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59 Cards in this Set
- Front
- Back
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% of adults who have used illegal drugs?
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15.6% (29 million)
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% of people that abuse drugs?
% that are currently dependent? |
abuse: 3.1% (5.8 million)
dependent: 2.9% (5.4 million) |
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% of people that have ever used marijuana?
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40%
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% of people that have ever used pain meds?
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10-15%
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% of people that have used marijuana in past 12 months?
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10%+
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Major risk factor for drug use?
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genetics (40-50%)
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DSM-IV Criteria for Dependence:
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=maladaptive behavior that leads to clinically significant impairment or distress, as manifested by 3 OR MORE of the following:
1. Tolerance - need more to get same effect 2. Withdrawl - marker of physical dependence: signs/symptoms appear when drug is stopped and cease when drug is used 3. taken in larger amts than intended 4. persistent desire or unsuccessful efforts to cut down or control use 5. lots of time spent getting drug, using, or recovering 6. give up important social/job/recreational activities b/c of usage 7. continued use despite recognition that it is causing problems |
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DSM-IV Criteria for Abuse:
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=maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by ONE OR MORE of the following at any time in the same 12-month period:
1. recurrent use resulting in failure to fulfill major roles at work, home, school 2. recurrent use in situations where it is physically hazardous 3. recurrent substance-related legal problems 4. continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by effects of the drug |
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Why are dependence and abuse considered to be mutually exclusive?
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with abuse there are never the symptoms that are associated with dependence
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Abusers of what drugs are most likely to become dependent?
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1. tobacco - 32%
2. heroin - 23% 3. cocaine - 17% 4. EtOH - 15% 5. stimulants - 11% 6. marijuana - 9% |
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What brain region is related to a drug's ability to control behavior?
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mesolimbic dopaminergic pathway (VTA --> nucleus accumbens --> prefrontal cortex) = "pleasure center" or "reward center"
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What process alters the brain with chronic drug use that makes people susceptible to relapse?
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Neuroadaptations - since these changes occur, addiction and dependence are now considered to be diseases
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What Schedule is cocaine?
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Schedule II
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Medical uses of cocaine? (2)
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1. local anesthetic - replaced by synthetic local anesthetics
2. topical anesthetic - blocks nerve conduction and vasoconstricts |
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What substance is measured in urine test to check for cocaine?
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benzoylecgnonine
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What substance is found in the body when cocaine is ingested w/ EtOH?
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Cocaethylene (active metabolite)
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What body parts can cocaine metabolites be measured from?
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urine
saliva hair meconium breast milk |
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How does cocaine block nerve conduction?
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reduces Na+ conductance
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What is the primary site of action of cocaine and other stimulants?**
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the monoamine transporter**
i.e. more DA in synapse |
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How do cocaine and amphetamines increase DA levels in the synapse?
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cocaine: blocks presynaptic reuptake of DA
amphetamines: stimulates the release of monoamines (produces non-physiologic levels) |
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Signs of cocaine intoxication:
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euphoria
AROUSAL* increased energy and activity decreased appetite self-confidence "rush" (orgasmic) increased HR and BP* bronchodilation pupillary dilation |
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When is the withdrawl peak from cocaine?
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2-4 days
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Drugs to treat cocaine overdose/intox:
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propranolol
diazepam Ca++-channel blockers |
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Drugs to treat symptoms of cocaine withdrawl:
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bromocriptine
diazepam time |
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What is the pharmacological treatment for long-term addiction?
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does not exist!
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Physio consequence of amphetamine abuse?
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evidence of neurotoxicity to DA and 5-HT neurons (i.e. loss of nerve terminals)
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What kind of a substance are amphetamines?
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phenylethylamine (synthetic)
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Medical uses for amphetamines? (3)
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1. obesity
2. narcolepsy 3. ADD |
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Dependence on amphetamines is related to what brain region?
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mesolimbic dopamine system
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Prescription Amphetamines (2):
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Adderall
Ritalin |
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How can signs and symptoms of cocaine and amphetamines be distinguished?
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they are the same!
(withdrawl symptoms are also the same) |
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other clues for amphetamine use:
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HIV
hepatitis "track marks" abscesses bacterial endocarditis chronic respiratory symptoms |
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What amphetamine is commonly used at raves?
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MDMA = ecstasy
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What does MDMA neurotoxicity cause?
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degeneration of 5-HT terminals
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Medical uses of opioids?
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pain
diarrhea cough |
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What are 2 prescription opioids?
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Oxycontin
Vicodin |
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Pharmacokinetics of heroin?
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heroin is a prodrug that is metabolized to morphine (active half-lfe of 1.9 hours)
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What receptor is involved in opiate abuse?
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mu
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What receptors are are responsible for pharm effects of opiates?
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mu
kappa delta |
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What receptors mediate the pharmacodynamic effects of opiates?
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Mu, delta, and kappa receptors**
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What are the signs and symptoms of opiate/heroin abuse?
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Miosis
Respiratory depression* Unconsciousness Bradycardia Hypotension Pulmonary edema |
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What are the withdrawl symptoms from opiates/heroin? When do they occur?
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Withdrawl symptoms occur after 7-10 days:
Anxiety, dysphoria, carving, drug-seeking, sleep disturbances, nausea, vomiting*, diarrhea*, lacrimation, rhinorrhea, yawning, sweating*, mydriasis*, cramps, hyperpyrexia, involuntary movements |
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what drug is used to treat opioid overdose?
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naloxone
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Naloxone:
-use? -why must it be closely monitored? |
use: treat opioid overdose
monitor closely b/c it has a shorter 1/2-life than heroin so person may look fine, but then go back into overdose symptoms (which may lead to death) |
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What drugs are used to detox an opiate abuser? How are they given?
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methadone
buprenorphine give as tapered dose |
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What's a problem w/ rapid detoxification from opiate overdose?
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can be very dangerous --> death
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What drug is used alone or w/ methadone/buprenorphine to treat opioid withdrawl?
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clonidine
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Clonidine:
-use? -MOA? |
use: treat opioid withdrawl
MOA: alpha-2 adrenergic agonist --> blocks autonomic hyperactivity (i.e. blocks withdrawl symptoms) |
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What drug is used to prevent heroin relapse?
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naltrexone ("r" for relapse)
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Naltrexone:
-use? -MOA? |
use: prevent heroin relapse
MOA: antagonist |
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What drug is used as substitution therapy* for heroin addiction?
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methadone
(note: substitution therapy is aka agonist therapy - develop cross-tolerance and prevents withdrawl by activating mu receptors) |
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Problems w/ Methadone therapy?
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1. only dispensed in federally licensed clinics (physicians cannot prescribe!)**
2. controversy about substituting one drug for another |
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Buprenorphine:
-use? -MOA? -advantages? -disadvantages? |
use: substitution therapy for heroin
MOA: partial mu agonist** - both an agonist and antagonist; blocks heroin effects advantages: 1. less liability and toxicity than methadone 2. physicians can get a waiver so they can prescribe it** (only to 100 patients) 3. easier to taper; less S/Es disadvantages: not as good as methadone (especially for highly dependent people) |
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What is the active constituent of marijuana?
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delta-9-tetrahydrocannabinal (THC)**
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Name of the THC prep used for medical purposes?
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dronabinol (Marinol)
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Receptor activated by marijuana?
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cannabinoid receptor*
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Newly discovered neurotransmitter that activates cannabinoid receptors?
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anandamide (an endocannabinoid)
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Medical uses of marijuana (Marinol)?
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nausea, vomiting (due to chemotherapy)
glaucoma "wasting" conditions related to AIDS |
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For how long can urine tests for marijuana remain positive?
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up to 4 weeks
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