Neurology class 3 Flashcards
psychological dependence
caused by decreased activity in the ventromedial prefrontal cortex which leads to decreased impulse control
opioids, ketamine, PCP, mushrooms, DMT, benzodiazepines
‘downers’
cannabinoids, alcohol, nicotine
‘mixed’
CNS stimulants, psychoactive stimulants
‘uppers’
altered mood, relaxation (euphoria), uninhibited behaviour
desired effect of downers
modulate serotonin, increase dopamine, inhibit substance P, decrease glutamate, inhibit ion channel transport
dynamics of downers
opioid dynamics
inhibition of substance P produces analgesia and the more drug there is the more dopamine (reward pathway) is released
- decreased neuronal excitation which causes CNS depression
most potent opioid
fentanyl
least potent opioid
codeine
what to monitor for patients on opioids
- orthostatic hypotension due to peripheral vasodilation
- itching due to mast cell stimulation and histamine release
- nausea due to substance P binding
fentanyl
‘downer’
extremely potent and commonly laced into other drugs
Heroin
‘downer’
highly lipophilic and crosses the BBB quickly
- commonly combined with fentanyl and if so then it is poison
ketamine
dissociative anesthetic; ‘downer’
- potent, high sedation, causes amnesia, and respiratory depression
- known as date rape drug
PCP
derivative of ketamine; ‘downer’
- originally developed for anesthesia
- goes from excitation to sedation but depends on dosage
mushrooms
hallucinogenic; ‘downer’; increases GABA and decreases glutamate
- low potency and low addiction
DMT (dimenthyltryptamine)
‘downer’
altered mood, relaxation, un-inhibition of behaviour
desired effects of mixed drugs
addiction
negative neuroplasticity in the brain
vape
- safety testing based on ingestion not inhalation
- aerosols more toxic when heated
- formaldehyde, glycidol, acetol
nabilone, dronabinol
cannabinoids
CB1
target CNS
CB2
target PNS
- modulate serotonin which deals with mood alterations
- increased anandamide which results in memory loss
- stimulate dopamine release
CB1 and CB2 receptors
competition of these cannabinoids at receptors to create a balance
CBD and THC
antagonizes adrenergic NS producing a “calming” effect
high CBD
modulates adrenergic NS producing alertness, focus, and agitation along with VS changes and hallucinations
high THC
binds nicotinic receptors (cholinomimetic and adrenergic)
- vasoconstriction, decreased GI motility
- stimulates dopamine release
- lipophilic
- oxidizes lipoproteins causing plaque formation in atherosclerosis
nicotine
increase in Ach and serotonin –> stimulation of dopamine –> increase in GABA –> decrease in glutamate
effects of alcohol (in order)
- absorbed via gastric mucosa
- crosses BBB
- hepatic metabolism (uses vitamin B)
- zero order kinetics
- withdrawal syndrome ‘delirium Tremens’
alcohol
metadoxine
accelerates the removal or clearance of alcohol by enhancing metabolism to inactive metabolites
altered mood, excitation (euphoria), uninhibited behaviour
- increases norepi, serotonin, dopamine
‘uppers’ abuse desired effect
hallucinogenic, psychedelic, altered reality, visual alterations
stimulant abuse desired effect
sympathomimetics, amphetamines
stimulants
cocaine, crystal meth
stimulants
cocaethylene
cocaine and alcohol
amphetamine-type, hallucinogenics
psychoactive stimulants
LSD (acid), ecstasy (MDMA)
psychoactive stimulants
