S64 - Abuse of Illicit Drugs

Question 1

Morphine* - 1 pea
Heroin - 1 sunflower seed
Fentanyl - 1 sesame seed
Sufentanil - 1 grain of sand
Carfentanil - 0.5 grain of salt

Answer 1

lethal dose

Question 2

Most common illicit drug

Answer 2

amphetamines

Question 3

MOA of amphetamines: release of catecholamines from presynaptic terminals leading to hyperadrenergic state

Answer 3

true

Question 4

Chronic use: repetitive use contamination leading to necrotizing vasculitis and various infections cardimyopathy.

Answer 4

true

Question 5

Management of amphetamine toxicity

Answer 5

Agitation BZD’s

Propofol for status eleticus

Question 6

Diffuse CNS excitation results in acute toxicity

Answer 6

General supportive care and sedation are the mainstays in treatment of acute cocaine toxicity

Question 7

Rapid hydrolysis to 6-mono-acetylmorphine (6-MAM).

Then, hydrolyzed to Morphine

Answer 7

true

Question 8

Morphine – converted to active metabolite morphine-6-glucuronide (M6G) and inactive metabolite M3G. CYP3A4 converts normorphine.

Answer 8

true

Question 9

Codeine (inactive prodrug) is converted to morphine via CYP2D6. Also – CYP3A4 converts to norcodeine and then CYP2D6 to normorphine.

Answer 9

true

Question 10

Heroin absorption IV within 2 minutes

Answer 10

true

Question 11

Heroin absorption IM withing ~5 minutes

Answer 11

true

Question 12

Opiod dependent get high concentration opposed to opioid naive individual.

Answer 12

true

Question 13

IV route yields rapid heroin plasma concentration within a few minutes.

Answer 13

true

Question 14

IM route leads to Cmax at 10 min and < 30 min for heroin and morphine, respectively.

Answer 14

true

Question 15

PO route results in dose-dependent increases in Cps with Cmax about 1 hour.

Answer 15

true

Question 16

Higher Cps of morphine (and metabolites) occur from oral heroin administration than oral morphine administration (more polar molecule).

Answer 16

true

Question 17

Higher Cps are reached with persons who opioid-dependent vs opioid naïve persons.

Answer 17

true

Question 18

Fatality from amphetamine or cocaine toxicity originates from which organ system?

Answer 18

Cardiovascular

Question 19

Does heroin and morphine have “active” metabolites?

Answer 19

Yes.. Heroin to morphine; morphine to M6G

Question 20

Which illicit drug was recently FDA approved for treatment-resistant depression?

Answer 20

Ketamine