2.2 Pharm Exam 5: Drugs Of Abuse

Front 1

MOA of antidote for Acetaminophen OD?

Back 1

MOA: glutathione precursor, helps inactivate the toxic acetaminophen metabolite (N-acetyl)

Front 2

Bicarb urine alkalinization can be used for __________ OD

Back 2

aspirin OD

Front 3

Ventral tegmental area neurons produce _________, responsible for the reward pathway

Back 3

dopamine

(activated mesolimbic dopamine system & reward system = psychosis + euphoria)

Front 4

Chronic drug abuse results in tolerance & dependence d/t _______________

Back 4

enhanced metabolism (increased enzymes & elimination, need more to maintain effects)

& down-regulation of receptors

(NEVER stop drugs cold-turkey--> dangerous withdrawal)

Front 5

If a patient comes in suffering from acute heroin withdrawal (dysphoria, nausea, diarrhea), what should you give them?

what should you NEVER give them?

Back 5

tx: methadone (long-acting opioid replacement for long-term opioid withdrawal program, acute withdrawal is NOT safe)

NEVER give them Naloxone alone--> will worsen withdrawal--> possible death!! (Naloxone is for OD only!)

Front 6

Alcohol is metabolized to acetaldehyde by alcohol dehydrogenase (ADH) & microsomal ethanol oxidizing system, what drug inhibits the breakdown of acetaldehyde & causes headaches, N/V, etc w/ alcohol consumption?

Back 6

Disulfiram

*causes "disulfiram reaction" by inhibiting acetaldehyde dehydrogenase & causes acetaldehyde to accumulate--> neg effects even w/ low alcohol consumption

(used in alcoholic pts, not very good compliance)

Front 7

MOA of alcohol

Back 7

facilitates GABA & inhibits NMDA glutamate receptors-->

decr cog fxn

depression of myocardial contractility

vasodilation-->hypothermia

relaxed uterine smooth muscle

loss of liver fxn (hepatitis, cirrhosis, liver failure)

inhibition of gluconeogenesis--> hypoglycemia

Front 8

Chronic alcohol abuse can lead to what complications?

Back 8

irritation, inflammation, bleeding, & scarring of the gut wall-->

pancreatitis

peripheral neuropathies

Wernicke-Korsakoff syndrome

Gynecomastia, testicular atrophy, edema

Front 9

Heavy alcohol consumption during the 1st trimester can lead to......

d/t accumulation of fatty acid ethyl esters (FAEEs), which are present in the newborn's meconium

Back 9

Fetal alcohol syndrome:

mental retardation (MC)

growth deficiency

microcephaly

midfacial underdevelopment

Front 10

BAC > _______ can cause motor impairment

>_________ can cause coma

Back 10

> 100 motor impairment

> 300 coma

(>500 death)

Front 11

Alcohol abuse causes cross tolerance to sedative-hypnotic drugs, however ________ may be used to help prevent delirium or seizures during withdrawal, BUT only given In-hospital bc combining alcohol w/ this can cause DEATH!!

Back 11

Benzodiazepines

(chlordiazepoxide, lorazepam)

Front 12

________ can also be used for alcohol withdrawal to reduce tremors & HR & BP

Back 12

propranolol (beta-blocker) or clonidine (alpha2-agonist)

Front 13

What are the 2 diff forms of cocaine?

Which one has a much higher blood concentration when snorted?

(cocaine is made from erythroxylon coca plant)

Back 13

1. hydrochloride salt = powder cocaine/coke, used IV (dissolved in water) or snorted

2. free base = crack, smoked or snorted, *much higher concentrations

Front 14

MOA of cocaine

What metabolite can be detected in urine up to 5 days after use?

Back 14

MOA: (amino ester)
Blocks dopamine reuptake into pressynaptic nerve terminals via transporter blockage--> Inc dopamine in synapse--> pleasure*

Blocks NE reuptake

Blocks serotonin reuptake

Blocks sodium channels in axonal membrane (anesthetic effects)

*rapid metabolism by plasma pseudocholinesterase, lose high & crash w/i 3 hrs*

metabolized to---> Benzoylecgonine

Front 15

Cocaine short-term effects

(cocaine is not commonly used as a topical local anesthetic d/t neg SEs)

Back 15

Increased energy

Decreased appetite

Mental alertness

Vasoconstriction, Inc HR & BP (d/t inc NE, can lead to MI!!!)

Inc temperature

Dilated pupils

IV site allergic rxn

Front 16

Cocaine long-term effects

Back 16

Addiction

Irritability & mood disturbance, restlessness

Paranoia, auditory hallucinations

Arrhythmias*

MI*

Respiratory failure*, chest pain

Strokes*

Seizures, HA

Abdominal pain, Nausea, bowel gangrene

Nosebleeds, runny nose

Front 17

What should you NEVER give to a pt w/ cocaine OD?

*suspect OD if pt comes in w/ chest pain, cardiac arrest or arrhythmia (v fib), DILATED pupils (ANS overdrive)

Back 17

beta-blocker

Front 18

Pt presents w/ dysphoria, depression, sleepiness, fatigue, bradycardia (withdrawal sx) & has a damaged nasal septum*

What drug is he likely withdrawing from?

Back 18

Cocaine

(no tx for withdrawal, supportive care)

Front 19

A newborn of a drug-addict displays tremulous, extreme irritability, suckling problems, vision problems, lack of coordination, & cognitive/neurobehavioral problems.

What drug was the mother likely doing while pregnant?

What other maternal complications can occur from this drug?

Back 19

Cocaine

maternal malignant hypertension, cardiac ischemia, cerebral infarction, sudden death, spontaneous abortion, death in utero, high risk of premature membrane rupture, preterm delivery, IUGR, abruptio placentae

Front 20

Cocaine mixed w/ _________ creates a very toxic metabolite that leads to lethal seizures & cardiac arrest

Back 20

alcohol

Front 21

_______ may also be combined w cocaine in a brewed tea.

What else is this drug commonly combined w/ in a hand-rolled cigarette form?

Back 21

Marijuana

combined with ketamine in joint, causes hallucinations

*various parts of the cannabis sativa plant are used, the top resin/hashy part is the most potent

Front 22

Marijuana causes the release of ______ leading to the euphoric "high"

What are the other effects?

Back 22

release of dopamine--> euphoric "high"

other effects:

Inc HR

bronchodilation

vasodilation--> red eyes (conjunctiva)* (d/t dilated vessels of the eye)

Stinging/burning cough (d/t THC effects)

cough & phlegm production (worsens COPD & asthma)

Front 23

Marijuana impairs ability to focus attention, form memories, recal events, coordination, & balance. High doses may lead to what?

Back 23

acute toxic psychosis- hallucinations, delusions, depersonalization

Front 24

__________ cause pts to see images, hear sounds, feel sensations (hallucinations), & rapid emotional swings

Back 24

Hallucinogens- LSD Mescaline, Psilocybin

(anything in right combo can cause hallucinations, typically gas, shrooms, LSD, PCP, aerosols)

Front 25

MOA of hallucinogens

Back 25

Stimulation of presynaptic & postsynaptic serotonin receptors

Front 26

_______ is the MOST POTENT hallucinogen

*rapidly absorbed, lasting 6-8 hrs, producing distortions (visual hallucinations- color & shape changes), mood changes (elation, paranoia & depression), & intense arousal (but decr performance) @ doses of 100 microg

Back 26

LSD (lysergic acid diethylamide)

*clear, white, odorless water-soluble, sold as stamps, etc, similar to ergot alkaloids--> severe, prolonged vasoconstriction--> ischemia

Front 27

What are the SEs of LSD?

Back 27

pupillary dilation

Inc BP & HR

flushing

salivation

lacrimation

hyperreflexia

Front 28

____________ cause hallucinations of sight, sound, & depersonalization (out-of-body experience)

MOA?

Back 28

PCP (phenyclidine) & Ketamine

*dextromethorphan (cough suppressant) can also cause similar effects at very high doses)

MOA: blocks NMDA glutamate receptors in cortex & limbic structures-->

GABA overdrive

Front 29

If a pt comes in w/ vertical & horizontal nystagmus (blurred vision), ANS overdrive, & extreme aggitation & strength (req 5 ppl to hold them down), what do you suspect?

*also likely have nausea, dizziness, decr pain perception, uncoordinated bizarre posture

What can occur a year after cessation of chronic use?

Back 29

PCP

(white powder, soluble in water or alcohol, snorted, smoked, or ingested)

memory loss & depression may persist up to a year after stopping

Front 30

__________ causes similar effects as cocaine (euphoria, increased alertness/ concentration, self-confidence, sexual excitation, decreased appetite & need to sleep) but is much LONGER lasting & effects are INSTANTaneous

MOA?

Back 30

Methamphetamine (meth)

MOA:

Blocks reuptake AND increases release of dopamine--> massive amounts of dopamine stimulation of mesolimbic reward pathway

Blocks NE (adrenergic) reuptake

Inhibits MAO-a

Front 31

Chronic use of methamphetamines leads to?

(meth can be injected, snorted, ingested, smoked (ice))

Back 31

addiction

weight loss

depression

tooth decay "meth mouth"

injection site necrosis

neurotoxicity

paranoia, hallucinations

Front 32

Meth withdrawal is a very severe crash accompanied by ________

Back 32

hypoglycemia, dehydration, disorientation

Front 33

________ is the tablet form of meth, causes dry mouth, jaw clenching, muscle aches.

May cause visual hallucinations, hyperthermia (inability to regulate temp--> may lead to liver, kidney, CV failure), & panic attacks at high doses.

How does withdrawal present?

Back 33

MDMA (ecstasy, 3, 4 methylenedioxymethamphetamine)

withdrawal- severe depression, anxiety, sleep problems, confusion, drug craving

(meth withdrawal sxs)

Front 34

Meth is synthesized from man-made products, often via ________________(using cold meds), which involved very volatile substances & often leads to explosions

Back 34

pseudoephedrine reductase method

Front 35

_________ interact w/ mu receptors to cause euphoria, spinal analgesia, sedation, & eventually lead to tolerance & dependence.

How does abstinent withdrawal present?

(NEVER take pts off abruptly to prevent!!)

Back 35

Opiates (including heroin)

withdrawal- ANS hyperexcitability, muscle spasm, lacrimation, tremor, diarrhea

Front 36

Tx options for opiate withdrawal?

Back 36

Buprenorphine (partial agonist) - initial tx for withdrawal

Buprenorphine + Naloxone (antagonist, prevents "high" effects) OR Methadone (long-lasting opioid substitute, no euphoric effects) for long-term withdrawal /opioid addiction

Front 37

How does Opioid OD present?

Back 37

pinpoint pupils**

histamine release

reduced uterine contraction

urinary retention/ constipation

coma

Front 38

___________ should also not be abrupty stopped d/t severe withdrawal sxs including hallucinations, anxiety, insomnia, irritability & seizures*

How can withdrawal be tx?

Back 38

Benzodiazpenines

withdrawal tx w/ chlordiazepoxide or larazepam, tapered dose 5-7 days

Front 39

Benzo OD can present w/ bradycardia, hypotension, memory impairment, dizziness, CNS & respiratory depression. How can OD be tx?

Which "date rape drug" is purposefully give to cause these effects, & exacerbate them w/ alcohol?

Back 39

OD tx w/ Flumazenil

date rape drug = Flunitrazepam

(flu's are opposite)

Front 40

Benzodiazepines bind alternate site & increase GABA binding--> Cl influx--> hyperpolarization

Which benzo is often used as a party drug bc it keeps abuser at a "zoned out level"?

Back 40

Alprazolam (Z-bars, zandy bars, football, zannies)

*can decrease the desire for alcohol, but if taken w/ alcohol will cause OD--> CNS depression