Tobacco, Vaping, Medical Marijuana, and CBD Flashcards
What are some benefits of vaping when compared to smoking?
- 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
How do e-cigarettes work?
- 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
What is a big area of concern with e-cigarettes?
- 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
What are some reasons someone will vape?
- 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
What is a problem with e-cigarettes and high school users?
- Students become addicted to nicotine which can harm a developing brain
- Leads them to burned tobacco products
What can e-cigarettes do to former smokers?
- Get them re-addicted to nicotine
Why do we see high schoolers using e-cigarettes?
- 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
What does nicotine do to the prefrontal cortex?
- 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
What alterations does impaired neuroplasticity lead to?
- Gene expression
- Cell structure
- Intracellular signaling
- Synaptic pruning
- Axon myelination
What causes the lung illness outbreaks linked to vaping?
- There is no single agent that has been linked to all cases, ~80% acknowledged use of cannabinoid products
What is a main ingredient in almost all cannabis samples?
- Vitamin E acetate which is a thickening agent to dilute THC oil (could be linked to the injuries caused by vaping)
What lung illness is seen due to vaping?
- Likely not an active infection
- Seems to be an acute toxic lung injury with onset of few days to weeks
What can the lung damage from vaping mimic?
- Acute eosinophilic pneumonia
- Organizing pneumonia
- Lipoid pneumonia
- Diffuse alveolar damage
- ARDS
- Diffuse alveolar hemorrhage
- Hypersensitivity pneumonitis
- Giant-cell interstitial pneumonitis
What are some theories of the cause of the sudden vaping health crisis?
- Bad ingredients (Vit E acetate, diacetyl)
- Contaminants
- Internet recipes
- Chinese tariffs (making poor quality materials more available)
- Slow regulations
What is the use of medical marijuana?
- Use to treat medical conditions rather than recreational use
What are the two main chemicals in marijuana plants?
- THC (“High”)
- CBD
What is required to get medical marijuana in missouri?
- Written recommendation from a licensed doctor
- Qualifying medical condition
- +/- medical card
What are some qualifying conditions for medical marijuana?
- Cancer
- Epilepsy
- Glaucoma
- Intractable migraines
- Chronic conditions that cause severe persistent pain
- Debilitating psychiatric disorders like PTSD
- HIV/AIDS
What are some routes of administration of medical marijuana?
- Smoke
- Vape
- Eat it
- Apply to skin in lotion, spray, oil, or cream
- Place drops sublingually
What is the MOA of marijuana?
- 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
What does stimulation of the presynaptic CB1Rs do?
- Inhibits adenylyl cyclase causing hyperpolarization of presynaptic neurons due to less Ca2+ influx and greater K+ conductance outward
What are some examples of synthesized endocannabinoids?
- Anandamide (partial agonist)
- 2-arachidonoylglycerol (full agonist)
What breaks down anandamide?
- Fatty acid amide hydrolase (FAAH) found principally in postsynaptic cells
What breaks down 2-AG?
- Monoacylglycerol lipase (MAG-lipase) primarily in presynaptic cells
Where are CB2 receptors found?
- Primarily on immune cells, modulate cytokine release
What receptor does anandamide and 2-AG have a higher affinity for?
- CB1 over CB2
What is dronabinol?
- Orally administered synthetic THC with peak effects in 2-4 hours
What receptors does dronabinol bind to?
- CB1 and CB2 the same amount but less efficacy at CB2
What does dronabinol binding at CB1 cause?
- Analgesia
- Appetite enhancement
- Muscle relaxation
- Hormonal actions
What are psychological effects of dronabinol?
- Affective (euphoria)
- Sensory (increased perception of external stimuli)
- Somatic (feeling of body floating)
- Cognitive (altered time perception)
What are some labeled indications of dronabinol?
- Anorexia in AIDS patients
- Chemotherapy-induced nausea and vomiting
What are some adverse effects of dronabinol?
- Affects judgement and coordination thereby increasing risk for accidents
- Sedation
- Bloodshot eyes
- Depression
- Dizziness
- Tachycardia
- Hypotension
- Hallucinations
- Dry mouth
What are some concerns in using dronabinol in younger patients?
- Adverse effects on intelligence and mental function in younger people with sill developing brains
What are some conditions that have evidence for cannabis efficacy?
- 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
What are some conditions where cannabis isn’t effective?
- Acute pain
- Tremor in MS
- Huntington’s disease
- Glaucoma
- Schizophrenia
- Depression
What are some contraindications of cannabis?
- History of psychosis
- Current or past substance abuse disorder
- Cardiovascular or respiratory disease
What are some cautions of cannabis?
- Age <25
- Active mood disorders
- Risk factors for cardiovascular disease
- Ongoing use of high doses of alcohol or benzodiazepines
What is another way to alter cannabinoids in the body?
- FAAH inhibitors which breaks down the anandamide FAAH
What is CBD?
- 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
What gives CBD a greater bioavailability
Aerosolized inhaled CBD
What are some adverse effects of CBD?
- 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
Is there a potential for abuse or withdrawal with CBD?
- No signs have been noticed or reported with either
What is the toxicology of CBD?
- 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
When is CBD useful?
- Used for childhood epileptic disorders like Lennox-Gastaut syndrome and Dravet syndrome
What two childhood epileptic disorders does CBD work?
- Dravet syndrome
- Lennox-Gastaut syndrome
Where is CBD most well known?
- Is legal for sale in “cosmetics”
- A lot are in unsactioned medical use like oils, supplements, gums, and many other remedies for ailments
