Tobacco, Alcohol, Benzos

Question 1

Nicotine directly activates _____ _____ receptors. Where:

Answer 1

nicotinic ACh receptors

centrally, peripherally, and at the Nm junction

Question 2

How much less nicotine do nicotine replacements contain vs. cigarettes?

Answer 2

1/3 to 1/2 less nicotine

Question 3

Why is nicotine replacement less likely to cause addiction?

Answer 3

It takes a longer type for systemic absorption. Inhaling nicotine allows for very fast entrance to circulation.

Question 4

OTC Nicotine replacement products include:

Answer 4

Gum (Nicorette)
Lozenges (Commit)
Patch (Nicoderm CQ)

Question 5

Rx Nicotine replacement products include:

Answer 5

Oral inhaler (Nicotrol inhaler)
Nicotine nasal inhaler (Nicotrol NS)

Question 6

Instructions and SE for nicotine gum:

Answer 6

Keep between cheek and gums, do not chew

SE: tingling on tongue, hiccups, jaw pain, nausea/heartburn if chewed

Question 7

Instructions and SE for nicotine lozenge:

Answer 7

Do not swallow

SE: HA, flatulence, hiccups, nausea/heartburn if swallowed

Question 8

Instructions and SE for nicotine patch:

Answer 8

Dose: Stepwise based on number of cigarettes/day
SE: Skin rash, use topical antihistamine
Sleep disturbance, take patch off at night

Question 9

Instructions and SE for nicotine inhaler:

Answer 9

Avoid in patents with resp. disease, like asthma

SE:cough, scratchy throat, GI upset

Question 10

Which antidepressant is used for smoking cessation and its presumed MOA?

Answer 10

Bupropion (Zyban)-usually added with nicotine replacement product
Noradrenergic and dopaminergic effects play a role

Question 11

AE of using Buproprion for smoking cessation:

Answer 11

Difficulty sleeping, issues concentrating, tremors, GI upset

Question 12

What is Varenicline (Chantix) MOA and AE:

Answer 12

Agonist at a sub-type of the nicotinic ACh receptor
This blocks nicotines activity of the receptor eliminating the reward experience caused by smoking
AE: nausea, HA, insomnia, abnormal dreams
(usually start prior to patient quitting)

Question 13

What black box warning do Bupropion and Varenicline have?

Answer 13

Serious neuropsychiatric events

Depression- suicidal ideation. Changes in behavior- aggression, hostility, agitation

Question 14

What receptors does alcohol act on?

Answer 14

GABA (inhibitory)
NMDA glutamate (excitatory)
Cannabinoid

Question 15

What does GABA mediate?

Answer 15

Anxiolytic and sedative effects as well as muscle coordination, tolerance, and dependence

Question 16

What is used in the treatment of acute alcohol withdrawal?

Answer 16

Benzodiazepines

Question 17

What drugs are used in maintenance of alcohol cessation?

Answer 17

Disulfiram (Antabuse)
Acamprosate (Campral)
Naltrexone

Question 18

Benzos can be used for?

Answer 18

Sleep 
Anxiety
Alcohol withdrawal 
Seizures
Anesthesia

Question 19

Withdrawal s/s of benzos include:

Answer 19

Anxiety, insomnia, irritability, nausea, blurred vision, confusion, delirium, seizures

Question 20

What is the advantage of benzos with a longer half-life?

Answer 20

Self-tapering effect= less s/s of withdrawal

Question 21

The benzos with the least drug interactions include:

Answer 21

Lorazepam
Oxazepam
Temazepam
(not metabolized by the CYP3A4 pathway)

Question 22

Diazepam (Valium), Alprazolam (Xanax), and Clonazepam (Klonopin) are all metabolized by:

Answer 22

CYP3A4

Question 23

MOA of Disulfiram (antabuse):

Answer 23

Inhibits aldehyde dehydrogenase, a critical enzyme in the alcohol metabolism pathway. Aldehyde is unable to be broken down to acetic acid and begin to accumulate

Question 24

S/S of aldehyde accumulation:

Answer 24

Facial flushing, HA, N/V, weakness, orthostatic hypotension

Question 25

What is the proposed MOA of Acamprosate (Campral) in alcohol abstinence?

Answer 25

May restore the balance of glutamate and GABA neurotransmitters that is altered d/t chronic alcohol abuse

Question 26

Acamprosate (Campral) does not cause alcohol _______ .

Answer 26

aversion | also lacks antidepressant, anxiolytic, anticonvulsant activity

Question 27

What is Dronabinol (Marinol) and who is approved for?

Answer 27

Synthetic THC available for appetite stimulation and antiemetic properties in AIDS and chemo patients

Question 28

Cocaine's intense euphoric effects are secondary to blocking reuptake of ______ with lesser effects on ______ and ______ .

Answer 28

Dopamine | NE and 5HT

Question 29

Which type of drugs have been linked to decrease cocaine cravings?

Answer 29

Antidepressants- desipramine and fluoxetine

Question 30

MDMA/Ecstasy acts on what neurotransmitter?

Answer 30

5HT, causes release into the synaptic cleft, inhibits synthesis, and inhibits reuptake (can result 5HT store depletion)

Question 31

Which benzo is often used in ETOH abuse and withdrawal and why?

Answer 31

Diazepam (Valium) is beneficial due to fast onset and long 1/2 life (other benzos with long 1/2 life, clonazepam, chlordiazepoxide)

Question 32

Benzos least likely to cause DI?

Answer 32

Lorazepam Oxazepam Temazepam