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Pharmacology
Chapter 9
updated 7 years ago by MeaganShanahan
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1

Drug misuse

refers to indiscriminate or recreational use of a chemical substance or its use for purposes other than those for which it is intended.

2

Drug abuse

defined and may be considered drug use inconsistent with medical or social norms,overindulgence of a chemical substance that results in a negative impact on the psychological, physical, or social functioning of an individual

3

Drug addiction

should be considered a complex disease of the central nervous system (CNS) characterized by a compulsive, uncontrolled craving for and dependence on a substance to such a degree that cessation causes severe emotional, mental, and/or physiologic reactions

4

Bupropion

Bupropion is an atypical (heterocyclic) antidepressant unrelated to nicotine that has been approved by the FDA for smoking cessation

5

How does Bupropion work to aid in the cessation of smoking?

It is thought to inhibit neuronal reuptake of dopamine, and to a lesser degree norepinephrine, and this reduces the urge to smoke and minimizes some symptoms of nicotine withdrawal. Bupropion may be combined with NRT to provide additional benefit. Bupropion is marketed as Zyban for smoking cessation; it is available as Wellbutrin for use as an antidepressant

6

What are the physiological and psycological effects of Nicotine?

Increased arousal and alertness; performance enhancement; increased heart rate, cardiac output, and blood pressure; cutaneous vasoconstriction; fine tremor, decreased appetite; antidiuretic effect; increased gastric motility

7

What are the RARE symptoms of Nicotine toxicity?

Nausea, abdominal pain, diarrhea, vomiting, dizziness, weakness, confusion, decreased respirations, seizures, death from respiratory failure

8

What are the symptoms of withdrawal from Nicotine?

Craving, restlessness, depression, hyperirritability, headache, insomnia, decreased blood pressure and heart rate, increased appetite

9

What are the physiological and psychological effects of Cocaine and other stimulants such as amphetamines?

Euphoria, grandiosity, mood swings, hyperactivity, hyperalertness, restlessness, anorexia, insomnia, hypertension, tachycardia, marked vasoconstriction, tremor, dysrhythmias, seizures, sexual arousal, dilated pupils, diaphoresis

10

What are the symptoms of toxicity effects of Cocaine and other stimulants such as amphetamines?

Agitation; increased temperature, pulse, respiratory rate, blood pressure; cardiac dysrhythmias; myocardial infarction; hallucinations; seizures; possible death

11

What are the symptoms of withdrawal from Cocaine and other stimulants such as amphetamines?

Severe craving, severely depressed mood, exhaustion, prolonged sleep, apathy, irritability, disorientation

12

What are the physiological and psychological effects of Alcohol and other depressants?

Initial relaxation, emotional lability, decreased inhibitions, drowsiness, lack of coordination, impaired judgment, slurred speech, hypotension, bradycardia, bradypnea, constricted pupils

13

What are the symptoms of toxicity effects of alcohol and other depressants?

Shallow respirations; cold, clammy skin; weak, rapid pulse; hyporeflexia; coma; possible death

14

What are the symptoms of withdrawal from alcohol and other depressants?

Anxiety, agitation, insomnia, diaphoresis, tremors, delirium, seizures, possible death

15

What are the physiological and psychological effects opioids?

Analgesia, euphoria, drowsiness, detachment from environment, relaxation, constricted pupils, constipation, nausea, decreased respiratory rate, slurred speech, impaired judgment, decreased sexual and aggressive drives

16

What are the symptoms of opioid toxicity?

Slow, shallow respirations; clammy skin; constricted pupils; coma; possible death

17

What are the symptoms of withdrawal from opiods?

Watery eyes, dilated pupils, runny nose, yawning, tremors, pain, chills, fever, diaphoresis, nausea, vomiting, diarrhea, abdominal cramps

18

What are the physiological and psychological effects of cannabis?

Relaxation, euphoria, amotivation, slowed time sensation, sexual arousal, abrupt mood changes, impaired memory and attention, impaired judgment, reddened eyes, dry mouth, lack of coordination, tachycardia, increased appetite

19

What are the symptoms of cannabis toxicity?

Fatigue, paranoia, panic reactions, hallucinogen-like psychotic states

20

What are the symptoms of withdrawal from cannabis?

With heavy use: insomnia, restlessness, irritability, tremor, weight loss, hyperthermia, chills

21

What are the physiological and psychological effects of psychedelics?

Perceptual distortions, hallucinations, delusions (PCP), depersonalization, heightened sensory perception, euphoria, mood swings, suspiciousness, panic, impaired judgment, increased body temperature, hypertension, flushed face, tremor, dilated pupils, constricted pupils (PCP), nystagmus (PCP), violence (PCP)

22

What are the symptoms of toxicity of psychedelics?

Prolonged effects and episodes, anxiety, panic, confusion, blurred vision, increases in blood pressure and temperature

23

What are the symptoms of withdrawal from psychedelics?

No physical withdrawal, but psychological desire may occur

24

What are the physiological and psychological effects of inhalants?

Euphoria; decreased inhibitions; giddiness; slurred speech; illusions; drowsiness; clouded sensorium; tinnitus; nystagmus; dysrhythmias; cough; nausea; vomiting; diarrhea; irritation to eyes, nose, and mouth

25

What are the symptoms of toxicity from inhalants?

Anxiety, respiratory depression, cardiac dysrhythmias, loss of consciousness, sudden death

26

CHANTIX

a novel drug approved for smoking cessation that is an alternative to NRT and bupropion. It is a nicotinic receptor partial agonist that reduces cravings for nicotine and decreases the pleasurable effects of cigarettes and other tobacco products if tobacco is used. The approved course of varenicline treatment is 12 weeks, and those who successfully quit smoking during treatment may continue with an additional 12 weeks to increase long-term cessation. In clinical trials, the most common adverse effects were nausea, headache, vomiting, flatulence, insomnia, abnormal dreams, and a change in taste perception.

27

two drugs not approved by the FDA to help with quiting smoking, what are they?

Nortriptyline (Aventyl, Pamelor) and clonidine (Catapres) are used as second-line drugs to reduce nicotine withdrawal symptoms and promote cessation. These drugs are not approved by the FDA for this purpose, and their action in nicotine addiction is not clearly understood. Nortriptyline is a tricyclic antidepressant (see Chapter 28). Clonidine is a centrally acting alpha2-agonist used to treat hypertension.

28

What is the most potent drug in the stimulant category?

Cocaine is the most potent of the abused stimulants

29

What are the ways an individual can use cocaine?

Cocaine hydrochloride is usually “snorted” intranasally. Cocaine can also be smoked as “crack” cocaine or in “freebase” form, injected intravenously (IV), taken orally, or absorbed through mucous membranes. Smoking and IV methods result in the fastest absorption and the highest “rush.” Peak blood levels develop within 5 to 30 minutes with most methods of administration. The longest effects occur following intranasal use because absorption is delayed by vasoconstriction of the nasal vessels. Cocaine is rapidly metabolized by the liver.

30

What is the half life of cocaine when ingested, snorted and iv?

Elimination half-lives by oral, intranasal, and IV routes are 50, 80, and 60 minutes, respectively.

31

how does cocaine make a person high?

cocaine inhibits the neuronal uptake of dopamine in the brain and increases the activation of dopamine receptors in the brain reward system. This action magnifies pleasures and leads to rapid dependence. Cocaine also increases norepinephrine at postsynaptic receptor sites, producing intense vasoconstriction and cardiovascular stimulation. Drug interactions with cocaine are identified in

32

Describe cocaine psychosis.

A cocaine psychosis usually progresses from paranoid delusions to visual hallucinations of “snow lights,” (colored lights when cocaine is administered) and tactile hallucinations of bugs crawling under the skin. Skin excoriations from scratching; needle marks; and elevated blood pressure, heart rate, and temperature are findings that help differentiate a stimulant psychosis from schizophrenia.

33

What are the emergency management interventions for an assessment of cocaine toxicity?

Establish IV access and initiate fluid replacement as appropriate.

Anticipate the need for propranolol (Inderal) or labetalol (Normodyne) for hypertension and tachycardia.

Severe hypertension may require administration of nitroprusside (Nipride) or phentolamine (Regitine).

Treat ventricular dysrhythmias as appropriate with lidocaine, bretylium (Bretylol), or procainamide (Pronestyl).

Aspirin may be administered to lower the risk of myocardial infarction

34

What schedule are amphetamines and cocaine listed in?

Schedule II drug of the Controlled Substance Act.

35

How are amphetamines taken, and how long are their peak effects?

Amphetamines are prescribed for oral use, with peak effects occurring within 60 to 90 minutes and lasting 2 to 4 hours. More rapid effects are obtained by smoking, snorting, or IV injection and are therefore more frequently used illicitly in these manners. Amphetamines have a longer half-life than cocaine and have a longer, more intense effect.

36

When will withdrawal begin after using methamphetamine iv and orally?

IV use will cause the onset of withdrawal symptoms in approximately 2 hours, whereas oral use results in withdrawal symptoms in 8 to 10 hours

37

What is the treatment for complications of methamphetamine?

Emergency management of amphetamine toxicity is the same as that for cocaine.Establish IV access and initiate fluid replacement as appropriate.

Anticipate the need for propranolol (Inderal) or labetalol (Normodyne) for hypertension and tachycardia.

Severe hypertension may require administration of nitroprusside (Nipride) or phentolamine (Regitine).

Treat ventricular dysrhythmias as appropriate with lidocaine, bretylium (Bretylol), or procainamide (Pronestyl).

Aspirin may be administered to lower the risk of myocardial infarction
Drug elimination can be enhanced by administering agents such as ammonium chloride that acidify the urine.

38

Drug interactions with cocaine are....

sympathomimetics/adrenomimetics

CNS stimulants

Cholinesterase inhibitors (e.g., neostigmine)
may increase CNS and cardiac effects

Tricyclic antidepressants, digoxin, methyldopa
May increase cocaine-induced dysrhythmias

Adrenergic beta-blockers
may decrease effects

39

Drug interactions with amphetamines are....

Tricyclic antidepressants

Sympathomimetics/adrenomimetics

CNS stimulants
increased effect of tricyclic antidepressants and sympathomimetics; increased effect of amphetamines

GI antacids/urinary alkalinizing agents

MAOIs
Increased amphetamine effect

meperidine (Demerol)
Amphetamines increase analgesic effect; meperidine increases risk of seizures and vascular collapse

Thyroid hormone-Reciprocal increase in effects

Adrenergic blockers

Antihistamines

Antihypertensives
Amphetamines may decrease effects.