Drugs Of Abuse

Front 1

What is the definition of drug abuse?

Back 1

Drug abuse is the excessive self-
administration of any substance for
nonmedical purposes.

Front 2

What is the definition of reinforcing properties?

Back 2

properties of the drug that are
responsible for drug-seeking behavior

Front 3

What drugs of abuse do not cause addiction?

Back 3

Hallucinogens
Dissociative anesthetics

Front 4

What 4 behaviors characterize addiction?

Back 4

1. impaired control over drug use
2. compulsive use
3. continued use despite harm
4. craving

Front 5

What is a patient that abuses prescribed drugs?

Back 5

Medical addict

Front 6

What is a state of adaptation manifested by a drug class-specific withdrawal syndrome?

Back 6

physical dependence

Front 7

What 4 things can produce withdrawal?

Back 7

1, abrupt cessation
2. rapid dose reduction
3. decreasing blood level of the drug
4. administration of an antagonist

Front 8

Which is a state of adaptation in which exposure to a drug decreases the drug's effect over time?

Back 8

tolerance

Front 9

What characteristics of the drug are subject to tolerance?

Back 9

Tolerance to both:
Desired (euphoria)
Undesired (constipation)
Tolerance can:
Develop slowly (analgesia)
Develop more rapid (respiratory depression)

Front 10

What classes of drugs can patients become physically dependent upon?

Back 10

Physical dependence is a normal
response that often occurs with the
persistent use of certain medications
including β-blockers, α2 adrenergic
agents, corticosteroids, antidepressants, and other
medications that are not
associated with addictive disorders.

Front 11

How often do prescribed drugs cause addiction?

Back 11

rarely

Front 12

What is the different between addiction and pseudoaddiction?

Back 12

ADDICTION: Patient with addiction is not in control, uses drugs without regards to proper or legal use, and
continues with no regards to their
own or others' safety.
PSEUDOADDICTION: Patient with
undertreated pain exhibits behaviors
that are focused on obtaining meds
for pain. When pain is being
effectively treated, the behaviors
cease. Patient remains in control
and uses meds as prescribed.

Front 13

What area in the brain is the prime target of addictive drugs?

Back 13

The mesolimbic dopamine system is
the prime target of addictive drugs. As
a general rule, ALL addictive drugs
activate the mesolimbic dopamine
system.

Front 14

Where does the mesolimbic system originate?

Back 14

This system originates in the ventral
tegmental area and projects to the
nucleus accumbens, the amygdala,
and the prefrontal cortex.

Front 15

What are the 3 classes of CNS depressants?

Back 15

Ethanol
Benzodiazepines
Barbituates

Front 16

What are the 3 classes of psychostimulants?

Back 16

Methylxanthines
Cocaine
Amphetamines

Front 17

What are the 4 psychedelic agents?

Back 17

LSD
Mescaline
Psilocibin
MDMA

Front 18

What are the 5 classes/drugs that do not fit into a class?

Back 18

Nicotine
Opioids
Marijuana
Inhalants
Anabolic Steroids

Front 19

What is the most common liquid drug?

Back 19

ethanol

Front 20

What does ethanol produce?

Back 20

sedation
sleep

Front 21

Is ethanol a depressant or a stimulant?

Back 21

depressant

Front 22

Why do some think its a stimulant?

Back 22

because it depresses inhibition in low doses

Front 23

What 6 cellular functions does alcohol influence?

Back 23

GABA-R
Kir3/GIRK channels
Adenosine reuptake
Glycine receptors
NMDA receptors
5HT3 receptors

Front 24

What are the 2 consequences of heavy consumption of alcohol?

Back 24

acquired tolerance
physical dependence

Front 25

When does alcohol dependence become apparent (in hours)?

Back 25

6-12 hours after cessation of heavy drinking

Front 26

What are the early sx of alcohol withdrawal (6-12 hours after cessation)?

Back 26

more common:
tremor
nausea
vomiting
sweating
anxiety
agitation
less common:
hallucinations
*visual
*tactile
*auditory

Front 27

What are the late sx of alcohol withdrawal (24-72 hours after cessation)?

Back 27

generalized seizures (24-48 hrs)
delirium tremens (48-72 hrs)
**associated with 5-15% mortality

Front 28

What are the DOC for alcohol withdrawal?

Back 28

DOC Benzodiazepines:
Diazepam and chlordiazepoxide
*long-acting
For liver failure or elderly patients:
Lorazepam and oxazepam
*intermediate acting

Front 29

What are the three drugs approved for tx of alcoholism?

Back 29

disulfiram
naltrexone
acomprosate

Front 30

How is disulfiram effective?

Back 30

It is an inhibitor of aldehyde
dehydrogenase and creates an
aversion to drinking.
If ethanol is consumed by a patient
who has taken disulfiram,
acetaldehyde accumulation leads to
nausea, headache, flushing, and
hypotension.

Front 31

How is naltrexone effective?

Back 31

It is an orally available opioid receptor antagonist with a mild effect on reducing cravings.

Front 32

How is acamprosate effective?

Back 32

It is an NMDA receptor antagonist and
prevents relapse by interfering with the
hyperactive glutamate system that
persists even after alcohol
consumption ceases.

Front 33

What does topiramate do to help with alcohol addiction?

Back 33

Facilitates GABA function and
antagonizes glutamate and may
decrease mesocorticolimbic
dopamine release and reduce
cravings.
Antiepileptic.
Not FDA approved.

Front 34

What are the most commonly prescribed drugs worldwide?

Back 34

benzodiazepines

Front 35

What are benzo's main indications?

Back 35

anxiety disorders
insomnia

Front 36

Does benzo cause addiction?

Back 36

yes, but rarely

Front 37

What about benzo dependence?

Back 37

2 types:
normal dose
high dose

Front 38

How long is the average time for 50% of patients to achieve benzo dependence from therapeutic doses?

Back 38

3 years

Front 39

What is the minimal time to develop tolerance to benzo?

Back 39

1. several weeks - little tolerance - no difficulty in stopping meds
2. several months - proportion of patients developing tolerance increases - withdrawal occurs

Front 40

What are the sx of low dose benzo withdrawal from normal dose dependence?

Back 40

Mild or moderate:
"BRIAN SaVonT"
Blurred vision
Restlessness
Incoordination
Anorexia
Nausea
Sweating
Vomiting
Tremor

Front 41

What are the sx of high dose benzo withdrawal fro high dose dependence?

Back 41

BRIAN SaVonT
AND
seizures
psychosis
depression

Front 42

What is the treatment for a benzo low dose withdrawal?

Back 42

If patient is on short acting drug:
SWITCH to LONG ACTING
DIAZEPAM to reduce the severity of
withdrawal and reduce dose over 4-8
weeks.

Front 43

What is the tx for high dose benzo withdrawal?

Back 43

If no other drugs are taken, take
DIAZEPAM or other long-acting
benzo. If the situation is complicated
by alcohol or other illicit drug, wean
off of alcohol or other drug first and
then tackle the benzo.

Front 44

How are barbitutates used?

Back 44

They aren't!

Front 45

Where are methylxanthine (MX) compunds found?

Back 45

Coffee, tea, cola, chocolate, OTC meds

Front 46

What are the 3 MX compounds?

Back 46

CAFFEINE (mose widely consumed)
theophylline
theobromine

Front 47

What do MX drugs block?

Back 47

adenosine receptors

Front 48

Where are adenosine receptors located?

Back 48

on presynaptic boutons on many
neurons, including adrenergic neurons

Front 49

What do adenosine receptors do?

Back 49

all over: inhibit NE release
in the CNS:promote sleep and drowsiness

Front 50

How does caffeine affect adenosine receptors?

Back 50

Caffeine et al competitively
antagonizes adenosine receptors,
removing inhibition, and allowing NE
release--> stimulant effects of
caffeine in addition to producing
alertness and insomnia (from CNS
effects)

Front 51

How many cups of coffee is 100-200mg of caffeine?
What are the effects?

Back 51

1-2 cups
decrease fatigue
increase mental alertness

Front 52

How many cups of coffee is 1.5g of caffeine?
What are the effects?

Back 52

12-15 cups
anxiety
tremors

Front 53

What do very high doses (2-5g) of caffeine stimulate?
What are the effects?

Back 53

spinal cord
convulsions

Front 54

What are caffeine effects on the heart?

Back 54

Positive inotrope and chronotrope

Front 55

What are caffeine effects on circulation?

Back 55

Mild diaretic
Increases urinary output of:
*Na
*Cl
*K

Front 56

What are MX effects on the GI?

Back 56

Stimulate HCl secretion from gastric mucosa (avoid w/peptic ulcers)

Front 57

When does tolerance to caffeine stimulation happen?

Back 57

rapidly

Front 58

So what does the normal person do?

Back 58

Drinks MORE caffeine

Front 59

What are the withdrawal sx from caffeine?

Back 59

Fatigue
Sedation

Front 60

How addictive is caffeine?

Back 60

VERY (from my experience)
acutally, not listed as an addictive substance
WHA??????

Front 61

What are 3 AE from caffeine?

Back 61

Insomnia
Anxiety
Agitation

Front 62

What are 2 AE from high doses of caffeine?

Back 62

Emesis
Convulsions

Front 63

What is the lethal dose of caffeine?

Back 63

10 g (about 100 cups of coffee)
Cardiac arrhythmias
Death (highly unlikely)

Front 64

On to the big hitters....
COCAINE
What is its MOA?

Back 64

Inhibits DOPAMINE reuptake
Inhibits NE reuptake
Inhibits 5HT reuptake

Front 65

What is the major outcome of cocaine actions?

Back 65

Potentiates and prolongs CNS and
peripheral actions of those
monoamines.
In particular, the dopaminergic affect
produces the intense euphoria that
is characteristic of cocaine.

Front 66

What are the cocaine actions on the sympathetic nervous system?

Back 66

Cocaine also potentiates NE action
and produces a flight or fight
syndrome of noradrenergic
stimulation:
tachycardia
HTN
pupillary dilation
peripheral vasoconstriction

Front 67

What are the other CNS actions of cocaine?

Back 67

1. Stimulation of cortex and brainstem
2. Increases mental awareness and produces a feeling of well-being and euphoria.
3. Involuntary motor activity, stereotyped behaviour and paranoia
4. Irritability and increased risk of violence are found among heavy chronic users.
5. Increases heat production by direct action on thermoregulatory centers in the hypothalamus and increased psychomotor activity.
6. Impairs sweating, cutaneous vasodilation, and heat perception.

Front 68

What are the effects of high doses of cocaine?

Back 68

1. tremors
2. convulsions
3. respiratory
4. vasomotor depression

Front 69

When are cocaine related deaths more common?

Back 69

In summer, due to direct
thermoregulatory effects and the
subsequent strain on cardiac reserve.

Front 70

What 2 methods of administration are the most common for cocaine OD?

Back 70

1. IV administration
2. freebase (crack) smoking

Front 71

What is found in the urine that would ID a cocaine user?

Back 71

benzoylecgonine

Front 72

What are the 6 sx of cocaine withdrawal?

Back 72

Generally mild:
Dysphoria
Depression
Sleepiness
Fatigue
Cocaine withdrawal
Bradycardia

Front 73

What is the treatment for cocaine withdrawal?

Back 73

Nothing has shown to be effective.

Front 74

What are the 2 Class II Drugs by the DEA?

Back 74

Cocaine
Amphetamines

Front 75

What 4 drugs are in the class of amphetamines?

Back 75

amphetamine
methamphetamine
phenmetrazine
methylphenidate

Front 76

What 3 MOA for amphetamines?

Back 76

1. increase release of catecholamines, including dopamine
2. weak inhibition of MAO
3. direct catecholaminergic agonists in the CNS

Front 77

What are the CNS effects of amphetamines in the CNS?

Back 77

BEHAVIORAL effects similar to
COCAINE (d/t release of
DOPAMINE and to a lesser degree
NE):
1. increased alertness
2. decreased fatigue
3. depressed appetite
4. insomnia

Front 78

What are the CNS effects of high dose amphetamines in the CNS?

Back 78

PHYCHOSIS
CONVULSIONS

Front 79

What are 2 clinical indications for amphetamines?

Back 79

Attention deficit disorder AND Narcolepsy can both be tx with:
1. amphetamine
2. methylphenidate

Front 80

What are the withdrawal sx of amphetamine use?

Back 80

increased appetite
sleepiness
exhaustion
mental depression

Front 81

What is the tx for withdrawal sx of amphetamine use?

Back 81

Antidepressants

Front 82

What is the second most common CNS stimulant after caffeine?

Back 82

Nicotine

Front 83

What is the second most abused drug after alcohol?

Back 83

Nicotine

Front 84

What is nicotine's MOA?

Back 84

Full selective agonist of nicotinic receptor

Front 85

What does the rewarding effect of nicotine depend on?

Back 85

Stimulation of the ventral tegmental area where nicotinic receptors are expressed on dopaminergic neurons.

Front 86

What happens when nicotine excites these neurons?

Back 86

Dopamine is released in the nucleus accumbens and prefrontal cortex.

Front 87

What are nicotine's actions in low doses?

Back 87

ganglionic stimulation by depolarization

Front 88

What are nicotine's actions in high doses?

Back 88

ganglionic blockade

Front 89

What are nicotine's specific actions in the CNS?

Back 89

Euphoria
Arousal
Relaxation
Improved attention, learning, problem solving, reaction time
Appetite supressant

Front 90

What does the nicotine high-dose ganglionic blockade cause?

Back 90

Central respiratory paralysis
Severe hypotension caused by medullary paralysis

Front 91

What is the amount of nicotine per cigarette?

Back 91

Most cigarettes contain 6-8 mgs of nicotine

Front 92

What is the amount of nicotine per cigarette that a person takes in?

Back 92

1-2 mgs

Front 93

What is the lethal dose of nicotine?

Back 93

60 mgs

Front 94

What percent of inhaled nicotine in smoke is absorbed?

Back 94

90%

Front 95

Is nicotine withdrawal mild, moderate, or severe?

Back 95

mild

Front 96

What are the sx of nicotine withdrawal?

Back 96

irritability
sleeplessness

Front 97

Is nicotine addictive?

Back 97

Nicotine is among the most addictive
drugs and relapse is very common.

Front 98

Can a pregnant/nursing woman smoke?

Back 98

Not advised. Nicotine crosses the placenta and is secreted in breast milk.

Front 99

What is nicotine replacement tx?

Back 99

Nicotine is administered by:
transdermal patch
gum
nasal spray
vapor inhaler
buccal lozenge

Front 100

What other drugs are used for nicotine addiction?

Back 100

Buproprion
*mechanism unclear
Varenicline
*partial agonist at nicotinic CNS receptors

Front 101

What are the most commonly abused opioids by non health professionals?

Back 101

Heroin
Morphine
Codeine
Oxycodone

Front 102

What are the most commonly abused opioids by health professionals?

Back 102

meperidine
fentanyl

Front 103

Do opioids cause dependence and addiction?

Back 103

yes, strongly

Front 104

What does addiction to heroin cause?

Back 104

behavior problems that are
incompatible w/productive life (same
as for other short-acting opioids)

Front 105

Is opioid withdrawal life-threatening?

Back 105

no, but its very unpleasant

Front 106

What are the sx of opioid withdrawal?

Back 106

dysphoria
lacrimation
rhinorrhea
yawning
sweating
weakness
gooseflesh
nausea
vomiting
tremor
muscle jerks
hyperpnea

Front 107

What is the detox regimen for opioid withdrawal?

Back 107

Long acting opioid
Dose slowly reduced

Front 108

What is the DOC for opioid withdrawal?

Back 108

Methadone is preferred
Buprenorphine is next

Front 109

What is an alternative to using an opioid for opioid withdrawal?

Back 109

Use adrenergic agonists

Front 110

What are the 2 presynaptic α2 agonists used for this?

Back 110

Clonidine
Lofexidine

Front 111

Why do they work?

Back 111

1. Tolerance to opioids in the CNS is
mediated by noradrenergic pathways.
2. Withdrawal leads to a rebound firing of the neurons.
3. A noradrenergic storm results
and is responsible for many of the
withdrawal symptoms.
4. Clonidine and Lofexidine
act as presynaptic α2 agonists,
which inhibit this and are able to
attenuate symptoms

Front 112

What is the active ingredient in pot?

Back 112

Δ9-tetrahydrocannabinol
(Δ9-THC, THC, dronabinol)

Front 113

What are the 2 cannabinoid receptor subtypes?

Back 113

CB1 found in brain
CB2 on immune cells

Front 114

What type of receptors are CB1 and CB2?

Back 114

G-protein receptors (Gi)

Front 115

Activation of CB1 and CB2 receptors leads to what?

Back 115

INHIBITION of adenylyl cyclase
Opening of K+ channels
Closing of Ca++ channels

Front 116

What are the 2 endogenous cannabinoid ligands?

Back 116

anandamide
2-arachidonylglycerol

Front 117

THC causes euphoria followed by what?

Back 117

drowsiness
relaxation

Front 118

How does THC affect:
memory?
mental activity?
muscle strength?
motor activity?

Back 118

decreases or impairs all of those functions

Front 119

What are other effects of THC?

Back 119

appetite stimulation
xerostomia
visual hallucinations
delusions
enhancement of sensory activity

Front 120

What are THC AE?

Back 120

increased HR
decreased BP
reddening of the conjunctiva
toxic psychosis (at high doses)

Front 121

What about tolerance and dependence?

Back 121

mild

Front 122

What is therapeutoc THC called?

Back 122

Dronabinol

Front 123

What is dronabinol approved for?

Back 123

Anorexia in AIDS
Nausea, vomiting associated w/cancer chemo

Front 124

What do psychedelic agents affect?

Back 124

thought
perception
mood

Front 125

Do they cause psychomotor stimulation?

Back 125

No

Front 126

Do they cause depression?

Back 126

No

Front 127

Why not?

Back 127

Psychedelic agents are not stimulants or depressants

Front 128

What are the the 3 drugs in the LSD class?

Back 128

LSD
mescaline
psilocybin

Front 129

What are the LSDs similar to?

Back 129

NE, 5HT, Dopamine

Front 130

What are the LSDs MOA?

Back 130

Agonists at 5HT2 receptors in the CNS
(remember 5HT2 receptors inhibit
dopamine release).

Front 131

So, why is inhibition of dopamine important?

Back 131

LSDs are not associated with physical
dependence, addiction, or
withdrawal (which are mainly effects of increased dopamine).

Front 132

What do LSDs have?

Back 132

tolerance develops after 3-4 doses

Front 133

What are normal dose LSDs AE?

Back 133

Hyperreflexia
Nausea
Muscular weakness

Front 134

What are high dose AE?

Back 134

Long lasting psychoses

Front 135

What are the drugs needed to block LDSs hallucinatory effects?

Back 135

Haloperidol and other neuroleptics

Front 136

What was PCP introduced as?

Back 136

anesthetic

Front 137

Due to AE, what was PCP replaced with as an anesthetic?

Back 137

Ketamine

Front 138

What is PCPs mechanism?

Back 138

Non-competitive antagonist at NMDA
subtype Glutamate receptor

Front 139

What does PCP do at higher doses?

Back 139

inhibits reuptake of dopamine

Front 140

What does PCP stand for?

Back 140

phenylcyclidine

Front 141

What sx does normal dose PCP cause?

Back 141

Dissociative anesthesia
(insensitivity to pain w/o loss of consciousness)
Analgesia
Staggered gait
Slurred speech
Muscular rigidity
Behavior can be hostile

Front 142

What sx does PCP cause at high doses?

Back 142

Anesthesia
Stupor
Coma (though eyes remain open)

Front 143

What is another name for MDMA?

Back 143

ecstasy

Front 144

What sx does MDMA cause?

Back 144

Empathy
Intimacy
Tachycardia
Muscle aches
Agitation
Hyperthermia
Seizures

Front 145

What is the MOA for MDMA?

Back 145

*similar to amphetamines
*displaces 5HT from presynaptic
intrabouton vesicles
*preferential affinity for 5HT SERT transporter
*reverses action of transporter and pumps out 5HT

Front 146

What is the affect of a single dose of MDMA?

Back 146

almost complete depletion of 5HT
reserves inside the cell for 24 hours
after the single dose

Front 147

What are the sx of MDMA withdrawal?

Back 147

Mood offset
Depression
Lasts several weeks
Produces degeneration of serotonergic
neurons in rats

Front 148

What does nitrous oxide inhalant cause?

Back 148

35% N2O mixed with O2
euphoria
analgesia
loss of consciousness

Front 149

What does 100% N2O cause?

Back 149

asphyxia
death

Front 150

Who sniffs volatile organic solvents (VOS) like paint thinner?

Back 150

teen boys from lower SES

Front 151

What are the sx of VOS use?

Back 151

exhilaration
light-headedness

Front 152

What are some toxic effects of VOS?

Back 152

Cancer
Cardiotoxicity
Neuropathy
Hepatotoxicity

Front 153

What organic nitrites are abused and what are their sx?

Back 153

Amyl nitrite: dilates smooth mm,
enhances erection, used in angina
Butyl nitrite: enhances erection

Front 154

What are anabolic steroids used for?

Back 154

Used to increase mm size in
body-building competitors.