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Questions and Answers
What is the term used to describe the need for larger doses to achieve the same effect from a drug?
What is the term used to describe the need for larger doses to achieve the same effect from a drug?
Which of the following describes a user with a profound emotional need for repeated drug use?
Which of the following describes a user with a profound emotional need for repeated drug use?
What is the effect called when the combined use of two drugs results in a greater effect than if used separately?
What is the effect called when the combined use of two drugs results in a greater effect than if used separately?
What describes the symptoms experienced when a user stops taking a drug they are dependent on?
What describes the symptoms experienced when a user stops taking a drug they are dependent on?
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What is the recommended understanding of addiction based on the three Cs?
What is the recommended understanding of addiction based on the three Cs?
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What can result when energy drinks are consumed with alcohol?
What can result when energy drinks are consumed with alcohol?
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Which route of administration is characterized by ingesting the drug through the skin?
Which route of administration is characterized by ingesting the drug through the skin?
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What effect is noted when prior use of one psychoactive drug diminishes the response to another within the same category?
What effect is noted when prior use of one psychoactive drug diminishes the response to another within the same category?
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What does the therapeutic index (TI) compare?
What does the therapeutic index (TI) compare?
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What is the definition of drug potentiation?
What is the definition of drug potentiation?
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What characterizes drug tolerance?
What characterizes drug tolerance?
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Which scenario best illustrates cross-tolerance?
Which scenario best illustrates cross-tolerance?
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What effect does psychological dependence primarily involve?
What effect does psychological dependence primarily involve?
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What is characteristic of sensitization to drugs?
What is characteristic of sensitization to drugs?
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What risk is associated with a therapeutic index under 10?
What risk is associated with a therapeutic index under 10?
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What is the primary outcome of physiological antagonism between two drugs?
What is the primary outcome of physiological antagonism between two drugs?
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What is a primary reason for the abuse of OxyContin among chronic pain sufferers?
What is a primary reason for the abuse of OxyContin among chronic pain sufferers?
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What effect does the combination of energy drinks and alcohol have?
What effect does the combination of energy drinks and alcohol have?
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Which of the following is a common withdrawal symptom of narcotic analgesics?
Which of the following is a common withdrawal symptom of narcotic analgesics?
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What is a misconception associated with the use of heroin?
What is a misconception associated with the use of heroin?
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What chronic illness is NOT related to frequent alcohol consumption?
What chronic illness is NOT related to frequent alcohol consumption?
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What is one of the primary effects of central nervous system depressants, such as alcohol?
What is one of the primary effects of central nervous system depressants, such as alcohol?
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Which of the following is true regarding the classification of narcotic analgesics?
Which of the following is true regarding the classification of narcotic analgesics?
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What characteristic of heroin makes it more attractive for some users?
What characteristic of heroin makes it more attractive for some users?
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Study Notes
Drug-Specific Information
- Drugs on the street where you live are discussed in chapter 3.
- Learning objectives for this chapter involve understanding current marijuana use trends, including medical applications, and the hazards of combining energy drinks with alcohol.
- The chapter also covers key terms like physical and psychological dependence, tolerance, cross-tolerance, synergism, and antagonism.
- Defining and describing addiction, routes of drug administration, set and setting, and drug absorption, distribution, and elimination are also included in the objectives.
- Learning objectives also require understanding addiction using the three Cs (compulsion, control, continued use), identifying and listing drugs for each classification, and describing hazards from mixing alcohol with sedative-hypnotics.
Defining Addiction
- Addiction is defined by three Cs: compulsion, control, and continued use.
- Compulsion and obsession are key elements.
- Loss of control or stopping use is important.
- Continued misuse despite adverse consequences is crucial.
Drugs in Society
- Drug use became a major part of the hippie movement in the 1960s and 1970s, with marijuana and hallucinogens (particularly LSD) being prominent.
- Cocaine and crack cocaine were popular in the 1980s.
- Celebrity deaths related to drugs raised awareness of drug use.
- In the 1990s, ice (methamphetamine hydrochloride) gained popularity.
Definitions of Terms (1)
- Physical dependence: A state where a person cannot stop using a drug without withdrawal symptoms.
- Withdrawal symptoms: Physical symptoms arising from stopping drug use.
- Psychologically dependent: A user with a strong emotional or mental need to repeatedly use a drug.
- Tolerance: Users needing increasing doses to achieve the same effect.
- Cross-tolerance: Diminished responses to a drug due to prior use of other drugs in the same category.
Definitions of Terms (2)
- Synergism: Combined effect of multiple drugs greater than the sum of individual effects.
- Antagonism: Combined effect of multiple drugs is less than the sum of individual effects.
- Routes of administration: Ways drugs are taken (oral, skin, injection, smoking, etc.).
Definitions of Terms (3)
- Drug action: Specific molecular changes when a drug binds to a receptor.
- Drug Effects: Changes in physiological or psychological functions.
- Therapeutic effects: Desired physical or behavioral changes from drug-receptor interaction.
- Side effects: Undesired effects.
- Specific effects: Unique effects of a drug on a target site.
- Nonspecific effects: Effects based on individual characteristics.
Nonspecific Drug Responsiveness
- Set: Psychological makeup and expectations of the person taking the drug.
- Setting: Social and physical environment of drug use.
- Biochemical makeup: Each individual has a unique biochemical makeup influenced by genetics.
Definitions of Terms (4)
- Pharmacokinetics: Processes that involve drug movement in the body (absorption, distribution, binding, metabolic alteration, excretion).
- Pharmacodynamics: Biochemical and physiological effects of drugs.
Definitions of Terms (5)
- Duration of action: Time a drug remains active in the bloodstream.
- Drug half-life: Time for the body to eliminate half the drug. Longer half-life means a longer duration of action.
Pharmacokinetics
- Pharmacokinetics is divided into four processes: absorption, distribution, metabolism, and elimination/excretion.
- Absorption is the drug's entry into the bloodstream. First-pass metabolism changes drugs before they enter the bloodstream.
- Distribution moves the drugs into tissues and organs. The organ with the highest blood supply typically has the highest concentration of the drug.
- Metabolism (biotransformation) changes the chemical structure of a drug to prepare it for elimination. The liver is the primary site for metabolism.
- Elimination/excretion removes the drug from the body.
Routes of Administration
- Enteral routes include oral, sublingual, buccal, and rectal.
- Parenteral routes involve injection (intravenous, intramuscular, subcutaneous).
- Topical routes deliver drugs directly to the skin or mucous membranes.
- Inhalation delivers drugs through the respiratory system.
Intracerebroventricular
- Some drugs cannot cross the blood-brain barrier.
- Injection directly into the cerebrospinal fluid or ventricular system is required if these drugs need to reach the brain.
Drug Interactions
- Physiological antagonism occurs when two drugs counteract each other.
- Additive effects mean the combined drug effect equals the sum of individual drug effects.
- Potentiation means combined effects are greater than the sum of the individual drug effects.
Drug Tolerance
- Tolerance is a reduction in drug potency or efficacy with repeated use.
- Larger doses are required to produce the same effect.
- Cross-tolerance occurs when tolerance to one drug affects responses to another drug of a similar type.
Characteristics of Tolerance
- Tolerance is reversible and depends on the dose and frequency of use.
- Environmental factors influence tolerance levels.
- Not all drug effects show the same degree of tolerance.
Sensitization
- Drug sensitization refers to the enhancement of drug effects with repeated administration of the same dose (reverse tolerance).
- The same effect can happen with a lower dose in subsequent administrations.
Psychological Dependence
- Psychological dependence is a strong compulsion or craving for a drug to experience pleasure or reduce discomfort..
- Context-specific tolerance is linked to reinforcement linked to excessive drug use (e.g., coping, social motives).
Physiological Dependence
- Physiological dependence is the development of physical symptoms when a drug is stopped or an antagonist is administered (withdrawal).
- Abstinence syndrome consists of physical disturbances that are often opposite to the drug’s intended effects
- The duration and intensity of the withdrawal are tied to the drug's duration and intensity.
Dependence/Addiction Takeaways
- Predisposing factors contribute to initial drug use, and other factors continue the use of drugs.
- Methods focusing solely on physical dependence might not eliminate the psychological dependence and withdrawal.
Strong Potential for Physical & Psychological Dependence
- Sedative-hypnotics (alcohol, barbiturates, non-barbituate ones, antianxiety drugs) and narcotics/opioids have a high potential for physical and psychological dependence.
- Included are heroin, morphine, codeine, and Methadone.
Strong Potential for Psychological Dependence – Unclear Physical Dependence
- Psychostimulants (cocaine, amphetamines, and marijuana) have a high potential for psychological dependence but not so much for physical dependence.
Rare Psychological Dependence & No Documented Physical Dependence
- Hallucinogens (LSD, mescaline, and psilocybin) are associated with rare psychological dependence and little physical dependence.
Classification of Drugs
- Nonpsychoactive drugs do not directly affect the brain (e.g., vitamins, antibiotics).
- Psychoactive drugs affect brain functions, mood, thoughts, and/or behavior.
- Psychoactive drugs are often classified according to their physiological and psychological effects.
Drug Classification Dilemma
- Classifying drugs comprehensively is challenging
- Similar molecular structures can produce very different effects, some drugs have similar effects but different structures, and the effect of a drug is often dependent on the dose.
Classification - Therapeutic Action
- The therapeutic action is frequently used to classify drugs.
- This method is helpful in describing the actions of newly developed drugs.
- The drawback is that many drugs do not act consistently with the same effects.
Classification – Neurochemical Actions
- A drug’s neurochemical actions are needed to consider the drug’s behavioral effects.
- This clearer approach examines how the drug acts on the nervous system through neurotransmitters while also considering the therapeutic effect.
Psychoactive Drug Classification
- Different classes of psychoactive drugs are commonly used.
- A table demonstrates the classification of psychoactive drugs and examples of each.
The DSM-5-TR
- Substance-related disorders resulting from drug use are recognized by the DSM-5-TR in ten separate drug classes.
Narcotic Analgesics
- Narcotic analgesics are used for pain relief and induce feelings of well-being.
- Users may inject these drugs intravenously, subcutaneously, or deep into muscle tissue.
- Hazards include overdose risk and infectious diseases associated with sharing needles.
- Tolerance develops rapidly based on administration routes.
- Withdrawal symptoms include loss of appetite, nausea, vomiting, dilated pupils, gooseflesh, restlessness, chills, and irritability.
- The classification of narcotic analgesics is presented as a table differentiating natural, synthetic, and semisynthetic opioids along with specific antagonists.
Heroin
- Heroin is a powerful opioid drug that's often used intravenously and is increasing in popularity.
- Its purity and method of use increase its addictive qualities.
OxyContin(Oxycodone) Abuse
- OxyContin is a time-release opioid prescribed for chronic pain.
- Abusers seek a quick high by injecting, snorting, or dissolving the drug in water.
Central Nervous System Depressants: Alcohol
- Alcohol is a toxic substance with irritating and sedative properties, inducing adverse effects like amnesia, permanent memory loss, mental confusion, vision problems, gastrointestinal issues, and breathing concerns.
- Energy drinks and alcohol are a particularly dangerous combination.
- Withdrawal symptoms can involve psychomotor agitation and hallucinations.
- Risk factors associated with alcohol use include premature death, vitamin deficiencies, and sexual impotence.
- Pregnant women using alcohol can affect their offspring through fetal alcohol syndrome.
Central Nervous System Depressants: Barbiturates & benzodiazepines
- Barbiturates, sometimes mistaken as safer tranquilizers, are heavily controlled in various countries. The use of benzodiazepines is more frequent due to perceived greater safety. Small doses can cause drowsiness and motor impairments, with increased risk of accidents during the first weeks of use.
Central Nervous System Depressants: Barbiturates
- Barbiturates can induce sleep, reduce pre-menstrual tension and motion sickness, but at higher doses affect reaction time and precision.
- Withdrawal symptoms include physical weakness, dizziness, anxiety, and hallucinations.
- Methaqualone is a non-barbiturate drug with similar properties.
Tranquilizers
- Tranquilizers are used for tension, insomnia, behavioral excitement, and anxiety.
- They are conventionally taken as pills, capsules, or liquids, and can cause drowsiness, disorientation, confusion, lethargy, and rage.
- Withdrawal from tranquilizers can cause tremors, rapid pulse, fever, loss of appetite, nausea, and vomiting.
- Classification tables identify various benzodiazepine tranquilizers and sedative antihistamines.
Classification of Major Tranquilizers (Antipsychotic Agents)
- Provides a table of major tranquilizers (antipsychotic agents), distinguishing between phenothiazines, butyrophenones, thioxanthenes, and other classes, each with its specific drugs.
Central Nervous System Stimulants: Amphetamines
- Amphetamines are prescribed for obesity, depression, and narcolepsy and can be taken orally or injected.
- Effects include reducing sleepiness, fatigue, and boredom; and may increase confusion and anxiety.
- Withdrawal symptoms include fatigue, brain wave abnormalities, prolonged sleep, dehydration, and weight loss.
Crystal Methamphetamine
- Crystal methamphetamine is a stimulant, synthesized in labs and available under various street names (speed, crank, ice, crystal, etc., based on geographical region).
- It rapidly produces feelings of euphoria and excitement, increases speech and activity levels, and reduces appetite,
- Excessive use can lead to a rise in heart rate and blood pressure, potentially leading to irregularities in heart rhythm, body temperature fluctuations, convulsions, cardiovascular collapse, and even death.
- Individuals abusing this substance commonly exhibit behaviors associated with paranoid schizophrenia.
Ice
- Ice (smokable form of methamphetamine) is extremely pure, resulting in prolonged periods of high stimulation and a subsequent crash characterized by exhaustion, sleep issues, and lack of motivation.
- Common for mixing with alcohol.
Classification of Stimulants
- Shows a table for classifying stimulants, including amphetamines (benzedrine, dextroamphetamine, methamphetamines, desoxyn), cocaine, and other stimulants (ritalin, preludin, tenuate, caffeine, nicotine).
Central Nervous System Stimulants: Cocaine
- Cocaine, a stimulant, can be inhaled, injected, or smoked, with freebase cocaine offering a smokable form.
- Its effects are intense, inducing excitation, euphoria, depression, and anxiety, and triggering potential sudden death (kindling effect).
Cocaine Clinical Syndromes
- Presents a table for classifying the clinical syndromes resulting from cocaine use, breaking it down by euphoria, dysphoria, and psychosis.
MDMA (Ecstasy)
- MDMA, sometimes called ecstasy and related to mescaline and amphetamines, is a mood-enhancing stimulant. It can be taken orally or injected.
- Overuse can lead to significant fatigue, dilated pupils, dry mouth, throat tension, teeth grinding, and intensified stimulation.
Central Nervous System Stimulants: Tobacco
- Tobacco is the most heavily abused drug. High rates of tobacco-related deaths lead to concern overall. This drug causes a variety of illnesses in the user (e.g., heart disease, peripheral vascular disease, cerebrovascular disease, cancer, chronic obstructive lung disease, and colds).
Hallucinogens
- Hallucinogens alter perceptions of time, space, self-awareness, emotion, and one's sense of body image. They induce mood and perceptual changes, mild anxiety, paranoia, or severe panic. Includes LSD, mescaline, psilocin. These can be ingested orally, smoked, snorted, or injected.
Phencyclidine (PCP)
- Phencyclidine (PCP) is hard to categorize as a stimulant, hallucinogen, or depressant, causing auditory and visual disturbances, loss of feeling, and the inability to feel pain.
- There's a significant risk of depression and suicide-related issues as a result of withdrawal and chronic use.
Cannabis
- Cannabis can be any product from the plant Cannabis sativa, including marijuana (unprocessed) and hashish (potent product from resin).
- Marijuana is smoked as joints, showing use for spasm/asthma relief, anxiety reduction, and alcohol withdrawal relief.
- Hashish is a potent processed form from the plant resin.
Major Effects of Cannabis
- Cannabis can intensify thoughts and feelings, induce exhilaration, increase heart rate slightly, and cause drowsiness, dry mouth, throat issues, and bloodshot eyes.
- Short-term memory, focus, and cognitive processes may be affected, along with the perception of time and space.
Effects of Chronic Use of Cannabis
- Chronic use raises concerns about psychological and physical dependence, irritability, and other symptoms like reduced appetite, emotional swings, sleep disturbances, sweating, nausea, diarrhea.
- Potential consequences include damage to the respiratory system, impaired sperm motility and testosterone levels, menstrual cycle disruption, lack of motivation, and overall reduction in coordination and motor function.
A New Era for Marijuana: Its Medical Usage
- Legalization of medical marijuana is a critical development, with federal limitations and inconsistencies in medical research.
- Varied potency, administration methods, frequency, and other factors create inherent research challenges.
Inhalants
- Inhalants are solvents, aerosols, and other gases inhaled recreationally.
- Their effects include reduced inhibition, elevated mood, confusion, psycho-motor retardation, and potential gastrointestinal issues (gastritis, peptic ulcers).
- Withdrawal symptoms involve hallucinations, headaches, chills, delirium tremens, and stomach cramps (even death).
Classification of Inhalants
- Many household products can be abused as inhalants. Commonly used inhalants are glue, shoe polish, and gasoline. Earlier use leads to greater dependence.
Signs and Symptoms of Inhalant Use
- Common signs include slurred speech, odor of the inhalant, mental disorientation, headaches, dizziness, muscle spasms, euphoria, loss of balance and coordination (ataxia), and eye movements (nystagmus and involuntary eye movement).
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