substance use

Question 0

ethanol intoxication sx:

1. low dose (25-100mg%BAC)
2. higher dose (>100mg)

Answer 0

1. mild intox; impairment: loss of inhibitions, altered mood and cognition, incoordination, sedation –> results from preferential involvement of polysynaptic neuronal pathways in reticular formation (cerebral cortex, brain stem, cerebellum)
2. diplopia, nystagmus, dysarthria, ataxia –> from cerebellar and vestibular disfnc –> stuper –> death
   ,

Question 1

what are 4 agents that augment GABA at GABAa receptors?

Answer 1

ethanol, barbs, benzos, anesthetics

Question 2

antabuse

Answer 2

disulfiram

Question 3

mechanism of antabuse?

Answer 3

inhibits aldehyde dehydrogenase –> if drink more –> toxic from inc acetaldehyde –> pulsating ha, nausea, hot, vomit, CP, weak, dizzy

Question 4

“drygas”, windshield washer antifreeze

Answer 4

methyl alcohol

Question 5

what is methyl alcohol?

Answer 5

formaldehyde and formic acid –> very toxic: acidosis, visual disturbances (blindness)

Question 6

tx for methyl alcohol (methanol) and ethylene alcohol toxicity?

Answer 6

ethyl alcohol and bicarb (ties up alcohol dehydrogenase)

Question 7

automotive antifreeze that’s oxidized to oxalic acid (very toxic to kidney); causes renal insuff, acidosis, and CNS excitement –> depression

Answer 7

ethylene glycol

Question 8

rubbing alcohol that causes gastritis, acidosis, CNS sx. no tx –> sx/supportive tx only

Answer 8

isopropyl alcohol

Question 9

which is more important for CNS stimulation: NE, 5HT, or DA?

Answer 9

DA: central and peripheral stimulant: wakefulness, alertness, dec fatigue sense, elevate mood, inc concentration ability, improve physical performance.

Question 10

CNS (and peripheral) stimulant that blocks reuptake of DA, NE, 5HT; has a free base called ___

Answer 10

cocaine, crack

but its the DA that’s most important for CNS stimulation (and pleasure-reward)

Question 11

how is cocaine metabolized?

Answer 11

rapidly by plasma cholinesterase.

Question 12

used as a topical anesthetic for URT (combined vasoconstrictor and local anesthetic). has sympathetic effects that include paranoia and aggression.

Answer 12

cocaine

Question 13

class: methylxanthines; competitive antagonists at adenosine (“purinergic”) receptors.
(adenosine makes u sleepy (sedative, anxiolytic, anticonvulsant, analgesic)
at higher doses: inhibits phosphodiesterases (thus, inc cAMP and cGMP)

Answer 13

caffeine (also theophyline and theobromine ), in coffee, tea, chocolate, energy drinks, some drug preps

Question 14

CNS: stimulation, nervousness, anxiety, irritability, restlessless, insomnia, tremors
PNS: inc capacity for sk mm work, bv dilate (but brain’s bv’s constrict (therefore tx headaches)), inc force of contraction and HR, DIURETIC, relieve bronchoconstriction and reduce inflm (theophylline is used to tx asthma

Answer 14

methylxanthines (caffeine, etc)

Question 15

leading cause of preventable deaths in this country

Answer 15

nicotine

Question 16

• activates nicotinic ach receptors in periphery and CNS
• ganglionic stimulant
• depolarizing ganglionic blocker
• CNS stimulant

Answer 16

nicotine!

Question 17

10 opioids

Answer 17

1. morphine
2. codeine
3. tramadol
4. fentanyl
5. methadone
6. oxycodone
7. meperidine
8. propoxyphene
9. loperamide
10. diphenoxylate

Question 18

do opioids cross tolerate and exhibit cross dependence?

Answer 18

yes! thats why you can use methadone for heroin addicts

Question 19

3 schedule 1 hallucinogens

Answer 19

1. LSD
2. mescaline
3. psilocybin

Question 20

from ergot fungus

Answer 20

LSD

Question 21

how do hallucinogen’s work? (mechanism)

Answer 21

1. agonist at inhibitory 5HT2a receptors on Raphe cell body —> inhibits raphe nuclei firing –> increased sensory input
2. partial DA agonist

Question 22

physiological effects of hallucinogens

Answer 22

mydriasis (dilation), inc HR/BP/RR, hyperreflexia, inc mm tone, occasionally N/V and ataxia

Question 23

sensory effects of hallucinogens

Answer 23

simple to complex hallucinations (distortion of perceptions), often more than 1 modality

Question 24

psychic effects of hallucinogens

Answer 24

magical/religious, sometimes paranoid. may include: synesthesia (hear colors, see sounds), changes in mood (usually euphoria) (can shift from fear/panic/bad trip) sense of temporal and physical detachment, fluid mental state

Question 25

LSD effects

Answer 25

altered perceptions: magical thinking, loss of ego boundaries, mood changes (ecstasy --> panic), heightened sensory awareness, mild sympathomimetic effects (inc BP, mydriasis, etc). trip ends in 8-12hrs

Question 26

does hallucinogens cross tolerate?

Answer 26

yes. LSD with mescaline and Psilocybin (not with THC or PCP)

Question 27

how do raphe nuclei work in human brain?

Answer 27

raphe nuclei fires tonically to inhibit postsynaptic neurons. raphe nuclei are serotonergic and firs tonically to inhibit reactiveness to stimuli

Question 28

T/F: LSD excites post synaptic neurons, thus, heightens response to stimuli and produce sensory and emotional flood.

Answer 28

T or F: LSD releases post-synaptic neurons from tonic inhibition, so raphe nucleus inhibits post neurons, but LSD release that inhibition

Question 29

tx for LSD toxicity?

Answer 29

1. talk down; LSD pts are very susceptible to suggestion; (pts on PCP are not) 2. diazepam

Question 30

LSD (dont die from it), what are some sx of toxicity?

Answer 30

1. bad trips: anixety, panic-attack 2. flashbacks 3. chronic psychosis 4. street drug life style

Question 31

hits cannabinoid receptors, (CB1, CB2 --> both GPCRs)

Answer 31

1. marijuana (THC=delta9-tetrahydrocannabinol) 2. anandamide 3. dronabinol 4. nabilone

Question 32

of the drugs that hit canabinoid receptors, which one is an endogenous cannabinoid?

Answer 32

anandamide (derived from arachidonic acid)

Question 33

which two are synthetic THCs?

Answer 33

dronabinol and nabilone

Question 34

which of the cannabinoids is approved for tx of chemo-induced N/V, that has not responded to conventional antiemetics, and it is useful in tx of anorexia and weight loss in AIDS pts? and it also have less psychoactive SEs than marijuana

Answer 34

nabilone

Question 35

schedule 1 hallucinogen, antiemetic, antinausea, appetite stimulant for chemo and AIDs pts, - analgesic for neuropathic pain - potentially glaucoma, asthma, anxiolytic, migraine, MS tx.

Answer 35

marijuana

Question 36

SE of marijuana?

Answer 36

- vasodilation --> tachy, dilation of conjunctival vessels --> dec IOP, - bronchodilation - hunger - may impair reproductive fnc in adolescents, and heavy use may impair development in young kids, possible respiratory damage due to tar

Question 37

structure and activity thats similar to iv. anesthetic, ketamine?

Answer 37

PCP - phencyclidine

Question 38

agonist at mu opioid receptors, antagonist of ion channel assoc with NMDA receptor

Answer 38

PCP

Question 39

effects: violent behavior, coma, seizures, arrest, inexplicable psychosis (schizo's + and -'s); - dissoc, confusion, ataxia, marked nystagmus.

Answer 39

PCP (highly lipid soluble and have active metabolites (long T1/2))

Question 40

TX of PCP "bad trip"

Answer 40

isolation (no talk down) | diazepam (sometimes anti-pscyhotic (haloperidol))

Question 41

``` indirect sympathomimetic (release biologic amines from nerve terminals in periphery and CNS), DA most important. -tx narcolepsy, ADHD ```

Answer 41

amphetamines

Question 42

ecstasy

Answer 42

MDMA (3,4 methlenedioxymethamphetamine) --> may be a 5HT neurotoxin

Question 43

substituted amphetamine analogues based on cathinone structures (cathinone is the active stimulant in "khat")

Answer 43

bathsalts