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67 Cards in this Set
- Front
- Back
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What are the neural circuits involved in drug addiction?
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Reward
Drive Memory Cognitive Control |
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Where is Reward located?
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Nucleus Accumbens
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Where is Drive?
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Orbitofrontal CTX
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Where is Memory?
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Amygdala
Hippocampus |
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Where is Cognitive Control?
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Frontal CTX
Cingulate Gyrus |
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Addiction =?
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Addiction
= Compulsive Use + Withdrawal + Craving |
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What is up with the proposed cellular mechanism of withdrawal?
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Basically a decreased frequency of a drug leads to decreased dopamine being released which is further propagated by release of Dynorphin
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What are the Addiction Potential Variables
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Drug
User Environment |
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What is variable about the drug?
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Pharmacokinetics
Reinforcement |
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What is variable about the User?
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Gender
Genes Personality |
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What is variable about the environment?
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Peer Pressure
Drug Availability |
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What are the two main issues with drug pharmacokinetics?
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Rate of onset of "high"
Metabolism (duration) |
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How does the number of D2 Dopamine receptors affect risk of abuse?
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The lower the receptor level the better the "high."
So you're at an increased risk w/ less receptors |
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What are the main types of Drugs of Abuse?
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Psychomotor Stimulants
CNS Depressants Analgesics/Narcotics Dissociative Anesthetics Hallucinogens/Psychadelics |
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Examples of Stimulants?
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Cocaine
Ephedrine Amphetamine Methylphenidate Fenfluramine Methamphetamine |
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Example of way to get ephedrine?
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Ma Huang
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Types of amphetamines?
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Benzadrine
Dexadrine |
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Another name for methylphenidate?
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Ritalin
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Types of Methamphetamine?
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Desoxyn
Methadrine |
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Clinical Indications for Stimulants?
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Narcolepsy
ADHD Obesity |
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What can you give for Narcolepsy?
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Amphetamine
Methylphenidate Modafinil |
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For ADHD?
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Ritalin
Amphetamine |
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For Fatties?
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Fenfluramine
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Mech of Amphetamines?
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Stimulate release of DA, 5HT2, and NE
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Mech of Cocaine?
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Block reuptake of catecholamines
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Half life of amphetamines vs cocaine
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Amp: 10-12h
Coke: 1 hr |
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Metabolism of amphetamines vs coke?
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Amp:eliminated in pee
coke: metabolized by liver |
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Factors Leading to Potential for Stimulant Abuse
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Rapid Tolerance
Toxicity Binge Use |
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Sx's of Stimulant Withdrawal
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(mainly psychological)
Anxiety Guilt Insomnia Depression Anhedonia (can lead to suicide) |
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CNS DEPRESSANTS
examples? |
Alcohol
BZD's Barbituates Gamma Hydroxybutyrate (GHB) |
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Examples of BZD's prone to abuse?
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Diazepam
Flunitrazepam (rohypnol, roofies) |
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Mechanism of Depressants
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Hit lots of stuff. Often GABA receptor agonists
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Sx's of Depressant Intoxification
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Disinhibition
Ataxia Dysarthria Nystagmus Errors of Commission Paradoxical Agitation, Anxiety Anterograde Amnesia |
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OPIATE ANALGESICS
examples? |
Heroin
Morphine Mescaline Oxycontin |
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Sx's of Narcotic Intoxification
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Euphoria
Drowsiness Pinpoint Pupils Needle Tracks N&V Miosis |
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Hallucinogens/Psychadelics
Examples |
Lysergic Acid Diethylamide (LSD, mescaline)
Phencyclidine (PCP) Ketamine MDA, MDMA, ectasy |
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Mech of LSD/Mescaline?
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Not well understood
Maybe act on presynaptic 5HT receptors to increase glutamate release |
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Ketamine
mechanism? |
NMDA receptor Antagonist
Increases DA |
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Ecstasy (MDMA)
Mech? |
SERT antagonist
Increases 5HT and DA |
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Ecstasy
Toxicity |
5HT2 neurons (holes in brain)
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WEED!!!!
Mech? |
Inhibit GABA release in VTA
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Drug Abuse seen in ER
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Overdose
Withdrawal |
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Amphetamine and Coke OD Sx
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HTN
Tachycardia Seizures Arrhythmias Hyperreflexia Circulatory Collapse |
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Amphetamine and Coke OD
Rx |
BZD's
Antipsychotics Cooling +/- propanolol |
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Alcohol and Depressant OD
Rx |
Gastric Lavage
Activated Charcoal Ventilatory Support CV support IV Sodium Bicarb Flumazenil (BZD antagonist) |
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LSD/Mescaline OD
Sx |
Visual Hallucinations
Mild Tachycardia Pee Retention Dilated Pupils |
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LSD/Mescaline OD
Rx |
BZD's
Supportive Haloperidol |
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LSD/Mescaline withdrawal?
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RARE
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PCP and Ketamine
OD Sx's |
Nystagmus
Numbness Violence Delirium Catatonia Coma HTN Hyperthermia Psychosis |
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PCP and Ketamine
OD Rx |
BZD's
Cooling Anti-psychotics Life Support |
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PCP and Ketamine
withdrawal Sx's? |
ITS RARE!
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Patient is in a come...what do you DO?
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ABCD's
Airway Breathing Circulation Drugs (dextrose, thiamine, naloxone, flumazenil) |
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Alcohol and Depressant Withdrawal Sx's
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Seizures
Delirium Tremens (kills you) |
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Alcohol and Depressant Withdrawal Rx
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Clonidine
Diazepam Thiamine |
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What can cause seizures?
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Amphetamines
Depressants Coke PCP Theophylline |
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What are we trying to do, in theory, when we treat Drug abuse?
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Decrease:
withdrawal sx's Craving Reinforcing effects of drug |
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What do we do in practice to treat drug abuse?
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taper drug
cross-tolerant agonist (methadone) Alternate route of administration Avoid positive behavoiral associations Maintenance Diet |
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What can we give to Rx Opiate Addictions?
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Methadone
Buprenorphine Naloxone |
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Why does methodone work?
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it keeps them mellow. not too high, not too low
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what can we use to treat boozers?
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Disulfiram
Campral Naltrexone |
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Why is Buprenorphine good for opiate addicts?
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Lower abuse potential
Ceiling Effect Safer Reduced Withdrawal BUT watch out cause its a resp depressant |
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How does Disulfiram work?
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blocks alcohol metabolism from acetaldehyde-->acetic acid
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How does Campral work?
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glutamate/GABA
helps maintain abstinence (reduce cravings) Doesn't help with withdrawal sx's |
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How does Naltrexone work?
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Opiate Antagonist
Reduces pleasurable effects of booze Reduces relapse Better than campral, but really good if you combo them |
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Smoking Cessation Aids
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Nicotine Replacement Products
Bupropion Chantix |
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How does Bupropion (Zyban) work?
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blocks DA and NE reuptake
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How does Chantix work?
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partial agonist at nicotinic receptors
decreases cravings and withdrawal decreases satisfaction from smoking |
