Stimulants

Question 1

define stimulant

Answer 1

drugs that have a (net) excitatory effect on physiology and/or behavior

Question 2

how do you get stimulant effects in the cns?

Answer 2

direct neuronal excitation via increased nt release (amphetamine) inhibition of reuptake (TCA or SSRI), bind directly to receptors on neurons that have excitatiory effects
or:
blockade of inhibition of release of NT or bind to a neuron that has an inhibitory function

Question 3

generally, stimulants have:

Answer 3

positive psychoactive effects, reinforcing effects,

Question 4

reinforcement:

Answer 4

reward system, neurons that have cell bodies in vt and project to basal forebrain (NA) and these all increase activity in these systems
But there are not just reward, there is memory, inhibitory control of behavior, etc

Question 5

D2 dopamine receptors are highly expressed in the reward areas of the brain and in motor control areas like the basal gang striatum, globus palladus, and addicts have been shown on PET scans show a marked decrease in D2 receptors in those areas of the brain

Answer 5

a marked decrease in D2 receptors in those areas of the brain

Question 6

the same findings regards a decrease in D2 receptors in the reward system in the brain have been found in ______

Answer 6

obese people who have a problem with overeating (not genetically obese, but rather, addicted to food)

Question 7

in monkey study: dominant monkeys had a ______ in receptors, and subsequently had a _______, while subordinate monkeys had a ______ and a _________

Answer 7

22% increase in D2 receptors, decrease in their desire to engage in dopamine; 1% increase in D2 receptors and instantly began abusing the cocaine (environmental effects that influence susceptability)

Question 8

regarding physical dependence:

Answer 8

if someone if in a car accident and brought to the hospital, they will be put on opiods and develop a tolerance to fentynal or morphine, and become physically dependent

psychological dependent: an older term, even though now we know there is a great deal of crossing over

Question 9

tolerance:

what are the different types?

Answer 9

the same amount of a drug has less and less effect;

genetic or innate tolerance: when studying 20 year old children of alcoholic parents, that had a 4 x less sensitivity to alcohol, by the age of 30, they were 4x more likely to be alcohol dependent

acquired: three ways:
pharmacokinetics/pharmacodynamic (usually they both happen)

behavioral: getting better (improving) at their ability to perform at a normal level while intoxicated (drinking and driving)

Question 10

cross-tolerance:

Answer 10

developing a tolerance to a drug, not because you took so much of it, but because you took more or a drug with the same mechanism
alphetamine and cocaine: not same mechanism but both result in increased dopamine, and so you can develope a tolerance to having more dopamine in your reward cetners

Question 11

opponent processing theory

Answer 11

after first reaction, the cns begins compensating for the action of the drug, and eventually the compensatory response begins to graw (in an effort to balance out the effects of the drug)- decreased net effect

Question 12

withdrawl effects are:

Answer 12

opposite of the drug due to the compensatory effect

Question 13

allostasis is essentially:

Answer 13

oponent processes theory over time:

long term maladaptive changes in both brain and behavior

Question 14

drug abuse:

Answer 14

use of any drug in a manner that deviates from the way it is normally used (or that is socially acceptable)

Question 15

addiction:

Answer 15

a quantitative rather than qualitative degree to which drug use pervades the total activity of the user

Question 16

Maladaptive choices

Answer 16

drug user makes poor choices regarding use of the drug (going out for shots the night before step 1)

abusers overvalue drugs relative to other things in the environment that could/should be reinforcing.

mediated by brain areas (anterior cingulate/orbitofrontal cortex is known to be dysfunctinoal)

stresses role of environment

extensive involvement of memory (cravings)

Question 17

cocaine:

Answer 17

local anesthetic in the periphery bc it block Na channels
*very fast onset, short half life and comes on very quick
most addictive druf bc it is the most rapid acting
*blocks the reuptake of DA in the synaptic cleft (increases amount of DA available in EC space)
withdrawl: arousal and crash
toxicity: tachycardia, hyperthermia, sweating, mydriasis, agitation, anxiety, delirium
long term: tolerance develops to euphoric effects without tolerance to cardiovascular effects

Question 18

methylphenidate:

Answer 18

therapeutic use: ADHD (same as cocaine)

euphoria doesn’t last as long in methylphenidate, but remains in the system much longer (t1/2 of 5 hrs)

Question 19

amphetamines:

Answer 19

therapeutic use: appetite suppressant (rapid tolerance, decreases food intake)
ADHD: adderall

Question 20

amphetamines:

Answer 20

normal function:
action potential arrives ,Ca++ in, vesicles fuse, release DA, DAT takes up the DA
Cocaine blocks the transporter to prevent reuptake,
Amphetamines are taken into the cell and caus DA to be dumped out
*coke is monoamine reuptake inhibiter, amphetamines are monoamine releasers= results in a much bigger release of DA in the synapse, although it may take longer

Question 21

amphetamine derivatives:

Answer 21

MDMA: additional physiological effects becaus it can bind to serotonin receptors (same as LSD) and act as a hallucinogen (kids take at rave), bad hyperthermia (comes in with temp of 107)

Question 22

cocaine treatment:

Answer 22

NO FDA APPROVED MEDS
only thing that works is Amphetamines
CBT counseling+Contingency managemenr (reward system-give you a job, give you antidepressants)

Question 23

challenge in quitting cigarettes:

Answer 23

80% say they have a desire to quit, but only 35% try, and 5% quit
why?
10puffs per cigarette, 20 cigs 1 pack=200 reinforcers per day (nicotine goes from lungs to brain in 7 seconds)

Question 24

effects of nicotine:

Answer 24

acute:
rapid onset nausea vomiting (rapid tolerance)
high dose toxicity:
nicotine poisoning in children who ingest cigarettes
rebound depression of neuronal activity (receptors shut down)

Question 25

treating nicotine:

Answer 25

NRT: nicotine replacement therapy: patch, gum, etc
the patient is STILL ADDICTED to nicotine, just diff form ,etc
same idea as giving someone methamphetamine for cocaine addiction
Buproprion: sustained release antidepressant
Chantix: partial agonist of nicotine receptors

Question 26

caffeine

Answer 26

antagonist of adenosine receptor (and adenosine has inhibitory effect on neuron, inhibits Ca++ conductance

Question 27

Caffeine mechanism of action:

Answer 27

cAMP is metabolised by phosphodiesterase (PDE) (part of secondary messenger system) and caffeine inhibits PDE, so no break down of cAMP
PDE inhibits stimulatory action of neuron
Caffeine inhibits PDE from inhibiting cAMP

Question 28

caffiene can be used for:
theophylline can be used for:
theobomine can be used for:

Answer 28

anti-fatigue
asthma
less useful clinically

Question 29

caffiene can be used for:
theophylline can be used for:
theobomine can be used for:

Answer 29

anti-fatigue
asthma
less useful clinically

Question 30

_____ is the prototype methylxanthine, and is an oral bronchodilator that has some beneficial pulmonary effects in patients with COPD or asthma

Answer 30

theophylline

Question 31

26 yo is brought to ed after becoming physically aggressive with bff. He is belligerent, angry, and mildly paranoid. The patient has not been eating or sleeping well, resulting in 10 lb weight loss. No medical history, is belligerent and uncooperative, is somewhat paranoid and seems angry. His physical exam is positive for hypertension tachycardi dilated pupils, diaphoresis, and a fine bilareral tremor in his hands

Answer 31

amphetamine intoxication

Question 32

19 yo is brought to ed after behaving abnormally. Friends say they are unsure what she was taking. What would be most like amphetamine intoxication?
flush face, slurred speech, unsteady gait
anorexia, diaphoresis, pupillary dilation
prominent hallucinations, pupillary dilation, incoordination
miosis, slurred speech drowsiness
hyperphagia, conjunctival injection, tachycardia

Answer 32

anorexia, diaphoresis, pupillary dilation, also could be: tachycardia, HT, pupillary dilation

a= alcohol intoxication
D=opiod intoxication

Question 33

19 yo is brought to ed after behaving abnormally. Friends say they are unsure what she was taking. What would be most like amphetamine intoxication?
urine toxcology confirms intoxication with amphetamines, which of the following withdrawal syndromes would you expect?
diarrhea, piloerection, yawning
delirium, autonomic hyperactivity, visual or tactile hallucinations
crash of mood into depression, lethargy, increased appetite
tremor, headache, hypertension
postural hypotension, psychomotor agitation, insomnia

Answer 33

crash of mood into depression, lethargy, increased appetite

A opiod withdrawl
B delirium tremens
D alcohol withdrawl
E sedative hypnotic withdrawl

Question 34

20 yo is brought to mental health center by his parents who are at their wit’s end bc of son’s drug problem. Son is sullen and completely uncommunicative. The parents are naive and have no idea what he’s taking. How can you determine between the ause of cocaine vs amphetamine?
rhinorrhea
track marks on arm
severe smoker’s cough and respiratory problems
extremely poor dentition
weight loss

Answer 34

coke and amphetamines are similar, both can be used by smoking, insufflation (rhinorrhea) or iv. However, “meth mouth” is commonly seen with prolonged abuse of methamphetamines, caused by grinding teeth, lowered saliva production, and too much sugar

Question 35

a patient comes to ED in full restraints and supposedly attacked several individuals at a biker party after smoking methamphetamines. What is the best intervention?
citalopram
diazepam
ascorbic acid
haloperidol
buproprion

Answer 35

haloperidol: methamphetamines are psychotic inducing