Svensson Pharmacology of Cannabis/Cannabinoids Flashcards
How much THC is in hemp
0.3% or less
What is hemp grown for?
Agricultural products such as textiles, seeds and oils
How much THC is in marijuana?
15-20%
What was passed in 1937?
Congress passes Marijuana Tax Act of 1937
What was passed in 1996?
California passes prop. 215, becoming first legal medical marijuana state
What was passed in 2013?
Cole memo creates hands-off policy for legal marijuana states
What schedule is cannabis?
Cannabis remains Schedule 1 under Federal Controlled Substance Act
What bill allows hemp to be cultivated for research purposes?
The Farm Bill signed in 2014
What bill legalized hemp-derived products, including CBD?
The Farm Bill of 2018
What is the difference between delta-9 and delta-8?
One double bond is changed positions
How do you convert THCA to delta9-THC?
Heat
Difference between synthetic marijuana (spice) and natural cannabinoids
-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
What are the perceptual symptoms of acute cannabis intoxication?
-Temporal slowing
-Auditory, visual, oral tactile illusions
-De-personalization (out of body experience)
What are the affective symptoms of acute cannabis intoxication?
-Euphoria
-Disinhibition (impulsive)
-Anxiety
-Emotional lability (cry and laugh more easily)
What are the physical symptoms of acute cannabis intoxication?
-Tachycardia
-Postural hypotension
-Conjunctival injection (red eyes)
-Dry mouth
-Increased appetite
What are the cognitive symptoms of acute cannabis intoxication?
-Suspiciousness or paranoid ideation
-Impaired judgment
-Impaired reaction time
-Impaired attention
What is the endocannabinoid system comprised of?
-Receptors (CB1 and CB2)
-Ligands
-Transporter (EMT)
-Enzymes
Endocannabinoid/phytocannabinoid mechanism of action
They are retrograde regulators of neurotransmission, inhibiting the release of GABA and glutamate
Why are synthetic cannabinoids more potent than THC?
Synthetic cannabinoids are full agonists while THC is a partial agonist
Where are CB1 receptors predominantly located?
-In the brain
-Liver (increases lipogenesis) (upregulated in liver fibrosis)
Where are CB2 receptors predominantly located?
-In the periphery and the glia
-Lymphocytes
Marinol (Dronabinol) clinical pearls
-Synthetic delta 9 THC in sesame oil
-Schedule 3
-Counter loss of appetite
-Mostly used in cancer patients
-Tachycardia, red eyes
Nabilone (Cesamet) clinical pearls
-THC mimetic
-Schedule 2
-Anti-emetic
-Chronic pain (fibromyalgia and multiple sclerosis)
Challenges with medical marijuana use
-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)
Cannabidiol clinical pearls
-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
Problems with CBD products
CBD products are unregulated and of unknown and variable quality
What is CBD approved for treating?
Rare seizure disorders such as Dravet syndrome and Lennox-Gastaut syndrome
How much of the criteria must someone meet in order to be diagnosed with cannabis use disorder
2 or more
Is cannabis use associated with mental health disorders?
-Extremely difficult to prove and controversial
-Growing evidence for association with several disorders, cause and effect mot established
Risk factors for psychosis developed from cannabis use
Age of onset and potency appear to be key determinants
Diagnostic criteria for cannabinoid hyperemesis syndrome
-Cyclic vomiting/abdominal pain
-Presentation after prolonged, excessive use
-Relief by sustained cessation
-May be associated with pathological bathing (hot showers/bath)
How to treat cannabinoid hyperemesis syndrome
-Cannabis cessation
-Benzodiazepines
-Haloperidol
-Capsaicin cream (abdomen)