Pharm. - Drug Abuse

Front 1

definition of drug abuse

Back 1

the non medical use of a substance for any of three reasons:
1. psychic effect
2. dependence
3. suicide attempt/gesture

Front 2

how do you assess abuse liability of a medication?

Back 2

it's self administration factor

Front 3

self administration is tested with

Back 3

animal models (rats + lever)

Front 4

do humans generally self administer the same substances that animals do?

Back 4

yes, there is a 98% correlation

Front 5

2 exceptions to self administration

Back 5

1. hallucinogens
2. THC

Front 6

why don't rats self administer THC?

Back 6

slow onset and slow effect

Front 7

what changes the rats' self administration of THC?

Back 7

if they have a history of self administering another drug, they also tend to self administer THC

Front 8

tolerance definition (2 ways)

Back 8

1. the effect of a dosage decreases with repeated administration
2. a higher dosage is needed to produce the same effect with repeated administration

Front 9

three mechanisms for the development of tolerance

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1. dispositional tolerance
2. pharmacodynamic tolerance
3. behavioral tolerance

Front 10

dispositional tolerance is due to

Back 10

changes in the pharmacokinetic properties (movement: absorption, distribution, metabolism, or elimination) (example: body keeps making more enzymes)

Front 11

pharmacodynamic tolerance is due to

Back 11

adaptive changes in the affected systems (ex. down regulation of receptors)

Front 12

behavioral tolerance definition

Back 12

an individual alters their behavior in order to adapt or compensate for the presence of a drug

Front 13

cross tolerance definition

Back 13

if someone is tolerant to a drug, they will also be tolerant to another drug with the same M of A

Front 14

two types of dependence

Back 14

1. physical dependence
2. psychological dependence

Front 15

physical dependence is defined by the presence of?

Back 15

withdrawals.

Front 16

when pts are physically dependent on a drug, they take it for 2 reasons

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1. to alleviate withdrawal symptoms
2. to get high

Front 17

do all drugs of abuse produce physical dependence?

Back 17

NO

Front 18

behavioral/psychological dependence definition

Back 18

behavioral dependence is the enduring problem with drug abuse. it can orruc independently of physical dependence. This is what causes the problems at work and is the "control" issue.

Front 19

when pts are psychologically dependent on a drug, they take it why?

Back 19

to get high only

Front 20

do all drugs of abuse produce psychological dependence?

Back 20

YES

Front 21

cross dependence definition

Back 21

if you are dependent on one substance, you can alleviate withdrawal symptoms if you take a drug with the same M of A

Front 22

true or false: most drug abusers abuse a single drug

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false. most abusers are polydrug abusers.

Front 23

8 general types of abusive drugs

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1. cannabinoids
2. CNS stimulants
3. dissociative anesthetics
4. hallucinogens
5. opioids
6. sedative hypnotics
7. volatile intoxicants
8. nicotine

Front 24

4 types of CNS stimulants

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1. amines
2. caffeine
3. cocaine
4. amphetamines

Front 25

an example of an amine CNS stimulant

Back 25

ritalin

Front 26

CNS stimulants M of A

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indirect acting sympathomimetic

Front 27

do CNS stimulants have physical dependence?

Back 27

yes, it is weak

Front 28

what does CNS stim. dependence look like?

Back 28

depressive symptoms

Front 29

do CNS stims. have tolerance?

Back 29

yes, differential tolerance to some of the effects

Front 30

CNS stim. OD 2 signs

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1. psychosis
2. CV

Front 31

tx psychotic signs of CNS stim OD

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first generation antipsychotics

Front 32

tx CV signs of CNS stim OD

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beta blockers
antiarrhythmics

Front 33

tx dependence of CNS stimulants

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antidepressants

Front 34

name 2 cannabinoids

Back 34

1. THC (weed)
2. anandamide

Front 35

cannabinoids M of A

Back 35

act on CB1 receptors in brain and CB2 receptors in periphery

Front 36

do cannabinoids have physical dep.?

Back 36

not really, very weak

Front 37

to cannabinoids produce tolerance?

Back 37

yes

Front 38

tx of cannabinoid OD

Back 38

Rimonabant

Front 39

name 2 dissociative anesthetics

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1. ketamine
2. PCP

Front 40

dissociative anesthetics M of A

Back 40

glutamate receptor antagonists (glutamate is the major excitatory neurotransmitter)

Front 41

do dissociative anesthetics have physical dependence?

Back 41

yes, withdrawals are LIFE THREATENING

Front 42

do dissociative anesthetics produce tolerance

Back 42

yes

Front 43

dissociative anesthetics tx of OD

Back 43

life support (due to resp. depression)

Front 44

dissociative anesthetics tx of withdrawal

Back 44

anticonvulsants

Front 45

dissociative anesthetics dependence tx

Back 45

none

Front 46

name 4 types of hallucinogens

Back 46

1. tryptamines
2. phenalkylamines
3. phenethylamines
4. anticholinergics

Front 47

name a tryptamine

Back 47

LSD

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name a phenalkylamine

Back 48

MDMA (ecstacy)

Front 49

LSD and ecstacy M of A

Back 49

5HT2A agonists

Front 50

name 3 anticholinergics

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1. atropine
2. scopolamine
3. angel's trumpet

Front 51

anticholinergic M of A

Back 51

muscarinie receptor antagonists

Front 52

do hallucinogens produce physical dependence?

Back 52

not really, weak

Front 53

do hallucinogens produce tolerance?

Back 53

yes, very rapid tolerance and cross tolerance if same M of A

Front 54

tx of OD of LSD or MDMA

Back 54

5HT2A antagonists (geodon, risperidone)

Front 55

tx of OD of atropine/scopolamine/angel's trumpet

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cholinesterase inhibitor (physostigmine)

Front 56

name 4 opioids

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1. morphine
2. meperidine
3. fentanyl
4. codeine

Front 57

opioids M of A

Back 57

act at mu opioids receptors

Front 58

do opioids produce physical dependence and is it life threatening?

Back 58

yes, but it is NOT life threatening

Front 59

do opioids produce tolerance?

Back 59

yes, but like the CNS stimulants produce differential tolerance to some effects but not all. (ex you produce tolerance to the pain relief but not to the constipation)

Front 60

opioids OD tx

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Narcan

Front 61

Narcan 1/2 life

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30 minutes

Front 62

opioid tx withdrawal

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none

Front 63

opioids tx dependence (3 ways)

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1. substitution therapy
2. antagonist therapy
3. contingency therapy

Front 64

example of substitution therapy

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methadone

pt will be on methadone for weeks/months

Front 65

example of antagonist therapy

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naltrexone (naloxone/narcan but with a 24 h half life)

pts are on this for years, esp. healthcare professionals, pilots, etc. who cannot ever become dependent again.

Front 66

example of contingency therapy

Back 66

dilsulfiram (antabuse) produces very nasty symptoms. An alcoholic takes antabuse and then drinks (nausea/vomiting/etc.)

Front 67

if you give an antagonist to an opioid addict, what can happen?

Back 67

you can precipitate rapid and unpleasant withdrawal symptoms (ex. giving Narcan will make the pt unhappy)

Front 68

name 2 types of sedative hypnotics

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1. benzos
2. barbs
3. chloral hydrate

Front 69

sedative hyp. M of A

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act as GABAa modulators

Front 70

do sed-hypn. cause physical dependence?

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yes, and it can be LIFE THREATENING

Front 71

sedative hypnotic BENZO OD treatment

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benzo antagonist:
1. flumazenil

Front 72

sedative hypnotic BARB/ETOH OD treatment

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life support

Front 73

sedative hypnotic tx of ETOH withdrawals

Back 73

benzos

Front 74

sedative hypnotic tx of ETOH dependence

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benzos

Front 75

name 3 types of volatile intoxicants

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1. anesthetics
2. solvents
3. amyl nitrates (poppers)

Front 76

ex. of abusive anesthetics

Back 76

nitrous oxide
ether

Front 77

ex of abusive solvents

Back 77

airplane glue, paint thinner, spray paint

Front 78

volatile intoxicant M of A

Back 78

unknown specifics, however has been shown to produce cross tolerance with CNS depressants so most likely has a GABA component

Front 79

volatile intoxicant physical dependence

Back 79

weak, due to very short duration of action

Front 80

do volatile intoxicants produce tolerance?

Back 80

yes

Front 81

volatile intoxicant OD tx

Back 81

life support, anticonvulsants if seizures