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neurology/psychiatry > therapeutic use of medical cannabis > Flashcards

therapeutic use of medical cannabis Flashcards

1
Q

definition of hemp as in the farm bill

A

THC </= 0.3% on a dry weight basis

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2
Q

what are the different cannabis markets

A

the pharmacy
medical programs
adult use (21+)
hemp market (farm bill)
illicit (dealer)

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3
Q

what is the degree of regulation of each of the cannabis markets?

A

pharmacy most regulated
medical programs highly regulated but fewer lab testing requirements than pharmacy
adult use has less stringent regulations and lab testing
hemp market has regulations but lots of grey area
illicit has absolutely no regulation and you have to trust your dealer

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4
Q

primary function of endocannabinoid system

A

regulatory/homeostasis
ex: memory, pain, sleep, mood, etc.

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5
Q

what are the ligands in the endocannabinoid system

A

endocannabinoids: anandamide and 2-AG
phytocannabinoids: THC, CBD, CBG, CBN, etc
pharmaceutical cannabinoids: dronabinol, nabilone, cannabidiol, nabiximols

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6
Q

what are the receptors in the endocannabinoid system

A

CB1, CB2

CB1 primarily in brain, nervous system
CB2 primarily in immune system

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7
Q

role of the cannabinoid receptors CB1 and CB2

A

to modulate release of neurotransmitters like 5-HT, DA, NE
the most abundant G protein coupled receptor in brain

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8
Q

how do the cannabinoids activate the receptors

A

RETROGRADE signaling: cannabinoids activate CB receptors pre-synaptically through feedback inhibition as opposed to post-synaptically

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9
Q

what are the endocannabinoids

A

anandamide (AEA) which is selective for CB1
2-arachidonylglycerol (2-AG) which is more abundant, full agonist at CB1/CB2

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10
Q

what are the pharmaceutical cannabinoids

A

dronabinol (marinol) for CINV
nabilone (cesamet) for CINV
epidiolex (cannabidiol) for seizures, undergoing trials for Huntington’s disease
nabiximols (sativex)– not in the US

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11
Q

THC has enhanced activity for ___

A

CB1

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12
Q

CBD also inhibits ____

A

FAAH enzyme

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13
Q

different major roles of the phytocannabinoids

A

THC: psychotoxic
CBD: anticonvulsant
CBN: sedative
CBG: analgesic, anti-inflamm
THCV: appetite suppressnat

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14
Q

what are some other MOAs of medical cannabis

A

there is also activity outside of the endocannabinoid system
such as COX1/COX2
and mu opioid receptors, alpha-2 adrenergic, G-protein coupled receptors, many more

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15
Q

what is the difference between psychoactive and psychotoxic

A

psychoactive means affecting the mind, consciousness, mood, and thoughts
psychotoxic means intoxicating or causes significant mood change

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16
Q

what is the precursor/mother cannabinoid

A

CBGa

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17
Q

what is the role of the terpenes

A

odorous– scent and flavor profile in cannabis, protection & attraction

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18
Q

what are the flavonoids and flavorants

A

flavnonoids: color, aroma
flavorants: flavor, aroma

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19
Q

what is the entourage effect theory

A

cannabinoids, terpenes, flavonoids, flavorants, and other naturally occurring compounds in cannabis act synergistically to enhance the overall effects

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20
Q

what are the trichomes

A

tiny little crystals that cover the leaves and buds– produce and store cannabinoids, terpenes, and flavonoids

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21
Q

what are the different ways to classify cannabis

A

genotypes (Strain names– indicates possible characteristics)

phenotypes (Sativa, indica, hybrid)

chemotype (grouped by most abundant cannabinoid)

chemovar (defined by chemical variety)

22
Q

what are some differences between sativa and indica

A

sativa: tall, thin and lanky; leaves are thin; matures slower; effects are said to be uplifting and invigorating; daytime use

indica: short and stalky; leaves are broad/chunky; matures quicker; effects are said to be sedating and relaxing; nighttime use

23
Q

what are some different chemotypes?

A

type 1: THC
type 2: balanced 1:1
type 3: CBD
type 4: CBG

24
Q

what does isolate mean

A

contains one singular cannabinoid or terpene

25
Q

what does broad spectrum mean

A

contains one main cannabinoid and other naturally occurring plant compounds but excludes a specific cannabinoid

26
Q

what does full spectrum mean

A

contains all naturally occurring plant compounds

27
Q

what are some possible dosage forms for medical cannabis

A

inhalation (cartridge, concentrates, dry leaf)
ingestion (capsules, oral liquid, tinctures and elixirs, rick simpson oil)
topical
transdermal
suppository
distillate syringe

28
Q

true/false: you should hold in after you inhale

A

false
no evidence supports this

29
Q

bioavailability, onset, and duration of inhaled dosage form

A

<50% bioavailable
onset in 5-10 mins
duration 2-4 hours

30
Q

side effects from inhaled dosage form

A

throat irritation, coughing, bronchitis

31
Q

which of the inhaled dosage forms are free of other excipients

A

concentrates, dry leaf

32
Q

what was the cause of EVALI

A

additional excipients were used to thin out oil, leading to severe lung injury; toxic byproducts are formed (myrcene–methacrolein)

33
Q

considerations for temperature

A

boiling points vary from ~300-450
vaporizing at a temp too low will not express the cannabinoid or terpene; vaporizing at a temp too high will obliterate the cannabinoid or terpene providing little therapeutic benefit

34
Q

what are some factors that can alter the ingestion of cannabis

A

recent meals can delay the onset, prolong duration, and cushion the potency.
dose stacking can lead to overmedication

35
Q

bioavailability, onset, and duration of ingested cannabis

A

bioavailability 10-20%
onset 1-3 hours
duration 6-8 hours, up to 24

36
Q

counseling/dosing of ingested cannabis

A

start with a low dose, on an empty stomach

37
Q

onset/duration of transdermal cannabis

A

onset is variable ~30 mins
duration is variable ~8-12 hours

38
Q

onset/duration of suppository

A

onset 15-60 minutes
duration 2-8 hours

39
Q

how are distillate syringes used

A

they can be either ingested or inhaled

40
Q

combustion as a consumption method?

A

this is not approved in most medical programs due to harmful effects of inhaling carbon monoxide & tar production
an immediate loss of potency (30-60%) is noted upon incineration

41
Q

describe cannabis withdrawal symptoms/duration

A

insomnia, vivid dreams, anxiety
may last for up to 45 days

42
Q

what is a significant drug interaction to look out for

A

clobazam

43
Q

pharmacokinetic vs pharmacodynamic drug interactions

A

PK: clobazam, phenytoin, beta blockers, CCBs, warfarin, buprenorphine, valproic acid, theophylline, antifungals, antiretrovirals, tacrolimus, tizanidine

PD: additive effects
-additive depressant: alcohol, barbiturates, benzodiazepines
-additive tachycardia, hypertension with sympathomimetics
-additive xerostomia and drowsiness with anticholinergics

44
Q

what are the cardiac side effects

A

increased risk MI, stroke, heart failure

45
Q

what is cannabis hyperemesis syndrome

A

cyclic episodes of nausea/vomiting with chronic cannabis use
excessive bathing in hot water provides relief
treatment is cannabis holiday, IV fluids, antiemetics, PPIs, topical capsaicin

46
Q

contraindications

A

allergy to active drug or excipients
schizophrenia, psychosis, bipolar disorder
pregnancy, lactation
history of heart attack, stroke, angina
COPD, asthma
liver/kidney dysfunction

47
Q

what is the correct dose

A

the lowest dose that provides therapeutic benefit without adverse effects

48
Q

true/false: patient must experience psychoactivity to have effect

A

false

49
Q

which preparations should be used for chronic conditions vs prn

A

chronic: long acting oral preparation
prn: vaporization

50
Q

dosing for inhalation vs PO

A

inhalation: start with one inhalation and wait 15 minutes, may increase by 1 inhalation q15-30 minutes

oral: start with 2.5 mg at bedtime- increase to BID after 2 days- increase by 2.5 mg every 2 days

neurology/psychiatry (22 decks)

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