Pharm Drugs Of Abuse

Front 1

(Big Picture question)
What are the drug of abuse classes?

Back 1

1) Alcohol
2) Nicotine
3) Cannabis
4) Sedatives (benzodiazepines, barbiturates, gamma-hydroxybutyrate
5) Opioids
6) Stimulants (Marijuna)
7) Hallucinogens

Front 2

What type of disease is substance abuse?

Back 2

A chronic relapsing disease.

Front 3

Most substance dependence starts...

Why?

Back 3

Young

High incidence of impulsive behavior occurs during this time.

Front 4

True/False: If the pleasurable experience of using drugs outweighs the negative experience, it can lead to repetitive use.

Back 4

True

Front 5

True/False: Substance dependence includes on-going use DESPITE significant problems with its use.

Back 5

True

Front 6

What is the "pleasure neurotransmitter?"

Back 6

Dopamine

Front 7

Increased dopamine levels can be achieved by? (2 general routes)

Back 7

Drug Induced
Natural High

Front 8

Alcohol --> Acetaldehyde --> Acetic acid --> Carbon dioxide

Which of these metabolites can cause adverse effects in high concentrations (flushing, nausea, headache, increased heart rate)?

Back 8

Acetaldehyde

Front 9

True/False: Nicotine is highly toxic.

Back 9

True

Front 10

Who are uniquely susceptible to thrid hand smoke?

Back 10

Children

Front 11

Treatment for nicotine...
Toxicity?

Rehab/Abuse?

Back 11

1) N/A

2)
Bupropion
Varenicline
Nicotine Replacement Therapy

Front 12

MOA of Nicotine?

Back 12

Agonist at Nicotinic Cholinergic receptors.

Also directly depolarizes DA neurons.

Front 13

Symptoms of Nicotine...
Toxicity?

Withdrawal?

Back 13

1) N/A

2) Irritability, restlessness, insomnia, anxiety, cough/dry throat, decreased heart rate, hypotension

Front 14

MOA of Bupropion?

Any risks of seizures? In what patients?

Back 14

Blocks reuptake of DA and NE.

Decreases appetite/Weight loss. Helps with depression.

(Risk of seizure in anorexic patients).

Front 15

MOA of Varenicline?

Used for what?

Adverse effects?

Back 15

MOA: Partial agonist at Nicotinic acetylcholine receptors (alpha 4, beta 2).

Uses: Decrease craving and reward properties of smoking.
*Very effective

AE:
Nausea and Vomiting
Mood and Sleep disturbances

Front 16

MOA of Cannabis?

Back 16

THC is Agonist at CB1 receptor.

Inhibits Ca2+ and Na+ channels
Stimulates inward rectifying K+ channels
MAP Kinase Pathway

Front 17

Signs/Symptoms of Cannabis...
1)Toxicity?

2)Withdrawal?

Back 17

1) Euphoria, drowsiness/sedation, tachycardia, sensation of slowed time, increased appetite, dilation of conjunctival blood vessels, slowed reaction time.

2) Insomnia, irritability, dysphonia, anorexia, weight loss, hand tremor, and mild fever.

Front 18

Regular use of cannabis may be associated with an earlier onset of what?

Back 18

Psychotic symptoms.

Front 19

What treatment can you give for cannabis rehab/abuse?

Back 19

N/A

Front 20

MOA of Benzodiazepines?

Back 20

Bind GABA A receptor and increase frequency of channel opening, aka keep high influx of Chloride ion into neuron (hyperpolarizing neuron).

What neuron though? An inhibitory interneuron that has it's effects on Dopaminergic neurons originating in the Ventral Tegmental Area (VTA).

So it blocks/prevents (disinhibits) the inhibitory interneuron from working, which results in increased DA release.

Front 21

Signs/symptoms of Benzodiazepines during...
1) Toxicity/overdose?

2) How do you treat withdrawal of Benzodiazepines?

Back 21

1) Hypothermia, Nystagmus, Miosis, Diplopia, Hypotension, Bradycardia, Ataxia+dyskinesias

2) Long-acting barbiturates or benzodiazepines (why? b/c all drugs are cross resistant in this family)

Front 22

Treatment for toxicity of benzodiazepines?

Back 22

Flumazenil (use with caution)

Front 23

Flumazenil MOA?

Risks?

Back 23

Competitive antagonist for Benzodiazepine sites, allowing for a reversal of overdose/toxicity.

Risk of seizure.
Could precipitate withdrawal symptoms in pts on chronic benzodiazepines.

Front 24

Treatment for benzodiazepine rehab/abuse?

Back 24

Long-acting Barbiturates or Benzodiazepines.

Front 25

gamma-hydroxybutyric acid (or GHB)'s MOA?

Back 25

Acts at multiple sites including GHB and GABA B sites, working rapidly.

Front 26

gamma-hydroxybutyric acid alone (or with alcohol) will do what to a person?

Back 26

(Club drug/date rape drug)
Produce rapid onset coma and respiratory depression.

Memory loss
Euphoria

Front 27

True/False: gamma-hydroxbutyric acid has a narrow therapeutic index.

Back 27

True

2x the dose used to produce euphoria, memory loss, drowsiness and sleep will lead to produce coma.

Front 28

MOA of Opioids?

Back 28

mu receptor agonist
Decreases GABA
Increases Dopamine release from PIN

Front 29

Opiod toxicity signs/symptoms?

Back 29

Respiratory Depression (can lead to death)
Euphoria/hallucinations
Hypotension
Constipation
Urinary Retention
Pupil constriction (miosis)
Flushed, warm skin
Nausea and vomitting

Front 30

Withdrawal signs/symptoms of opioids?

Back 30

Panting+yawning, Diarrhea, Mydriasis, Dysphonia, Insomnia, Chills+goosebumps, Hyperthermia, Hypertension

Tx with Clonidine
(decreases sympathetic tone)

Front 31

What drug would you give to treat opioid toxicity?

Back 31

Naloxone

Front 32

What is naloxone's MOA?

How is it administered, why?

Why is it used?

Back 32

Mu receptor competitive antagonist.

Only active when given PARENTERALLY.

Used to reverse overdose of opioids.

Front 33

In order to prevent abusers from getting high off IV administered Buprenorphine...

Back 33

Naloxone is complexed with Buprenorphine. So if abuser tries to burn and inject, Naloxone will block high from Buprenorphine.

Front 34

Naltrexone is a treatment for?

Back 34

Tx Rehab/Abuse of:
Alcohol
Opioids
Cocaine (stimulants)

Front 35

Naltrexone's MOA?

Back 35

(Opioid receptor antagonist)
Specifically...
mu and k antagonist
k = kappa

Front 36

Administration type for Naltrexone?

Back 36

PO (per oral)

Front 37

Naltrexone is used for a few things including Tx rehab/abuse of alcohol, opioids, and cocaine.

Which of the three does it decrease the craving for?

Back 37

Alcohol
Cocaine

(Does not reduce craving for opioids)

Front 38

Buprenorphine MOA?

Administered how?

DOA?

Use?

Back 38

Competetive partial agonist for mu receptors (can displace opioids, has slow dissociation (aka prolonged therapeutic effect))

Sublingual (can only be given by certified physicians (office)).

DOA = 24 hours

Use: Prevents withdrawal and decreases craving for Opioids.

Front 39

Methadone MOA?

Administration?

DOA?

Use?

Back 39

mu agonist (synthetic opioid)

PO, (given only in special clinics)

Long DOA

Helps suppress craving as an Opioid rehab/abuse Tx.

Front 40

Cocaine MOA?

Back 40

Inhibits reuptake of 5-HT, NE, and DA.

Front 41

Amphetamine MOA?

Back 41

Induces release of neurotransmitters from presynaptic terminals/vesicles.
Binds MAO.
Binds DA reuptake site.

Front 42

Signs/symptoms of cocaine toxicity?

Back 42

Increased energy, stimulation, decreased need for sleep, anorexia, autonomic arousal, confusion, chest pain, cardiac arrhythmias, respiratory depression, seizures.

Front 43

Signs/symptoms of cocaine withdrawal?

Back 43

Dysphoria, fatigue, psychomotor retardation, increased appetite, craving.

Front 44

Disulfuram MOA?

Used for?

Back 44

Inhibits DA beta-hydroxylase and breakdown of DA.
Decreased NE production.

Rehab/abuse Tx for stimulants (cocaine, amphetamine)

Front 45

Bupropion's use in stimulant rehab/abuse tx?

Back 45

It's being tested for methamphetamine addition treatment.

Front 46

Alcohol MOA?

.........idk if the answer is right

Back 46

(First three most important)
Enhances GABA
Inhibits NMDA and AMPA receptors
Potentiates Nicotinic ACh,

Potentiate Glycine, and 5-HT3 receptors.
Blocks voltage-gated L-type Ca++ channels.
Opens K+ channels, etc...

Front 47

Signs/symptoms of alcohol toxicity?

Treatment for alochol toxicity?

Back 47

Ataxia, emotional instability, impaired judgement, nystagmus.

No treatment for it.

Front 48

Signs/symptoms of alcohol withdrawal?

Treatments for alcohol withdrawal?

Treatment for alcohol toxicity?

Back 48

Delirium, disorientation, alcoholic hallucinosis (hallucinations, illusions, vivid nightmares), convulsions, delirium tremens.

Treatments include:
Benzodiazepines (diazepam, lorazepam, oxazepam)
Carbamazepine, Valproate
Clonidine (as an adjunct)

No treatment for alcohol toxicity.

Front 49

What drugs can you use for opioid rehab/abuse treatment?

Back 49

Naltrexone
Buprenorphine
Methadone

Front 50

What drugs can you use for nicotine rehab/abuse treatment?

Back 50

Bupropion
Varenicline

Front 51

What drugs can you use for cocaine/stimulant rehab/abuse treatment?

Back 51

Disulfuram
Naltrexone
Bupropion