Svensson Pharmacology of Cannabis/Cannabinoids

Question 1

How much THC is in hemp

Answer 1

0.3% or less

Question 2

What is hemp grown for?

Answer 2

Agricultural products such as textiles, seeds and oils

Question 3

How much THC is in marijuana?

Answer 3

15-20%

Question 4

What was passed in 1937?

Answer 4

Congress passes Marijuana Tax Act of 1937

Question 5

What was passed in 1996?

Answer 5

California passes prop. 215, becoming first legal medical marijuana state

Question 6

What was passed in 2013?

Answer 6

Cole memo creates hands-off policy for legal marijuana states

Question 7

What schedule is cannabis?

Answer 7

Cannabis remains Schedule 1 under Federal Controlled Substance Act

Question 8

What bill allows hemp to be cultivated for research purposes?

Answer 8

The Farm Bill signed in 2014

Question 9

What bill legalized hemp-derived products, including CBD?

Answer 9

The Farm Bill of 2018

Question 10

What is the difference between delta-9 and delta-8?

Answer 10

One double bond is changed positions

Question 11

How do you convert THCA to delta9-THC?

Answer 11

Heat

Question 12

Difference between synthetic marijuana (spice) and natural cannabinoids

Answer 12

-Synthetic marijuana is more powerful than THC and can hospitalize people who use it
-Synthetic marijuana is still widely used even though it is illegal

Question 13

What are the perceptual symptoms of acute cannabis intoxication?

Answer 13

-Temporal slowing
-Auditory, visual, oral tactile illusions
-De-personalization (out of body experience)

Question 14

What are the affective symptoms of acute cannabis intoxication?

Answer 14

-Euphoria
-Disinhibition (impulsive)
-Anxiety
-Emotional lability (cry and laugh more easily)

Question 15

What are the physical symptoms of acute cannabis intoxication?

Answer 15

-Tachycardia
-Postural hypotension
-Conjunctival injection (red eyes)
-Dry mouth
-Increased appetite

Question 16

What are the cognitive symptoms of acute cannabis intoxication?

Answer 16

-Suspiciousness or paranoid ideation
-Impaired judgment
-Impaired reaction time
-Impaired attention

Question 17

What is the endocannabinoid system comprised of?

Answer 17

-Receptors (CB1 and CB2)
-Ligands
-Transporter (EMT)
-Enzymes

Question 18

Endocannabinoid/phytocannabinoid mechanism of action

Answer 18

They are retrograde regulators of neurotransmission, inhibiting the release of GABA and glutamate

Question 19

Why are synthetic cannabinoids more potent than THC?

Answer 19

Synthetic cannabinoids are full agonists while THC is a partial agonist

Question 20

Where are CB1 receptors predominantly located?

Answer 20

-In the brain
-Liver (increases lipogenesis) (upregulated in liver fibrosis)

Question 21

Where are CB2 receptors predominantly located?

Answer 21

-In the periphery and the glia
-Lymphocytes

Question 22

Marinol (Dronabinol) clinical pearls

Answer 22

-Synthetic delta 9 THC in sesame oil
-Schedule 3
-Counter loss of appetite
-Mostly used in cancer patients
-Tachycardia, red eyes

Question 23

Nabilone (Cesamet) clinical pearls

Answer 23

-THC mimetic
-Schedule 2
-Anti-emetic
-Chronic pain (fibromyalgia and multiple sclerosis)

Question 24

Challenges with medical marijuana use

Answer 24

-Lack of product quality control
-Absence of adequately designed studies for assessing efficacy and ADR
-Highly politicized environment precludes a rational approach
-Growing influence of big tobacco and alcohol industries in the cannabis industry (companies do not care about public health)

Question 25

Cannabidiol clinical pearls

Answer 25

-Low affinity for CB receptors
-May antagonize THC @ CB1
-Promiscuous effects on ECS
-Lacks euphoric effects
-CBD oil with less than 0.3% THC legal in IN
-Most common reported use is for pain
-Sold in many forms: oral, topical, cosmetic, edibles, vaporizers
-FDA approved drug for seizure disorder

Question 26

Problems with CBD products

Answer 26

CBD products are unregulated and of unknown and variable quality

Question 27

What is CBD approved for treating?

Answer 27

Rare seizure disorders such as Dravet syndrome and Lennox-Gastaut syndrome

Question 28

How much of the criteria must someone meet in order to be diagnosed with cannabis use disorder

Answer 28

2 or more

Question 29

Is cannabis use associated with mental health disorders?

Answer 29

-Extremely difficult to prove and controversial
-Growing evidence for association with several disorders, cause and effect mot established

Question 30

Risk factors for psychosis developed from cannabis use

Answer 30

Age of onset and potency appear to be key determinants

Question 31

Diagnostic criteria for cannabinoid hyperemesis syndrome

Answer 31

-Cyclic vomiting/abdominal pain
-Presentation after prolonged, excessive use
-Relief by sustained cessation
-May be associated with pathological bathing (hot showers/bath)

Question 32

How to treat cannabinoid hyperemesis syndrome

Answer 32

-Cannabis cessation
-Benzodiazepines
-Haloperidol
-Capsaicin cream (abdomen)