Psych 05: Drugs Of Abuse

Front 1

What is drug abuse?

Back 1

Use of a drug in a manner that deviates fro the approved medical patterns within a given society

Front 2

What are the forms / patterns of drug abuse?

Back 2

- Experimental: pressured to try it
- Recreational: casual, modest use for pleasure
- Circumstantial: help in particular situations (eg, amphetamines to stay awake or students to study)
- Intensive: increased frequency and amounts of drug, however still can choose to take or not take
- Compulsive: patterns of abuse that are perceived as detrimental to user and society

Front 3

If a patient is pressured to try a drug, what kind of drug use is this?

Back 3

Experimental

Front 4

If a patient uses a drug in modest amounts casually, what kind of drug use is this?

Back 4

Recreational

Front 5

If a patient is using a drug to help in particular situations (eg, amphetamines to stay awake or students to study), what kind of drug use is this?

Back 5

Circumstantial

Front 6

If a patient is using a drug in increased frequency and amounts of drug, however still can choose to take or not take, what kind of drug use is this?

Back 6

Intensive

Front 7

If a patient is using a drug with patterns of abuse that are perceived as detrimental to user and society, what kind of drug use is this?

Back 7

Compulsive

Front 8

What is tolerance?

Back 8

Decreased response to a drug as a result of repeated treatment with drug

Front 9

What are the types of tolerance?

Back 9

- Dispositional: pharmacokinetic cause
- Pharmacodynamic: changes in target organ sensitivity
- Behavioral: change in response to behavioral mechanisms
- Cross-tolerance: between drugs of same class

Front 10

What type of tolerance is caused by pharmacokinetics?

Back 10

Dispositional tolerance

Front 11

What type of tolerance is caused by changes in target organ sensitivity?

Back 11

Pharmacodynamic tolerance

Front 12

What type of tolerance occurs when a patient tries to act normal after taking a substance so they don't get in trouble (often unsuccessfully)?

Back 12

Behavioral tolerance

Front 13

What type of tolerance occurs between drugs of the same class (eg, morphine and methadone)?

Back 13

Cross-tolerance

Front 14

What are the types of drug dependence?

Back 14

- Physical: symptoms are produced by drug withdrawal
- Psychological: compulsive feelings of the need to take a particular drug

Front 15

What are the substance use disorders in DSM-5?

Back 15

Substance Use Disorders (previously broken down into separate categories: substance abuse and substance dependence)

Substance-Induced Disorders
- Substance intoxication
- Substance withdrawal
- Substance/medication-induced disorders included

Non-substance related disorders/addictions
- Gambling disorder

Front 16

What are the sedative/hypnotic/anxiolytic drugs that are abused?

Back 16

- Barbiturates
- Benzodiazepines

Front 17

What are the opioid drugs that are abused?

Back 17

- Heroin
- Prescription analgesics (eg, morphine, codeine, oxycodone)

Front 18

What are the stimulant drugs that are abused?

Back 18

- Amphetamines
- Cocaine

Front 19

What are the hallucinogen drugs that are abused?

Back 19

- Dissociative anesthetics: Ketamine, Phencyclidine (PCP)
- Entactogens: Ecstasy (MDMA)

Front 20

What are the general substance use disorder criteria?

Back 20

A problematic pattern of substance use within a 12 month period manifested by two or more symptoms that cause impairment in functioning:

For example:
- Taken in larger amounts or for longer than intended.
- Persistent desire or unsuccessful efforts to cut down use.
- Great deal of time spent in activities necessary to obtain the substance, use the substance, or recover from it’s effects.
- Important social, occupational, or recreational activities are reduced or given up because of substance use.
- Craving or a strong desire or urge to use the substance.

Front 21

Which parts of the brain are activated by drugs of abuse to stimulate the reward pathway?

Back 21

- Limbic system
- Nucleus accumbens

Front 22

What are the most commonly abused drugs in high school seniors?

Back 22

1. Marijuana / Hashish
2. Synthetic Marijuana
3. Vicodin
4. Adderall
5. Salvia

Front 23

How does the percentage of marijuana use compare across grades in high school?

Back 23

Increases with age

Front 24

How does the use of marijuana compare in genders?

Back 24

More common in males

Front 25

What determines how high you will get from marijuana?

Back 25

Δ9-THC content

Front 26

What are the constituents of marijuana?

Back 26

- Δ9-THC
- Cannabidiol
- Cannabinol

Front 27

If you give a marijuana user Δ9-THC, what will they think?

Back 27

They will think it is marijuana (most potent/active compound)

Front 28

If you give a marijuana user cannabidiol or cannabinol, what will they think?

Back 28

They don't think it is marijuana (not the same effects)

Front 29

How is marijuana metabolized?

Back 29

- In liver, rapid metabolism to 11-OH-Δ9-THC (highly active)
- Then metabolized to 9-nor-COOH-THC (inactive)

Front 30

What happens to the marijuana metabolites?

Back 30

- Excreted in urine and feces (detectable in urine for many days)
- Redistributed in fat

Front 31

How quickly does marijuana get into the brain? Duration of action?

Back 31

Smoked: reaches brain in 15-30 seconds
- 3-5x more potent smoked than ingested
Oral: onset is about 30 minutes

Duration of action: 1-6 hours (t1/2 in plasma = 20-50 hours); 20% remains in body after 5 days

Front 32

How long does it take for marijuana to be undetectable in body?

Back 32

30 days
(only 20% remains after 5 days)

Front 33

What is the mechanism of action of Δ9-THC?

Back 33

CB1 receptor:
- High densities in cerebellum hippocampus and basal ganglia
- Low in hypothalamus

CB2 receptor:
- Peripheral tissue (associated w/ immune system)

Negatively coupled to Adenylyl Cyclase (AC) via Gi → generally inhibits transmitter release

Affinity for receptor correlates with psychoactive potency of cannabinoid agonists

Front 34

What are the endogenous ligands for the CB1 receptor?

Back 34

Endocannabinoids:
- 2-Arachidonylglycerol
- Anandamide
(both are derived from arachidonic acid - lipid constituent)

CB1 antagonist: Rimonabant - reduces appetite but pulled off market for causing depression/suicide

Front 35

What are the effects of Marijuana (THC)?

Back 35

- Euphoria
- Memory impairment
- Perceptual-motor alterations
- Cardiovascular
- Pulmonary
- Reproductive
- Psychopathological effects

Front 36

What are the effects of Marijuana (THC) on memory?

Back 36

- Digit symbol substitution
- Choice - reaction time
- Digit span: how many numbers can you remember
- Repeated subtractions: serial 7's
- Recall of material learned while high is impaired

Front 37

What are the perceptual motor effects of Marijuana (THC)? Implications for driving?

Back 37

Not as easy to test (like there is for alcohol to determine BAC), have to use behavioral test

All impaired:
- Laboratory assessment of driving related skill
- Driver - simulator studies
- Test - course performance
- Street - driver performance

Studies of drivers involved in fatal accidents
- Most common is alcohol
- 2nd most common is THC

Front 38

What are the CV effects of Marijuana (THC)?

Back 38

- Tachycardia
- Orthostatic Hypotension
- Exacerbates Angina

Front 39

What are the Pulmonary effects of Marijuana (THC)?

Back 39

- Bronchodilation (normals and asthmatics - not via beta receptors)
- Lung irritant - may cause bronchoconstriction (smoke has as much tar as cigarettes and as carcinogenic)
- Decreased alveolar macrophage activity (possible risk of infections)
- Decrease in ciliary function

Front 40

What are the Reproductive effects of Marijuana (THC)?

Back 40

- Lowers T levels and sperm counts
- In rodents, gonadal weights are decreased
- LHRH release is decreased, which decreases levels of FSH and LH
- Prolactin release is decreased in females, greater incidence of abnormal menstrual cycles
- Hazard to marginally fertile

Front 41

What are the Psychopathological effects of Marijuana (THC)?

Back 41

- Acute anxiety reaction / panic attack (more common in naive users)
- Transient paranoid feelings
- Exacerbation of schizophrenia
- Diffuse acute brain syndrome w/ high doses - clouding of consciousness and memory, perceptual and sleep disorders
- Amotivational syndrome (people who are stoned a lot do not want to work a lot)

Front 42

Does tolerance / dependence develop to Marijuana (THC)?

Back 42

Yes - in frequent heavy users commonly reported symptoms associated with cessation of marijuana use include:
- Restlessness
- Irritability and mild agitation
- Sleep difficulties
- Decreased appetite and nausea
- Craving

Front 43

What are the therapeutic uses of Marijuana (THC)?

Back 43

- Oral THC in sesame oil: control of nausea, AIDS wasting syndrome
- THC/cannabidiol mixture: MS pain treatment and cancer pain
- CB1 antagonist: weight loss (removed from market)

Front 44

What are the other names for Synthetic Marijuana?

Back 44

K2 or Spice or other names

Front 45

What are the contents of Synthetic Marijuana?

Back 45

- Contains synthetic compounds that have THC-like CB1 agonist activity
- Compounds that are not yet DEA scheduled are "legal"

Front 46

What are the hallucinogen dissociative anesthetics?

Back 46

- Ketamine
- Phencyclidine (PCP)

Front 47

What are the absorption properties and t1/2 of Ketamine and Phencyclidine (PCP)?

Back 47

- Rapid / complete absorption
- Plasma t1/2: 12-24 hours (in overdose t1/2, 72 hours)

Front 48

How are Ketamine and Phencyclidine (PCP) metabolized? Excreted?

Back 48

Metabolized in liver:
- Hydroxylation
- Conjugation

Excreted in urine:
- Primarily as biotransformation products

Front 49

What are the autonomic and CV effects of Ketamine and Phencyclidine (PCP)?

Back 49

- Tachycardia
- Hypertension
- Potentiation of catecholamines
- Develops tolerance (but no dependence)

Front 50

What are the differences in effects of Ketamine and Phencyclidine (PCP)?

Back 50

Complex and dose related
- Ketamine is less potent and has a shorter duration of action than PCP

Front 51

Which statement best describes the comparison between the effects of THC and phencyclidine on the cardiovascular system?
a) THC produces a dose-related tachycardia and can produce orthostatic hypotension. Phencyclidine also produces tachycardia, but can also produce a severe hypertension.
b) Phencyclidine produces a dose-related tachycardia and can produce orthostatic hypotension. THC also produces tachycardia, but can also produce a severe hypertension.
c) Both produce dose-related tachycardia and can produce orthostatic hypotension.
d) Both produce tachycardia and can also cause severe hypertension.

Back 51

THC produces a dose-related tachycardia and can produce orthostatic hypotension. Phencyclidine also produces tachycardia, but can also produce a severe hypertension.

Front 52

What happens when Ketamine and Phencyclidine (PCP) are taken in small doses?

Back 52

"Drunken" state with numbness of extremities

Front 53

What happens when Ketamine and Phencyclidine (PCP) are taken in moderate doses?

Back 53

- Analgesia and anesthesia
- Psychic states crudely resemble sensory isolation except that sensory impulses reach neocortex
- Cataleptoid motor phenomenon are observed

Front 54

What happens when Ketamine and Phencyclidine (PCP) are taken in large doses?

Back 54

May produce convulsions

Front 55

What is the mechanism of Ketamine and Phencyclidine (PCP)?

Back 55

Block NMDA receptors (non-competetive antagonists)

Front 56

What are the symptoms of overdose of Phencyclidine (PCP)?

Back 56

CNS manifestations include:
- Anxiety
- Aggression
- Hallucinations
- Dysphoria
- Convulsions
- Delirium

Sympathomimetic manifestations include:
- Tachycardia
- Hypertensive crisis

Front 57

How do you treat an overdose of Phencyclidine (PCP)?

Back 57

- Support vital signs
- Gastric suction (try to remove some of it)
- Acidify urine (might increase excretion because it is a base)
- Diazepam
- Anti-HTN agent
- Haloperidol (low anti-cholinergic anti-psychotic)

Front 58

What are the hallucinogens?

Back 58

Indoleamines:
- LSD

Phenethylamines:
- MDMA (ecstasy)

Front 59

What are the pharmacological effects of LSD (how much penetrates the brain, onset, duration?)

Back 59

- <1% crosses BBB
- Onset: 15-20 minutes
- Duration: 12 hours

Front 60

What are the CV/autonomic effects of LSD?

Back 60

- Tachycardia
- Increased BP
- Psychomotor stimulation
- Tolerance and cross tolerance (to psilocybin/mushrooms)

Front 61

What are the sensory and subjective effects of LSD? Mechanism?

Back 61

- Altered perception, particularly visual
- Lability of mood
- Impaired judgment

- Mechanism: action at 5-HT2 receptors (agonist or partial agonist)

Front 62

What are the acute (<24 hours) toxic reactions to LSD? Treat?

Back 62

- Hallucinations
- Anxiety
- Panic
- Depersonalization

- Need quiet environment, benzos for sedation

Front 63

What are the long term toxic reactions to LSD?

Back 63

- Flashbacks: days to years later, can be associated with drug use
- Neurotoxicity: 5-HT damage may be associated with -phenethylamine type drugs such as MDMA

Front 64

What is the other name for ecstasy?

Back 64

MDMA

Front 65

What are the pharmacological effects of LSD (onset, duration?)

Back 65

- Onset: 20-40 minutes
- Duration: 3-4 hours

Front 66

What are the effects of MDMA/ecstasy?

Back 66

- Induces feeling of "well-being and connection"
- Altered time perception
- Psychomotor stimulation
- Restlessness
- Bruxism
- Anorexia
- Sweating
- Tremor

- Hangover: anhedonia

- Neurotoxicity: serotonin neurons?

Front 67

Which of the following is an official FDA indication for delta-9-tetrahydrocannabinol?
a) Asthma
b) Bradycardia
c) Chemotherapy-induced nausea and vomiting
d) Neuropathic pain
e) None in Wisconsin

Back 67

Chemotherapy-induced nausea and vomiting

Front 68

Where is Gamma-Hydroxybutyrate (GHB) found? What is it structurally similar to?

Back 68

Found in brain - precursor and metabolite of GABA; may have its own receptor; can be made in body

Front 69

How long do the effects of Gamma-Hydroxybutyrate (GHB) last?

Back 69

Lasts about 3 hours

Front 70

What are the effects of Gamma-Hydroxybutyrate (GHB)?

Back 70

- Primarily a depressant - induces a state of relaxation and tranquility
- Interacts with ethanol

Front 71

What are the characteristics of overdose of Gamma-Hydroxybutyrate (GHB)?

Back 71

- Drowsiness
- Ataxia
- Nausea
- Vomiting

Higher doses:
- Loss of bladder control
- Temporary amnesia
- Clonus
- Seizures

Front 72

What drug is an inhalant? Where is it found? Bad effects?

Back 72

Toluene
- Found in model airplane glue - led to glue sniffing
- Contaminated with benzene which may cause aplastic anemia

Front 73

What kind of drug is a perennial herb grown in Mexico?

Back 73

Salvia Divinorum - contains Salvinorin-A

Front 74

What are the effects of Salvinorin-A?

Back 74

- Extremely potent
- Psychedelic, dream-like experience w/ open and closed eyed visuals
- High doses may cause dissociation with fear and perspiration (considered unpleasant by many)
- Short duration of action: 20-45 minutes

Front 75

What is the mechanism of Salvia (Salvinorin-A)?

Back 75

Kappa opioid AGONIST

Front 76

Which receptor does phencyclidine produce its hallucinogenic effects at?
a) CB1
b) GABAa
c) N-methyl-d-aspartate
d) Norepinephrine – alpha2
e) Serotonin – 5-HT2

Back 76

NMDA receptor

Front 77

What OTC drug is abused?

Back 77

Dextromethorphan (cough suppressant)

Front 78

What is in "bath salts"?

Back 78

Stimulants that may be related to those found in "khat" which is used recreationally in part of Africa

Front 79

Lysergic acid diethylamide (LSD) demonstrates cross tolerance with what other drug?
a) Atropine
b) Cannabidiol
c) Ketamine
d) Mescaline
e) Salvia divinorum

Back 79

Mescaline