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62 Cards in this Set
- Front
- Back
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Define psychological dependence
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compulsive drug seeking behavior driven by the mind, deprivation of drug causes intense craving, often precedes physiologic depndence
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define physioloigcal dependence
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body drives dependence, trying to regain a balance after the drug is removed, asscoiated with tolerance
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define addiction
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vague term related to psychological and physiological dependence
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define tolerance
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decreased response to drug that requires more drug to get same response
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what are the principals of detox?
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substitute a longer acting drug (less severe withdrawal), a orally acitve drug (avoid psychology of injecting/shooting), a pharmacologically equivalent drug and stabilize the patient on the substituted drugs then slowly withdraw it
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What is part of the reward pathway?
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the nucleus accumbens and the VTA
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what is the main iliicit opioid used in the US?
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heroin
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what is the half life and method of administratin with heroin?
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short half life (3-5 hours) and it is given by IV = produces HIGH peak blood and CNS levels
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How is heroin overdose treated?
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naloxone or nalmefene
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what are the legal opioids of abuse?
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oxycodone and hydrocodone
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what are the symptoms of opioid withdrawal?
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lacrimation, rhinorrhea, yawning, seating, weakness, goose bumps, nausea, vomiting, tremor, muscle jerks, hyperpnea
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what is used as a substitute for opioids?
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methadone - long acting (daily) orally active mu agoinst; and buprenorphine - my partial agonist/kappa antagonist
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what is used to lessen opioid withdrawal symptoms?
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alpha2 agonists - clonidine; decreases sympathetic outflow
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are longer acting or shorter acting benzo's abused?
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shorting acting - valium
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what are the affects of BZD and barbiturates?
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similar to ethanol, disinhibition followed by drowsiness
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what type of depenence occurs with BZDs?
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psychological
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what are the symptoms of BZD withdrawal?
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similar to ethanol - derived from excessive CNS sitmulation, anxiety, tremor, nausea, twitches, cold-like syndrome, seizures
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what can help ease the symptoms of BZD withdrawal?
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clonidine or propranolol
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what is therapeutic withdrawal of BZD?
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classic withdrawal + weight loss, paresthesia and headache
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what is the withdrawal syndrome of caffeine?
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lethargy, irritability, headache
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what is the toxicity of nicotine and caffeine due to?
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excessive CNS stimulation
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what is the M.O. of cocaine?
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inhibits dopamine and NE reuptake systemically and non-specifically
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what can happen in a cocaine OD?
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hypertensive crisis - can cause death
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what is the M.O. of amphetamines?
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release of catecholamines (including dopamine) into the synaptic cleft
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what is dextroamphetamine?
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a major member of the amphetamine drug class
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what is methamphetamine?
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"speed" - preferred amphetamine of abuse due to ease of synthesis from pseudoephedrine
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what is the preferred route of administration of methamphetamine?
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IV, can be smoked
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What is methylphenidate?
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ritalin -an amphetamine used for ADHD
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what is methylenedioxymethamphetamine?
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MDMA - ecstasy; has more hallucinogenic than stimulant effects
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what are the withdrawal symptoms of amphetamines?
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increased appetite, sleepiness, exhaustion, mental depression
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what are the symptoms of amphetamine OD?
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aggitation, restlessness, tachycardia, hyperthermia, hyperreflexia, possibly seizures
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what are the effects of stimulate OD?
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it is rarely fatal however, MDMA can cause hyperthermia and death
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what drugs mimic psychoses in most patients?
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hallucinogens
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What system do hallucinogens NOT affect?
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dopaminergic
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What is the M.O. of PCP?
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blocks NMDA channels
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What is the M.O. of LSD?
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5HT-2A partial agonist
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are hallucinogens associated with dependence?
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No typically
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what are the symptoms of hallucinogen OD?
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"bad trip", acute psychosis, sympathetic overstimulation
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what are the 3 major cannabinoids?
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cannabidiol (CBD), delta-9-tetrahydrocannabinol, cannabinol
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how is MJ administered?
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smoking - THC is very lipid soluble
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what are the physiological signs of cannabis intoxication?
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increased pulse rate and reddening of the conjunctiva
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is MJ addictive?
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yes, some people are very susceptible
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what are the withdrawal symptoms of MJ?
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irritability, insomnia, mood changes
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what is the treatment for MJ withdrawal?
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anxiolytics and risperadone
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what happens in heavy long term MJ use?
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changes in cognition - attention and learning
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how is ethanol absorbed?
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rapidly by the GI tract - food delays absorption; peak concentration 30 minutes after administration
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how is ethanol metabolized?
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90% is oxidized in the liver, the majority of the rest is excreted in the urine
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what are the 3 major pathways of alcohol metabolism?
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1. alcohol dehydrogenase (men>women), 2. microsomal ehtanol oxidizing systems or mixed funciton oxidase system; 3. aldehyde dehydrogenase
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what are the kinetics of the alcohol dehydrogenase pathway?
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saturable kinetics, excess NADH is produced - can lead to emtabolic disorders
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when does the microsomal ethanol oxidizing system or mixed function oxidase system metabolize ethanol?
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when blood levels are high
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what enzyme do some asians lack that causes them to get sick easily with ethanol consumption?
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mitochondrial aldehyde dehydrogenase
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what does disulfiram do to ethanol metabolism?
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it inhibits aldehyde dehydrogenase = buildup of acetaldehyde = get sick, flushed when alcohol is consumed
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what is the M.O. of ethanol?
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no specific receptor, GABA-a agonist increase ethanol's effect; GABA-b antagonists decrease alcohol's effect; NMDA antagonist mimics the toxic effects of alcohol
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What happens to the CNS with ethanol use?
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relief of anxiety, sedation, intoxication at higher doses - slurred speech, imparied judgement, disinhibited behavior; severe CNS depression can occur (respiratory depression, coma)
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What happens to smooth muscles with ethanol use?
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vasodialtion due to effects on vasomotor center in the CNS, direct vasodilationby acetaldehyde, relaxes the uterus
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what happens to the liver with chronic alcohol use?
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liver disease that progresses from fatty liver to alcoholic hepatitis to cirrhosis
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what is the M.O. of liver disease with ethanol use?
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increased NADH/NAD ration leads to decreased gluconeogenesis, hypoglycemia and ketoacidosis and increased triglyceride synthesis = increased fat in the liver; there is also increased acetaldehyde buildup which direclty damages liver cells and increases inflammation
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what occurs in the GI tract due to chronic ethanol use?
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increased gastric and pancreatic secretions that breakdown the mucosal barrier = increased incidence of ulcers, can lead to malabsorption
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what are the symptoms of ethanol withdrawal?
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hyperexcitability, convulsions, delirium tremen (extreme confusion, agitation, hallucinations) usually starts 24-72 hours after last drink
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what is the M.O. of ethanol withdrawal?
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NMDA and GABA-a receptors are implicated, especially in seizures
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what is the importance of FAS?
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the leading cause of mental retardation and congenital birth defects in the US
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what are the manifestations of FAS?
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microencephaly, poor coordination, underdevelopment of midfacial region, minor joint abnormalities
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