Pharm - Vaping, Tobacco, Marijuana Flashcards
benefits of vaping compared to cigarettes
- less expensive
- tastes better
- less smell/stains on fingers
- less teeth staining
- sense of smell and taste improve
- social interactions increase
- less lung damage
describe the reward circuit leading to nicotine addiction
inhale nicotine –> nicotine acts on nicotinic acetylcholine receptors in ventral tegmental area –> dopamine is sent to prefrontal cortex –> glutamine is then sent from the prefrontal cortex to the nucleus accumbens
describe how nicotine can affect the adolescent brain
nicotine interferes with the maturity of the prefrontal cortex –> affects its neuroplasticity –> leads to alterations in:
- gene expression
- cell structure
- intracellular signaling
- synaptic pruning
- axon myelination
- memory and attention
what is synaptic pruning
removal of redundant connections
how does nicotine use in adolescence affect health later in life
can cause behavioral disturbances later in life such as substance abuse and mental health problems
what agent in e-cigarettes is most likely the reason for the lung illness outbreaks, and what does it cause
vitamin E acetate
- acute eosinophilic PNA
- organizing PNA
- lipoid PNA
- diffuse alveolar damage
- diffuse alveolar hemorrhage
- ARDS
- hypersensitivity pneumonitis
- giant cell interstitial pneumonitis
other than vitamin E acetate, what are the other likely reasons e-cigarettes caused a health crisis
- diacetal (butter flavor)
- contaminants (endotoxins, fungal glucan, formaldehyde)
- internet recipes
- chinese tariffs causing poor quality material use
- slow regulations
describe the endogenous cannabinoid system for the CB1 receptor
stimuli results in elevated intracellular Ca2+ –> endocannabinoids produced on demand in post-synaptic neurons –> activation of DAG-lipase –> synthesized endocannabinoids (anandamide and 2-AG) diffuse into synaptic space –> bind to CB1 receptors on presynaptic neurons –> inhibits adenylyl cylase –> hyperpolarization and less neurotransmitter release –> termination of endocannabinoid actions
how are endocannabinoid actions terminated
the two endocannabinoids: anandamide and 2-AG
anandamide: broken down by fatty acid amid hydrolase (FAAH) found in post-synaptic cells
2-AG: degraded by MAG-lipase in pre-synaptic cells
MOA dronabinol
it is synthetic delta-9-THC that has affinity for both CB1 and CB2
indications dronabinol
- anorexia in AIDS patients
- chemotherapy induced N/V
off-label use: severe obstructive sleep apnea
effects of dronabinol
- analgesia
- appetite enhancement
- muscle relaxation
- hormonal actions
what is nabilone
THC capsule approved for chemotherapy induced N/V
adverse effects of synthetic cannabinoids (dronabinol and nabilone)
- affects judgement and coordination
- sedation, bloodhost eyes, depression, dizziness, tachycardia, hypotension, hallucinations, dry mouth
what conditions have evidence of cannabis efficiency
- chronic pain
- nausea/vomiting
- stimulating appetite
- MS
- anxiety
for what types of chronic pain is cannabis effective in treating
- neuropathic pain*
- RA, ribromyalgia
- cancer pain
what conditions does cannabis LACK efficiency in treating
- acute pain
- tremor in MS (can treat other MS sx tho)
- huntington’s
- glaucoma (other drugs better)
- schizophrenia
- depression
- slowing cancer cell growth
contraindications for medical cannabis use
- hx of psychosis
- current or past substance abuse disorder
- CV or respiratory disease
cautions for medical cannabis use
- age < 25
- active mood disorder
- risk factors for CV dz
- ongoing use of high doses of alcohol of benzos
start low, go slow
describe missouri’s medical marijuana regulations
1) must obtain ID card (costs $25)
2) qualifying conditions:
- cancer
- epilepsy
- glaucoma
- intractable migraines
- chronic condition w/ severe persistent pain (MS, parkinson’s, tourettes)
- PTSD
- HIV/AIDS
why is fatty acid amide hydrolase (FAAH) of interest in pharmaceuticals
FAAH breaks down endocannabinoids to terminate their actions
FAAH inhibitors would prolong the effects of endocannabinoids –> less anxiety/fear, less sensitivity to pain, quicker healing
compare structure of CBD to THC
CBD has a hydroxyl group where THC has a cyclic ring
describe metabolism of CBD
- metabolized by CYP3A4 and CYP2C19
- it has poor aqueous solubility causing erratic absorption from the GI tract
- oral bioavailability is 6% (significant first mass mechanism)
- rapidly distributes and accumulates in adipose tissue
describe 4 important aspects of the pharmacodynamics of CBD
1) decreases FAAH –> increases anandamide
2) agonist on TRPV1 (heat sensing receptor) –> acts to decrease reactive oxygen species and decrease inflammation
3) agonist at PPARy –> decreases inflammation
4) agonist at serotonin receptors
5) inverse agonist/negative allosteric modulator at CB1 and CB2 receptors
compare adverse reactions b/w CBD and THC
- CBD does not produce the psychoactive effects that THC does and has not been shown to have a potential for abuse
- CBD tolerance and withdrawal have not been reported
describe CBD toxicology
- no effect on embryonic development
- no effect on wide range of physiological and biochemical parameteres
- maybe immune suppression at higher concentrations
drug interactions with CBD
some interactions through inhibition of CYP450
potential toxic effects of epidiolex (CBD)
- liver toxicity
- suicidal ideation
indications epidiolex
rare childhood epilepsies in pts 2 years and older
the epilepsies:
- lennox-gastaut syndrome
- dravet syndrome
besides childhood epilepsies, what are some other indications for CBD
- alzheimers
- N/V
- pain
- fragile X syndrome
- skin dz
- cancer
- CBD tampons (menstrual pain)
- ADHD
- anxiety/depression
- schizophrenia
how does CBD improve nausea and vomiting
indirect activation of somatodendritic 5-HT1A receptors in dorsal raphe nucleus
describe legal status of CBD
it is illegal to sell as food, dietary supplement, or animal feed unless derived from hemp
