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15 Cards in this Set
- Front
- Back
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1. Define and describe tolerance, dependence, addiction; be able to differentiate between these three responses in a case study.
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a. Tolerance: Physiological adaptation to drug so that drug dose is less effective.
b. Dependence: Physiological adaptation to drug so that body needs drug to function normally. c. Addiction: Compulsive use and impaired control over drug use despite harm. |
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2. Identify the 4 main mechanisms by which tolerance can occur. DEPendence
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a. down regulation Receptor/enzyme
b. desensitization Receptor c. Enhanced drug metabolism d. Physiological adaptation |
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3. Recognize which of the above responses from question 1 are common and expected with long-term opioid treatment for chronic pain and which are NOT.
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a. Tolerance and dependence are expected, addiction is not.
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Addiction is characterized by _____ _____ and _____ ______.
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compulsive use, impaired control
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4. Describe the two events that can induce opioid withdrawal. Know that opioid withdrawal syndrome is not life threatening.
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a. Abrupt reduction in dosage
b. administration of an antagonist |
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5. List the three pharmacological methods of treating opioid withdrawal syndrome.
(you don’t need to identify clonidine or benzodiazepines.) |
a. Opioid administration to reduce acute withdrawal
b. Taper dosages c. Symptom-mitigation drug therapy |
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6. Be able to counsel a patient that addiction produced by appropriate opioid use is very rare. Be able to give the percentage of all long-term opioid treated patients who become addicted. Be able to do this in a fill-in-the-blank.
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a. Long term opioid treated patients over all have a 3% chance of becoming addicted. If you do not have any previous addiction or substance abuse in your past that rate falls to 0.2% addiction rate.
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7. Describe the mechanism of addiction that all addictive drugs/activities have in common. Know the neurotransmitter and the brain areas involved. If you get this as an essay question, make sure you can spell everything correctly- this is part of professional communication.
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a. All addictive drugs/activities INCREASE Dopamine release in the Nucleus Accumbens. Reward pathways work by activating VTA dopaminergic neurons to release DA in the NA.
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8. List the 4 factors that govern addictiveness of a drug; be able to identify which of a list of hypothetical drugs will be most addictive based on a description of these properties.
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a. #1 – Rapidity of effect
i. Drug delivery addiction rate: Freebase > Intravenous > Intranasal SMOKE > VEIN > NASAL b. Lipophilicity. Heroin and phentinyl both cross BBB fast c. Efficacy of DA release d. Purity of sample |
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9. Rank the addictive potential of the agents listed on slide 33:
Alcohol Crack > powder cocaine Marijuana Methamphetamine Nicotine Opioids (recreational) Opioids (with pain) |
MC NOAM
1. Methamphetamine 2. Crack > powder cocaine 3. Nicotine 4. Opioids (recreational) 5. Alcohol 6. Marijuana 7. Opioids (with pain) |
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10. List the three major drugs used for long-term treatment of opioid addiction (BUPRENORPHINE, NALTREXONE, METHADONE), and contrast their receptor activities AND the differences in their anti-addictive action. For example, for each drug, answer (if applicable): does it decrease craving (and how), does it decrease withdrawal symptoms (and how), does it block illicit opiate action (and how)?
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a. Buprenorphine:
i. PA @mu, ANTAG @k-receptors ii. Blocks withdrawal and craving w/o narcotic high iii. Blocks illicit opiate action by slow dissociation from receptor (CI) b. Methadone i. Allows slow tapering off of dose and block additional “highs” ii. Blocks withdrawal and craving (agonist effect) without producing strong narcotic high because of gradual onset of activity. iii. Blocks other opioids from giving a kick because the receptors are already occupied. c. Naltrexone i. ANTAG @mu + kappa. ii. Instant reversal of mu overdose, but may need to give repeated doses as only 1-2 hr duration of action |
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11. For naloxone (Narcan), naltrexone (Revia), and nalmefene (Revex), Know that they cross the BBB and therefore would induce withdrawal symptoms if given to a patient who is currently opioid dependent. Classify them as short, mid, or long duration and know their most common use.
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a. Naloxone (Narcan): Short duration of action. Used for instant reversal of mu overdose
b. Nalmefene (ReVex): Mid duration. Used to reverse opioid anesthetics in surgery (analgesic) c. Naltrexone (ReVia): Long duration. Used as maintenance therapy for addicts who are no longer phycially dependent. Also to treat alcoholism |
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12. Explain the two reasons why naloxone would not be a good maintenance therapy for opioid addiction (as opposed to naltrexone).
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a. Naloxone only has 1-2 hr duration – would require way to many doses / day while naltrexone is 1 ever 1-2 days.
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13. Be able to explain why adding naloxone to a P.O. opioid would reduce injection abuse.
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a. Naloxone is only active when administered IV, so it would act as an antagonist to any opioid that was tried to be injected.
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14. For Alvimopan (Entereg) Know that it does not cross the BBB. Know its recommended use.
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a. A mu ANTAG Used to prevent post-op ileus or treat constipation in palliative care. Dose not induce withdrawal.
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