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NMSP Exam 3 > Tobacco, Vaping, Medical Marijuana, and CBD > Flashcards

Tobacco, Vaping, Medical Marijuana, and CBD Flashcards

1
Q

What are some benefits of vaping when compared to smoking?

A
  • Less expensive
  • Tastes better
  • Fingers don’t stink
  • Teeth get whiter after switching
  • Overall looks improve after switching
  • Sense of smell and taste improve after switching
  • Social interactions increase due to the dirty stigma of smoking
  • Don’t need to go outside for smoke break
  • Causes less damage to lungs
  • Can help people stop smoking cigarettes
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2
Q

How do e-cigarettes work?

A
  • Create an aerosol by using a battery to heat up liquid that usually contains nicotine, flavorings, and other additives
  • Users inhale this aerosol into lungs
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3
Q

What is a big area of concern with e-cigarettes?

A
  • 19% of girls and 23% of boys in middle and high schools used tobacco products
  • > 3.6 million teens in total population of 9 million regular users
  • 68% of users in high school use flavors
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4
Q

What are some reasons someone will vape?

A
  • Use by friend/family
  • Taste, variety of flavors
  • Belief that vaping is safer than other tobacco products (some believe they aren’t harmful, some believe there is little harm)
  • Curiosity
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5
Q

What is a problem with e-cigarettes and high school users?

A
  • Students become addicted to nicotine which can harm a developing brain
  • Leads them to burned tobacco products
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6
Q

What can e-cigarettes do to former smokers?

A
  • Get them re-addicted to nicotine
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7
Q

Why do we see high schoolers using e-cigarettes?

A
  • They are at an age of increased risk-taking, impulsivity, and novelty-seeking behavior
  • Their prefrontal cortex isn’t developed completely which means that they can’t differentiate between conflicting thoughts, can’t recognize good vs. bad, can’t anticipate consequences/outcomes based on current actions, activities, and urges
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8
Q

What does nicotine do to the prefrontal cortex?

A
  • Impair neuroplasticity (ability of the brain to change continuously throughout a person’s life)
  • In rats, causes long-term cognitive impairment
  • Shown to decrease memory and attention
  • May have behavioral disturbances later in life like substance abuse and mental health problems
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9
Q

What alterations does impaired neuroplasticity lead to?

A
  • Gene expression
  • Cell structure
  • Intracellular signaling
  • Synaptic pruning
  • Axon myelination
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10
Q

What causes the lung illness outbreaks linked to vaping?

A
  • There is no single agent that has been linked to all cases, ~80% acknowledged use of cannabinoid products
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11
Q

What is a main ingredient in almost all cannabis samples?

A
  • Vitamin E acetate which is a thickening agent to dilute THC oil (could be linked to the injuries caused by vaping)
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12
Q

What lung illness is seen due to vaping?

A
  • Likely not an active infection

- Seems to be an acute toxic lung injury with onset of few days to weeks

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13
Q

What can the lung damage from vaping mimic?

A
  • Acute eosinophilic pneumonia
  • Organizing pneumonia
  • Lipoid pneumonia
  • Diffuse alveolar damage
  • ARDS
  • Diffuse alveolar hemorrhage
  • Hypersensitivity pneumonitis
  • Giant-cell interstitial pneumonitis
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14
Q

What are some theories of the cause of the sudden vaping health crisis?

A
  • Bad ingredients (Vit E acetate, diacetyl)
  • Contaminants
  • Internet recipes
  • Chinese tariffs (making poor quality materials more available)
  • Slow regulations
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15
Q

What is the use of medical marijuana?

A
  • Use to treat medical conditions rather than recreational use
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16
Q

What are the two main chemicals in marijuana plants?

A
  • THC (“High”)

- CBD

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17
Q

What is required to get medical marijuana in missouri?

A
  • Written recommendation from a licensed doctor
  • Qualifying medical condition
  • +/- medical card
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18
Q

What are some qualifying conditions for medical marijuana?

A
  • Cancer
  • Epilepsy
  • Glaucoma
  • Intractable migraines
  • Chronic conditions that cause severe persistent pain
  • Debilitating psychiatric disorders like PTSD
  • HIV/AIDS
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19
Q

What are some routes of administration of medical marijuana?

A
  • Smoke
  • Vape
  • Eat it
  • Apply to skin in lotion, spray, oil, or cream
  • Place drops sublingually
20
Q

What is the MOA of marijuana?

A
  • Stimulates endocannabinoid (CB1, CB2) receptors
  • Endocannabinoid receptors are produced on demand in postsynaptic neurons by stimuli that result in elevations of intracellular Ca2+ levels causing activation of DAG-lipase
  • Synthesized endocannabinoids then diffuse into the synaptic space, travel in retrograde manner, and bind to CB1Rs on presynaptic neurons
21
Q

What does stimulation of the presynaptic CB1Rs do?

A
  • Inhibits adenylyl cyclase causing hyperpolarization of presynaptic neurons due to less Ca2+ influx and greater K+ conductance outward
22
Q

What are some examples of synthesized endocannabinoids?

A
  • Anandamide (partial agonist)

- 2-arachidonoylglycerol (full agonist)

23
Q

What breaks down anandamide?

A
  • Fatty acid amide hydrolase (FAAH) found principally in postsynaptic cells
24
Q

What breaks down 2-AG?

A
  • Monoacylglycerol lipase (MAG-lipase) primarily in presynaptic cells
25
Q

Where are CB2 receptors found?

A
  • Primarily on immune cells, modulate cytokine release
26
Q

What receptor does anandamide and 2-AG have a higher affinity for?

A
  • CB1 over CB2
27
Q

What is dronabinol?

A
  • Orally administered synthetic THC with peak effects in 2-4 hours
28
Q

What receptors does dronabinol bind to?

A
  • CB1 and CB2 the same amount but less efficacy at CB2
29
Q

What does dronabinol binding at CB1 cause?

A
  • Analgesia
  • Appetite enhancement
  • Muscle relaxation
  • Hormonal actions
30
Q

What are psychological effects of dronabinol?

A
  • Affective (euphoria)
  • Sensory (increased perception of external stimuli)
  • Somatic (feeling of body floating)
  • Cognitive (altered time perception)
31
Q

What are some labeled indications of dronabinol?

A
  • Anorexia in AIDS patients

- Chemotherapy-induced nausea and vomiting

32
Q

What are some adverse effects of dronabinol?

A
  • Affects judgement and coordination thereby increasing risk for accidents
  • Sedation
  • Bloodshot eyes
  • Depression
  • Dizziness
  • Tachycardia
  • Hypotension
  • Hallucinations
  • Dry mouth
33
Q

What are some concerns in using dronabinol in younger patients?

A
  • Adverse effects on intelligence and mental function in younger people with sill developing brains
34
Q

What are some conditions that have evidence for cannabis efficacy?

A
  • Chronic pain (neuropathic pain, RA, cancer pain)
  • Nausea and vomiting
  • Stimulating appetite during cancer or HIV anorexia and cachexia
  • MS (helpful for spasticity, associated pain, and bladder function)
  • Anxiety
  • Sleep quality
  • Tourette’s syndrome
  • Parkinson’s
  • Alzheimer’s
35
Q

What are some conditions where cannabis isn’t effective?

A
  • Acute pain
  • Tremor in MS
  • Huntington’s disease
  • Glaucoma
  • Schizophrenia
  • Depression
36
Q

What are some contraindications of cannabis?

A
  • History of psychosis
  • Current or past substance abuse disorder
  • Cardiovascular or respiratory disease
37
Q

What are some cautions of cannabis?

A
  • Age <25
  • Active mood disorders
  • Risk factors for cardiovascular disease
  • Ongoing use of high doses of alcohol or benzodiazepines
38
Q

What is another way to alter cannabinoids in the body?

A
  • FAAH inhibitors which breaks down the anandamide FAAH
39
Q

What is CBD?

A
  • Naturally occuring (-)-CBD enantiomer
  • Administered orally as either capsule, or dissolved in sesame or olive oil solution (poor bioavailability due to erratic absorption from the GI tract
40
Q

What gives CBD a greater bioavailability

A

Aerosolized inhaled CBD

41
Q

What are some adverse effects of CBD?

A
  • Generally well tolerated with no cardiovascular effects
  • Have seen increased drowsiness, fatigue, decreased appetite, diarrhea, anemia, infections
  • DOes not produce the psychoactive effects that are typically seen with cannabinoids such as THC
42
Q

Is there a potential for abuse or withdrawal with CBD?

A
  • No signs have been noticed or reported with either
43
Q

What is the toxicology of CBD?

A
  • No effect on embryonic development
  • No effect on a wide range of physiological and biochemical parameters
  • No evidence of abuse potential or dependence
  • Effects on immune system are unclear
  • Some potential for CBD to be associated with drug interactions through inhibition of cytochrome P450 enzymes
44
Q

When is CBD useful?

A
  • Used for childhood epileptic disorders like Lennox-Gastaut syndrome and Dravet syndrome
45
Q

What two childhood epileptic disorders does CBD work?

A
  • Dravet syndrome

- Lennox-Gastaut syndrome

46
Q

Where is CBD most well known?

A
  • Is legal for sale in “cosmetics”

- A lot are in unsactioned medical use like oils, supplements, gums, and many other remedies for ailments

NMSP Exam 3 (18 decks)

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