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Pharmacology > Tobacco, Alcohol, Benzos > Flashcards

Tobacco, Alcohol, Benzos Flashcards

1
Q

Nicotine directly activates _____ _____ receptors. Where:

A

nicotinic ACh receptors

centrally, peripherally, and at the Nm junction

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2
Q

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

A

1/3 to 1/2 less nicotine

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3
Q

Why is nicotine replacement less likely to cause addiction?

A

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

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4
Q

OTC Nicotine replacement products include:

A

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

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5
Q

Rx Nicotine replacement products include:

A 
Oral inhaler (Nicotrol inhaler)
Nicotine nasal inhaler (Nicotrol NS)
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6
Q

Instructions and SE for nicotine gum:

A

Keep between cheek and gums, do not chew

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

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7
Q

Instructions and SE for nicotine lozenge:

A

Do not swallow

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

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8
Q

Instructions and SE for nicotine patch:

A

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

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9
Q

Instructions and SE for nicotine inhaler:

A

Avoid in patents with resp. disease, like asthma

SE:cough, scratchy throat, GI upset

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10
Q

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

A

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

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11
Q

AE of using Buproprion for smoking cessation:

A

Difficulty sleeping, issues concentrating, tremors, GI upset

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12
Q

What is Varenicline (Chantix) MOA and AE:

A

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)

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13
Q

What black box warning do Bupropion and Varenicline have?

A

Serious neuropsychiatric events

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

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14
Q

What receptors does alcohol act on?

A

GABA (inhibitory)
NMDA glutamate (excitatory)
Cannabinoid

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15
Q

What does GABA mediate?

A

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

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16
Q

What is used in the treatment of acute alcohol withdrawal?

A

Benzodiazepines

17
Q

What drugs are used in maintenance of alcohol cessation?

A

Disulfiram (Antabuse)
Acamprosate (Campral)
Naltrexone

18
Q

Benzos can be used for?

A 
Sleep 
Anxiety
Alcohol withdrawal 
Seizures
Anesthesia
19
Q

Withdrawal s/s of benzos include:

A

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

20
Q

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

A

Self-tapering effect= less s/s of withdrawal

21
Q

The benzos with the least drug interactions include:

A

Lorazepam
Oxazepam
Temazepam
(not metabolized by the CYP3A4 pathway)

22
Q

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

A

CYP3A4

23
Q

MOA of Disulfiram (antabuse):

A

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

24
Q

S/S of aldehyde accumulation:

A

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

25
Q

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

A

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

26
Q

Acamprosate (Campral) does not cause alcohol _______ .

A

aversion

also lacks antidepressant, anxiolytic, anticonvulsant activity

27
Q

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

A

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

28
Q

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

A

Dopamine

NE and 5HT

29
Q

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

A

Antidepressants- desipramine and fluoxetine

30
Q

MDMA/Ecstasy acts on what neurotransmitter?

A

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

31
Q

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

A

Diazepam (Valium) is beneficial due to fast onset and long 1/2 life

(other benzos with long 1/2 life, clonazepam, chlordiazepoxide)

32
Q

Benzos least likely to cause DI?

A

Lorazepam
Oxazepam
Temazepam

Pharmacology (48 decks)

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