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Which of the following drugs is most commonly associated with rapid tolerance and dependence when administered intravenously?
Which of the following drugs is most commonly associated with rapid tolerance and dependence when administered intravenously?
Kratom has well-defined opioid effects and is widely prescribed as a treatment option.
Kratom has well-defined opioid effects and is widely prescribed as a treatment option.
False
What is the primary treatment for an opioid overdose?
What is the primary treatment for an opioid overdose?
Naloxone
The withdrawal effects of opioids are characterized by symptoms such as lacrimation, yawning, and __________.
The withdrawal effects of opioids are characterized by symptoms such as lacrimation, yawning, and __________.
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Match the following opioid analgesics with their common misuse forms:
Match the following opioid analgesics with their common misuse forms:
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What is a common effect following the initial 'rush' experienced from IV heroin?
What is a common effect following the initial 'rush' experienced from IV heroin?
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Amphetamines only have stimulant effects that lead to increased appetite and sleepiness during withdrawal.
Amphetamines only have stimulant effects that lead to increased appetite and sleepiness during withdrawal.
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Which opioid is known for its long half-life and is used for withdrawal symptoms?
Which opioid is known for its long half-life and is used for withdrawal symptoms?
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Which drug is commonly known as 'angel dust'?
Which drug is commonly known as 'angel dust'?
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Which of the following drugs is noted for having amnestic properties and is associated with 'date rape'?
Which of the following drugs is noted for having amnestic properties and is associated with 'date rape'?
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MDMA has no effect on serotonin transporters in the central nervous system.
MDMA has no effect on serotonin transporters in the central nervous system.
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What are the active compounds found in marijuana?
What are the active compounds found in marijuana?
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Ethanol is classified as a controlled substance with known abuse liability.
Ethanol is classified as a controlled substance with known abuse liability.
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______ and other muscarinic agents may have hallucinogenic effects.
______ and other muscarinic agents may have hallucinogenic effects.
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What primary neurotransmitter is facilitated by sedative-hypnotic drugs in the brain?
What primary neurotransmitter is facilitated by sedative-hypnotic drugs in the brain?
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Match the following hallucinogens with their common names:
Match the following hallucinogens with their common names:
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Sedative-hypnotic drugs reduce inhibitions, suppress anxiety, and produce __________.
Sedative-hypnotic drugs reduce inhibitions, suppress anxiety, and produce __________.
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Which of the following is NOT a cannabinoid compound?
Which of the following is NOT a cannabinoid compound?
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Match the following drugs with their properties:
Match the following drugs with their properties:
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Overdose with PCP can lead to horizontal and vertical nystagmus.
Overdose with PCP can lead to horizontal and vertical nystagmus.
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What is a significant effect of acute overdoses of sedative-hypnotic drugs?
What is a significant effect of acute overdoses of sedative-hypnotic drugs?
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Flumazenil is used as an antidote for both barbiturate and benzodiazepine overdoses.
Flumazenil is used as an antidote for both barbiturate and benzodiazepine overdoses.
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What is the effect of THC on the central nervous system?
What is the effect of THC on the central nervous system?
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What type of receptors do sedative-hypnotic drugs antagonize to achieve their effects?
What type of receptors do sedative-hypnotic drugs antagonize to achieve their effects?
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What is one of the potential therapeutic effects of marijuana?
What is one of the potential therapeutic effects of marijuana?
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Chronic use of marijuana does not have implications for cognitive impairment.
Chronic use of marijuana does not have implications for cognitive impairment.
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What substances are included in Dronabinol?
What substances are included in Dronabinol?
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Inhalation of nitrous oxide without oxygen can lead to ______.
Inhalation of nitrous oxide without oxygen can lead to ______.
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Match each inhalant with its potential effect:
Match each inhalant with its potential effect:
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Which of the following statements is true regarding anabolic steroids?
Which of the following statements is true regarding anabolic steroids?
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CBD has addictive properties.
CBD has addictive properties.
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What is Sativex composed of?
What is Sativex composed of?
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Which of the following drugs is most commonly associated with respiratory depression when overdosed?
Which of the following drugs is most commonly associated with respiratory depression when overdosed?
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Opioid analgesics are known for causing euphoria followed by sedation when administered intravenously.
Opioid analgesics are known for causing euphoria followed by sedation when administered intravenously.
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What is the primary management for opioid overdose?
What is the primary management for opioid overdose?
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The sensation of 'cold turkey' is associated with opioid withdrawal and is characterized by ______.
The sensation of 'cold turkey' is associated with opioid withdrawal and is characterized by ______.
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Match the following opioids to their common effects:
Match the following opioids to their common effects:
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Which symptom is NOT typically associated with opioid withdrawal?
Which symptom is NOT typically associated with opioid withdrawal?
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Chronic use of amphetamines can lead to marked tolerance and an increase in appetite during withdrawal.
Chronic use of amphetamines can lead to marked tolerance and an increase in appetite during withdrawal.
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What type of therapy is buprenorphine used for in opioid addiction?
What type of therapy is buprenorphine used for in opioid addiction?
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Opioid overdose can lead to ______, coma, and death.
Opioid overdose can lead to ______, coma, and death.
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Match the following opioid analgesics with their common forms of misuse:
Match the following opioid analgesics with their common forms of misuse:
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Which hallucinogen is known as 'angel dust'?
Which hallucinogen is known as 'angel dust'?
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Marijuana primarily acts on dopaminergic pathways in the brain.
Marijuana primarily acts on dopaminergic pathways in the brain.
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What are the psychoactive compounds in marijuana?
What are the psychoactive compounds in marijuana?
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PCP overdose can lead to horizontal and vertical __________.
PCP overdose can lead to horizontal and vertical __________.
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Match the following drugs with their classifications:
Match the following drugs with their classifications:
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Which of the following compounds is primarily responsible for the psychoactive effects of marijuana?
Which of the following compounds is primarily responsible for the psychoactive effects of marijuana?
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Cannabinoids have no known therapeutic effects.
Cannabinoids have no known therapeutic effects.
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What is the proposed effect of MDMA on interpersonal communication?
What is the proposed effect of MDMA on interpersonal communication?
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The endogenous cannabinoids in the CNS include __________ and 2-arachidonyl glycerol.
The endogenous cannabinoids in the CNS include __________ and 2-arachidonyl glycerol.
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Which effect is commonly associated with the use of PCP?
Which effect is commonly associated with the use of PCP?
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Which sedative-hypnotic drug is known for its high addiction potential when used long-term?
Which sedative-hypnotic drug is known for its high addiction potential when used long-term?
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Ethanol is categorized as a controlled substance with known abuse liability.
Ethanol is categorized as a controlled substance with known abuse liability.
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What is the primary neurotransmitter facilitated by sedative-hypnotic drugs in the brain?
What is the primary neurotransmitter facilitated by sedative-hypnotic drugs in the brain?
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The acute overdoses of sedative-hypnotic drugs can result in __________.
The acute overdoses of sedative-hypnotic drugs can result in __________.
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Match the sedative-hypnotic drug with its property:
Match the sedative-hypnotic drug with its property:
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Which drug is associated with 'date rape' due to its amnestic properties?
Which drug is associated with 'date rape' due to its amnestic properties?
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Benzodiazepines are classified as schedule IV drugs with low abuse liability.
Benzodiazepines are classified as schedule IV drugs with low abuse liability.
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What is one method of managing an overdose of benzodiazepines?
What is one method of managing an overdose of benzodiazepines?
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Sedative-hypnotic drugs are known to reduce inhibitions, suppress anxiety, and produce __________.
Sedative-hypnotic drugs are known to reduce inhibitions, suppress anxiety, and produce __________.
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Which of the following is not a method to reverse the effects of a barbiturate overdose?
Which of the following is not a method to reverse the effects of a barbiturate overdose?
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What is one of the therapeutic effects of marijuana?
What is one of the therapeutic effects of marijuana?
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Chronic use of marijuana is associated with cognitive impairment.
Chronic use of marijuana is associated with cognitive impairment.
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What substance is associated with impaired judgment and reflexes when used?
What substance is associated with impaired judgment and reflexes when used?
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The active ingredient in the controlled-substance formulation of THC is __________.
The active ingredient in the controlled-substance formulation of THC is __________.
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Match the following inhalants with their potential effects:
Match the following inhalants with their potential effects:
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Which of the following is NOT a potential adverse effect of anabolic steroids?
Which of the following is NOT a potential adverse effect of anabolic steroids?
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CBD has been approved for specific types of epilepsy and has addictive properties.
CBD has been approved for specific types of epilepsy and has addictive properties.
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What is the name of the botanical drug containing both THC and CBD?
What is the name of the botanical drug containing both THC and CBD?
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Chronic use of inhalants may lead to toxicity affecting the __________ system.
Chronic use of inhalants may lead to toxicity affecting the __________ system.
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Which of the following inhalants is recognized for causing asphyxia when inhaled as a pure gas?
Which of the following inhalants is recognized for causing asphyxia when inhaled as a pure gas?
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Study Notes
Sedative-Hypnotic Drugs
- Commonly Prescribed: Benzodiazepines (BDZs) for anxiety, categorized as Schedule IV with low abuse liability.
- High Addiction Potential: Short-acting BDZs like alprazolam and short-acting barbiturates like secobarbital have high addiction potential with long-term use.
- Ethanol: Ethanol, though not listed on the schedule of controlled substances, has high abuse liability.
- Actions: Reduce inhibitions, suppress anxiety, and produce relaxation, potentially leading to repetitive use. Facilitate GABA effects, antagonize cholinergic nicotinic receptors, and enhance brain dopaminergic pathways (likely related to addiction).
- Overdose: Commonly results in death due to depression of the medullary respiratory and cardiovascular centers.
- Management of Overdose: Maintaining airway and ventilatory support, Flumazenil to reverse BDZ effects, no antidote for barbiturates or ethanol.
Opioid Analgesics
- Pharmacologic Action: Primarily act on opioid receptors, also disinhibit dopaminergic pathways in the CNS.
- Most Commonly Abused: Heroin, morphine, codeine, oxycodone, hydrocodone, hydromorphone, meperidine, fentanyl.
- Effects: IV heroin results in a "rush" followed by euphoria and sedation. IV administration leads to rapid tolerance, dependence, and addiction. Oral administration/smoking provides milder effects and slower onset of tolerance and dependence.
- Fentanyl Crisis: High efficacy, abundance, and low cost contribute to a current fentanyl crisis.
- Overdose: Respiratory depression, coma, and death. Managed with naloxone or nalmefene and ventilatory support.
- Kratom: Crude plant extract with poorly defined opioid effects, misused due to OTC availability.
- Withdrawal Effects: Lacrimation, rhinorrhea, yawning, sweating, weakness, gooseflesh (cold turkey), nausea, vomiting, tremor, muscle jerks.
- Treatment: Replacement with a pharmacologically active equivalent, e.g., methadone, followed by slow dose reduction. Buprenorphine (partial agonist at µ-receptors) is also used for withdrawal symptoms and substitution therapy.
Stimulants - Amphetamines
- CNS Alteration: Alter amine transporter activity in the CNS, increasing dopamine, norepinephrine, and serotonin release, leading to feelings of euphoria and self-confidence and rapid addiction.
- Drugs Included: Dextroamphetamine, methamphetamine ("speed"), crystal form (“ice”) that can be smoked.
- Chronic Abuse: Leads to a psychotic state with delusions and paranoia.
- Overdose Symptoms: Agitation, restlessness, tachycardia, hyperthermia, hyperreflexia, and possible seizures. No antidote; supportive care focuses on temperature control, arrhythmia prevention, and seizure management.
- Tolerance: Marked, withdrawal symptoms include increased appetite, sleepiness, exhaustion, and mental depression.
- Congeners: 2,5-dimethoxy-4-methylamphetamine (DOM[STP]), dioxymethaphetamines (MDA), methylene dioxymethaphetamines (MDMA, ecstasy).
- MDMA: Selective serotonin transporter in the CNS, purportedly facilitating interpersonal communication and acting as a sexual enhancer.
Hallucinogens
- PCP and Ketamine: Antagonists at the glutamate NMDA receptor with no action on dopaminergic neurons.
- Common Psychotic Reactions: Impaired judgment often leading to reckless behavior.
- Overdose: Horizontal and vertical nystagmus, marked HTN, and fatal seizures. Diazepam or lorazepam used to curb excitation and prevent seizures.
- Other Hallucinogenic Drugs: LSD, mescaline, psilocybin.
- Scopolamine and Muscarinic Agents: Act on serotonin receptors, indirectly increase glutamate receptor release, no dependence, and do not act on dopaminergic pathways.
- Descriptive Terms: Psychedelic and mind revealing.
Marijuana
- Active Principles: Cannabinoid compounds - tetrahydrocannabinol (THC), cannabidiol (CBD), cannabinol (CBN).
- Subspecies: Hemp plant (low THC, high CBD), medical marijuana plants (higher THC vs CBD levels).
- Hashish: Partially purified THC-containing material with higher potency.
- Endogenous Cannabinoids: Anandamide and 2-arachidonyl glycerol act as retrograde messengers to inhibit presynaptic release of dopamine.
- Exogenous Cannabinoid Targets: Receptors for endogenous cannabinoids are thought to be the targets for exogenous cannabinoids in marijuana.
- CNS Effects: Euphoria, disinhibition, uncontrollable laughter, perceptual changes, dream-like state due to THC at the CB1 receptor.
- Mental Concentration: Difficult.
- Vasodilation: Increases pulse rate.
- Habitual Users: Reddened conjunctiva.
- Withdrawal States: Experienced by heavy users.
- Dangers: Impaired judgment and reflexes, effects potentiated by sedative-hypnotics, including ethanol.
- Chronic Use: Cognitive impairment, cannabis use disorder, hyperemesis.
- Therapeutic Effects: Lower intraocular pressure, analgesic effects, antiemetic action.
- Preparations: Dronabinol (THC), Nabilone (synthetic THC) for nausea and pain management. Nabiximols (Sativex) (THC and CBD) for specific types of epilepsy.
- CBD: No addictive properties.
- Rimonabant: Inverse agonist at CB1 receptors for obesity treatment in Europe but withdrawn.
Inhalants
- Euphoric and Disinhibitory Effects: Gases or volatile liquids.
- Anesthetics: Nitrous oxide, chloroform, diethyl ether - affect judgment and induce loss of consciousness.
- Nitrous Oxide Asphyxia: Asphyxia and death without oxygen.
- Industrial Solvents: Gasoline, paint thinners, aerosol propellants, glues, rubber cement, shoe polish.
- Active Ingredients: Benzene, hexane, methylethylketone, toluene, trichloroethylene.
- Toxicity: Liver, kidneys, lungs, bone marrow, and peripheral nerves.
Organic Nitrates
- Nitrites: Amyl nitrate, isobutyl nitrite ("poppers") - used as sexual enhancers.
- Inhalation Effects: Dizziness, tachycardia, hypertension, flushing.
Steroids
- Controlled Substances: Anabolic steroids due to abuse potential in many countries.
- Effects: Increased muscle mass and strength, rather than euphoria.
- Excessive Use: Adverse behavioral, cardiovascular (MI), and musculoskeletal effects.
- Androgenic Side Effects: Acne and masculinization in females.
Sedative-Hypnotic Drugs
- Includes benzodiazepines (BDZs), barbiturates, and ethanol
- BDZs are commonly prescribed for anxiety and are classified as Schedule IV, indicating a low potential for abuse
- Short-acting BDZs like alprazolam have a high potential for addiction when used long-term
- Short-acting barbiturates, like secobarbital, have a similar high potential for addiction
- Ethanol is not listed on the schedule of controlled substances with abuse liability, but is heavily abused
- These drugs reduce inhibitions, suppress anxiety, and produce relaxation, encouraging repetitive use
- Primary actions: facilitates GABA effects, antagonizes cholinergic nicotinic receptors
- Enhances brain dopaminergic pathways, a factor potentially linked to addiction
- CNS depressants, effects are enhanced by concomitant use of ethanol, opioids, analgesics, antipsychotic agents, marijuana, and other drugs with sedative properties
- Acute overdoses can lead to death due to the depression of the medullary respiratory and cardiovascular centers
- Treatment of overdose: maintain patient airway and ventilatory support
- Flumazenil is used to reverse the CNS depressant effects of BDZs
- No antidote for barbiturates or ethanol
- Flunitrazepam (Rohypnol) is a potent, fast-acting BDZ with amnestic properties, used in "date rape"
- Rohypnol is often added to alcoholic beverages, chloral hydrate or GHB in sufficient doses, rendering the victim incapable of resisting rape
Opioid Analgesics
- Opioids act mainly on opioid receptors
- Other actions include disinhibition of dopaminergic pathways in the CNS
- Most commonly abused drugs: Heroin, Morphine, Codeine, Oxycodone, hydrocodone, hydromorphone, Meperidine, Fentanyl
- IV heroin effects are described as a "rush" or organic feeling followed by euphoria and sedation
- IV administration of opioids results in rapidly developing tolerance, dependence, and addiction
- Oral administration/smoking produce milder effects with slower onset of tolerance and dependence
- Fentanyl's high efficacy, abundance, and low cost resulted in a fentanyl crisis
- Overdose of opioids leads to respiratory depression, coma, and death
- Overdose is managed with parenteral naloxone or nalmefene and ventilatory support
- Kratom, a crude plant extract with poorly defined opioid effects, has been misused because it is available as an OTC botanical
- Opioid withdrawal effects (abstinence syndrome): lacrimation, rhinorrhea, yawning, sweating, weakness, gooseflesh ('cold turkey'), nausea, vomiting, tremor, muscle jerks
- Treatment includes replacing illicit drugs with pharmacologically active equivalent agents like methadone, followed by slow dose reduction
- Buprenorphine, a partial agonist at µ-receptors and a longer-acting opioid (t1/2 >40hrs) is also used for withdrawal symptoms and substitution therapy for opioid addicts
Stimulants - Amphetamines
- Alter amine transporter activity in the CNS (dopamine, norepinephrine, and serotonin) increasing their release
- Feelings of euphoria and self-confidence contribute to the rapid development of addiction
- Drugs include: Dextroamphetamine, Methamphetamine ('speed'), and a crystal form ("ice") that can be smoked
- Chronic high-dose abuse leads to a psychotic state with delusions and paranoia
- Overdose symptoms: agitation, restlessness, tachycardia, hyperthermia, hyperreflexia and possible seizures
- No antidote, supportive care involves controlling body temperature, protecting against cardiac arrhythmias and seizures
- Tolerance can be marked, withdrawal symptoms include increased appetite, sleepiness, exhaustion, and mental depression
- Amphetamine congeners: 2,5-dimethoxy-4-methylamphetamine (DOM[STP]), dioxymethaphetamines (MDA), methylene dioxymethaphetamines (MDMA, ecstasy)
- MDMA selectively acts on serotonin transporters in the CNS, purportedly facilitating interpersonal communication and acting as a sexual enhancer
Hallucinogens
- Phencyclidine (PCP) ('angel dust') and ketamine ('special K'): antagonists at the glutamate NMDA receptor
- No action on dopaminergic neurons in the brain
- Psychotic reactions are common with PCP, impaired judgment often leads to reckless behavior
- PCP Overdose: horizontal and vertical nystagmus, marked HTN, and seizures, potentially fatal
- Parenteral BDZs (diazepam, lorazepam) are used to curb excitation and protect against seizures
- Other hallucinogenic drugs with abuse potential: lysergic acid diethylamide (LSD), mescaline, psilocybin
- Scopolamine and other muscarinic agents may have hallucinogenic properties
- Act on serotonin receptors and indirectly increase glutamate receptor release in the CNS, not known to cause dependence or act on dopaminergic pathways
- Terms used to describe these drugs: psychedelic and mind-revealing
Marijuana
- Marijuana ('grass' or 'pot'): a collective term for the psychoactive constituents in crude extracts of the plant Cannabis sativa and Cannabis indica
- Active principles include cannabinoid compounds: tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabinol (CBN)
- Cannabis sativa has subspecies: hemp plant (low THC and high CBD) and medical marijuana flowering/bud plants (generally higher THC vs CBD levels)
- Hashish is partially purified THC-containing material that is more potent
- Endogenous cannabinoids in the CNS (anandamide and 2-arachidonyl glycerol) are released postsynaptically and act as retrograde messengers to inhibit presynaptic release of conventional transmitters like dopamine
- The receptors for these endogenous compounds are believed to be the targets for exogenous cannabinoids present in marijuana
Effects of Marijuana
- CNS effects: feeling of being "high" with euphoria, disinhibition, uncontrollable laughter, changes in perception, and a dream-like state
- These effects are attributed to THC on the cannabinoid type-1 (CB1) receptor
- Mental concentration is difficult
- Vasodilation and increased pulse rate
- Habitual users often have reddened conjunctiva
- Withdrawal states are noted in heavy users
- Dangers: impairment of judgment and reflexes
- Effects are potentiated by concomitant use of sedative-hypnotics, including ethanol
- Chronic use is associated with cognitive impairment, cannabis use disorder, and hyperemesis
- Perceived risk of automobile accidents, roadside tests for "driving while high"
- Potential therapeutic effects: decrease intraocular pressure, analgesic effects, antiemetic action
Preparations
- Dronabinol: a controlled-substance formulation of THC, used to combat severe nausea and as an adjunct for chronic pain
- Nabilone: a synthetic analogue of THC, used to combat severe nausea and as an adjunct for chronic pain
- Nabiximols (Sativex): a botanical drug composed of THC and CBD
- CBD has recently been approved for specific types of epilepsy but lacks any addictive properties
- Rimonabant: an inverse agonist at CB1 receptors, approved for use in treating obesity in Europe, but has been withdrawn
Inhalants
- Certain gases or volatile liquids are abused for their euphoric and disinhibitory effects
- Anesthetics: nitrous oxide, chloroform, diethyl ether
- Affect judgment and induce loss of consciousness
- Inhalation of nitrous oxide as a pure gas (without oxygen) has caused asphyxia and death
Industrial Solvents
- Solvents and a wide range of volatile compounds found in commercial products like gasoline, paint thinners, aerosol propellants, glues, rubber cement, and shoe polish
- Active ingredients: benzene, hexane, methylethylketone, toluene, and trichloroethylene
- Many of these compounds are toxic to the liver, kidneys, lungs, bone marrow, and peripheral nerves
Organic Nitrates
- Amyl nitrate, isobutyl nitrite, and other organic nitrites referred to as "poppers" are used as sexual intercourse enhancers
- Inhalation of nitrites causes dizziness, tachycardia, hypertension, and flushing
Steroids
- Anabolic steroids are controlled substances in many countries due to their potential for abuse
- Effects sought by abusers: increased muscle mass and strength rather than euphoria
- Excessive use: adverse behavioral, CV (MI), and musculoskeletal effects
- Acne (sometimes severe) and masculinization in females are anticipated androgenic adverse effects
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Description
This quiz explores the characteristics and effects of sedative-hypnotic drugs and opioid analgesics, focusing on their pharmacologic actions, addiction potential, and management of overdoses. Understand the common medications, their classifications, and the risks associated with misuse and overdosing.