Substance Abuse Flashcards
1
Q
Cannabis-Pharmacokinetics and Mechanism
A
- Rapidly metabolized by the liver to 11-0H-delta9-THC=active form.
- Then metabolized to 9-nor-COOH-THC=inactive form.
- Metabolites are excreted in urine and feces–detectable for many days.
- Reaches brain in 15-30 seconds and is 3-5x more potent when smoked. Oral: onset of action is ~30mins.
- Metabolized and redistributed in fat–slowly leaves body.
- Duration of action: 1-6 hours. 20% remains in the body after 5 days and is undetectable after 30 days.
- Acts on CB1 receptor, which is uniquely found in the brain in the cerebellum, hippocampus, and basal ganglia. Acts on Gi receptor to decreases adenylyl cyclase activity–>inhibits release of neurotransmitter.
2
Q
delta-9-tetrahydrocannabinol
A
-Active form on cannabis in the body
3
Q
Phencyclidine (PCP)
A
- Mechanism: NMDA Antagonist
- Rapid, complete absorption
- Act as sympathomimetic on autonomic and CV systems: tachycardia, hypertension, potentiation of catecholamines
- Tolerance
- CNS: small doses produce drunken state with numbness of extremities. Moderate doses-analgesia and anesthesia. Large doses-convulsions.
- Overdose: CNS manifestations include anxiety, aggression, hallucinations, dysphoria, convulsions, delirium. Sympathomimetic manifestations include tachycardia and hypertensive crisis.
- Treatment: Support vitals, gastric suction, acidify urine, diazepam/antihypertensive agent, haloperidol
4
Q
Ketamine
A
- Mechanism: NMDA Antagonist
- Like PCP
- CNS effects are less potent and has shorter duration of action
5
Q
LSD
A
- Mechanism of sensory effects: agonist/partial agonist action at 5-HT2 receptors
- Indoleamine
- Less than 1% crosses BBB
- Onset of 15-20 mins, with duration of 12 hours
- Sympathomimetic effects: tachycardia, increased BP, psychomotor stimulation
- Sensory and subjective effects: altered perception (especially visual), lability of mood, impaired judgment
- Displays tolerance and cross-tolerance
- Toxicity: hallucinations, anxiety, panic, and depersonalization. Lasts less than 24 hours, treat with quiet environment and BDZs for sedation.
- Flashbacks can occur days-years later
6
Q
MDMA (methylenedioxymethamphetamine)
A
- Phenethylamine; “Ecstasy”
- Induces feelings of well-being and connection, altered time perception
- Onset of action is 20-40 minutes; duration is 3-4 hours
- Effects: psychomotor stimulation, restlessness, bruxism, anorexia, sweating, tremor
- Hangover: anhedonia
- Neurotoxicity: potentially on serotonin neurons
7
Q
Gamma-hydroxybutyrate (GHB)
A
- Precursor and metabolite of GABA.
- May have it’s own receptor
- Can be made in the body from GBL
- Effects last about 3 hours
- Primarily a depressant–induces relaxation and tranquility, and interacts with alcohol
- Overdose: drowsiness, ataxia, nausea, vomiting
- Higher doses: loss of bladder control, temporary amnesia, clonus, seizures
8
Q
Toluene
A
- Model airplane glue
- Inhalant
9
Q
Salvia divinorum
A
- Kappa opioid agonist
- Perennial herb; leaves contain salvinorin-A.
- Used as psychedelic
- Short duration of action (20-45 minutes)
- Creates dream-like experience with open and closed-eyed visual
- High doses: dissociation, with fear, panic, and perspiration
10
Q
Amphetamine
A
- Stimulant; causes release of dopamine
- Psychological effects: mood elevation, increased alertness and attention span, psychotic symptoms
- Physical effects: Loss of appetite and weight, pupil dilation
- Withdrawal: mood depression, psychological craving, hunger, pupil constriction, fatigue
11
Q
Cocaine
A
-Same as amphetamine, only mechanism is blockade of dopamine reuptake
12
Q
Alcohol
A
- Sedative, CNS depressant; increase GABA activity
- Psych effects: Mood elevation, decreased anxiety, somnolence, disinhibition
- Physical effects: sedation, poor coordination, respiratory depression
- Withdrawal: Anxiety, insomnia, psychotic symptoms, tremor, seizures, CV symptoms. Should be hospitalized due to life-threatening effects.
13
Q
Benzodiazepenes
A
Similar effects to alcohol.
Used to treat alcohol withdrawal.
High safety margin unless combined with another sedative.
14
Q
Barbiturates
A
Similar effects to alcohol. Low safety margin so very dangerous in overdose
15
Q
Heroin
A
- Opioid
- Compared to medically used opioids, is more potent, crosses BBB more quickly, and has faster and more euphoric action.
- Psych effects: mood elevation, relaxation, somnolence
- Physical effects: sedation, analgesia, respiratory depression, constipation, pupil constriction
- Withdrawal: mood depression, anxiety, insomnia, sweating, fever, rhinorrhea, piloerection, stomach cramps and diarrhea, pupil dilation. (Death is rare)
