers produced nervousness and can interfere with sleep

82
Q

high doses of caffeine short term effects

A

cause irritability, nervousness, rambling flow of thoughts and speech and psychomotor agitation

cause rapid and irregular heartbeat

83
Q

short term effects of caffeine - cardiovascular

A

produce constriction or cerebral blood vessels, increase peripheral blood flow and stimulates cardiac muscle

84
Q

short term effects of caffeine - respiration

A

mild stimulation of respiratory rate and relaxation of bronchial smooth muscles occurs

85
Q

clinical use of caffeine

A

stimulate breathing in preterm newborns

helps immature brains and lungs remember to breathe

86
Q

long term effect of caffeine

A
  • restlessness
  • nervousness
  • insomnia
  • increased urinary output
  • gastic upset
  • rambling speech and though
87
Q

special circumstances of caffeine

A
  • smoking
  • pregnancy
88
Q

caffeine and smoking

A

smoke increase metabolism of caffeine

duration of action of caffeine shortened (returns when smoker quits)

89
Q

caffeine and pregnancy

A

large doses of caffeine increase risk of stillbirth and miscarriage, decrease fetal growth cate

metabolism is slower in pregnant people, duration of action longer

90
Q

caffeine potential for misuse

A

misuse potential is low

doesnt act as mild reinforcer, though euphoria experienced (mild)

only larger dose are harmful

91
Q

caffeine potential for SUD

A

tolerance - only in some individual

withdrawal - mild, headache, fatigue, drowsiness

addiction - mild can occur

92
Q

drugs in sport

A

some athletes use performance enhancing substances

93
Q

effects of amphetamines

A

euphoria and reward

increased respiration

insomnia and psychoses

94
Q

benefits of amphetamines in sport

A

produce increase alertness, feeling of power, reduce fatigue, increase aggression, increase responsiveness

increase heat rate and blood pressure

cause appetite suppression, helpful in sports that benefit from weight loss

95
Q

amphetamine impact on endurance and speed

A

masks pain and fatigue felt by athletes

96
Q

toxicity of amphetamines

A

large doses lead to fatal increase in blood pressure

after drugs wear off person crashes

97
Q

anabolic steroids

A

used to increase muscle mass and strength

testosterone is an anabolic steroid but synthetic ( ones are used in sports performers

98
Q

synthetic anabolic steriods effects

A

has androgenic effects
- effects on secondary male sex characteristics

has anabolic effects
- building of mass

99
Q

difference between testosterone and synthetic anabolic steroids

A

testosterone has androgenic and anabolic properties while synthetic has androgenic and anabolic effects

100
Q

mechanisms of action of anabolic steroids

A
  • anti catabolic
  • anabolic
  • motivation
101
Q

mechanisms of action of anabolic steroids - anti catabolic

A

produce anti catabolic effect
- process that reduce breakdown of proteins and muscle tissue

helps athletes maintain muscle mass

102
Q

mechanisms of action of anabolic steroids - anabolic

A

anabolic effects result in protein production

greater effects at high does

protein supplementation also important

103
Q

mechanisms of action of anabolic steroids - motivation

A

motivational response

create aggressive behaviour (roid rage)

beneficial in sports (football)

104
Q

effect of anabolic steroids + doses

A

have greater effect in ppl with lower basal circulating levels of testosterone

low moderate dose
- modest effects

large dose w diet high in proteins
- increases in lean body mass body weight and strength
- aggressive behaviour

105
Q

toxicities of anabolic steroids

A
  • mood swings
  • severe acne
  • cardiovascular disease
  • altered liver function
  • reduced testosterone levels
106
Q

mood swings - anabolic steroids

A

chronic use associated with aggressive behaviour and mood swings

107
Q

severe acne - anabolic steroids

A

development of severe acne on face and body common adverse effect of chronic use

108
Q

cardiovascular disease - anabolic steroids

A

increase plasma levels of low density lipoproteins (bad cholesterol)

decrease the levels of high density lipoproteins (good cholesterol)

higher risk of cardiovascular disease

109
Q

altered liver function - anabolic steroids

A

associated with altered liver functions
- hepatitis
- liver failure
- liver cancer

110
Q

reduced testosterone levels - anabolic steroids

A

block the release of gonadotropin releasing hormone
- reduce testosterone levels and sperm production

can lead to infertility, reduced libido and impotence

111
Q

anabolic steroid toxicities in women - testosterone levels

A

produce some androgenic effects
- increase facial and body hair
- lowered voice
- enlarged clitoris
- increase libido
- amenorrhea (absence of menstruation)

may or may not be reversible upon cessation

112
Q

benzodiazepines

A

lorazepam (ativan) and diazepam (valium)

used to combat insomnia and anxiety in athletes

help them sleep and recover from training

113
Q

benzodiazepines side effects

A

can impair psychomotor coordination and focus at higher doses

cause benzodiazepine use disorder

114
Q

blood doping

A

effort to raise the number of blood cells by taking blood out storing it and then re infusing

when returned there is a sudden boost to the red blood cells which carry higher than normal amounts of oxygen to muscles

enhances performance

115
Q

erythropoietin (EPO)

A

boosts the bodies natural production of red blood cells

injection stimulates bone marrow to make more blood cells, thus boosting levels of oxygen

116
Q

blood doping and EPO use

A

used in sports (illegal)

used in people on dialysis (EPO), and removing blood and putting back is common during surgery

117
Q

toxicity of EPO

A

inappropriate use of EPO or its derivatives can result in thrombotic events (stoke, heart attack)

118
Q

detection of blood doping

A

measure the age of red blood cells

119
Q

detection of EPO

A

testing urine for the presence of recombinant EPO

120
Q

diuretics

A

drugs that enhance excretion of salt and water through kidneys

used before competitions to reduce body water, allowing lower weight class

sometimes used to hasten excretion to avoid detection of banned drugs

121
Q

toxicities of diuretics

A

excess electrolyte and water depletion (blood pressure drop and kidney failure)

122
Q
A

PHAR 100 (2 decks)

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