Substance Abuse

Question 1

stages of addiction

Answer 1

drug seeking (craving) –> drug taking (‘rush’, tolerance) –> drug cessation (w/d sx)

Question 2

disulfiram

Answer 2

inactivates alcohol dehydrogenase, resulting in acetaldehyde buildup/ Antabuse-alcohol dose-dependent reaction;
ADHERENCE

Question 3

naltrexone

Answer 3

acts on opioid receptors; reduces ‘reward feeling’ w/ heavy drinking; reduces craving to drink EtOH

Question 4

acamprosate

Answer 4

mechanism unclear; glutamate-receptor antagonist

Question 5

topiramate

Answer 5

increase GABA, decrease NMDA

Question 6

barbiturates

Answer 6

allosteric modulator of GABA-r; increases duration of channel opening

Question 7

benzodiazepines

Answer 7

allosteric modulator of GABA-r; increases frequency of channel opening

Question 8

rimonibant

Answer 8

CB-1 antagonist; improves cessation of smoking

Question 9

marijuana

Answer 9

THC acts at endocannabinoid receptors CB-1 and CB2; withdrawal; relaxation, decreased N/V, memory impairment; associated with psychosis at high doses

Question 10

PCP, ketamine

Answer 10

block NMDA-r Ca2+ influx; increases dopamine release; dissociation effects, can produce psychosis-like sx

Question 11

hallucinogen

Answer 11

bind at 5-HT2A receptor; produce illusions (misinterpretation of sensory stimuli), synesthesia, flashbacks; no physiologic dependence, tolerance disappears w/in 7d

Question 12

MDMA (ecstasy, Molly)

Answer 12

stimulant + hallucinogenic; release of NE, serotonin and dopamine; side fx: anorexia, hyperthermia; dehydration followed by hyponatremia and seizures

Question 13

amphetamine, methamphetamine

Answer 13

increases release of vesicular stores of dopamine and serotonin; reverse transport by DAT and SERT; rapid onset ~15s IV

Question 14

methylphenidate

Answer 14

blocks reuptake of dopamine and NE (no effect on serotonin); reduce risk of abuse

Question 15

cocaine

Answer 15

block reuptake of dopamine, NE and serotonin; rebound dysphoria; side fx: MI, seizures, paranoia

Question 16

cathinone, cathine

Answer 16

“bath salts”; block reuptake AND stimulate release of dopamine, NE

Question 17

heroin

Answer 17

pro-drug, 2-3x more potent than morphine; side fx: constipation, opiod-induced hyperalgesia

Question 18

methadone

Answer 18

opiod mu agonist; relieves w/d, DO NOT PRESCRIBE >40mg initially

Question 19

buprenorphine

Answer 19

partial mu agonist, high affinity; can relieve or cause w/d;; given sublingually

Question 20

naloxone

Answer 20

short-acting opiod (mu, kappa and delta) antagonist; block effect of any opiod; ADHERENCE