PASP 508: Opioids, Sedative-Hypnotics, Stimulants, and Drugs of Abuse Vocabulary

Vocabulary practice flashcards covering terminology, mechanisms of action, pharmacokinetics, adverse effects, and clinical concepts from PASP 508.

Addiction

A chronic neurobiological disease in which genetic, psychosocial, and environmental factors induce changes in an individual's behavior to compulsively use drugs despite harm.

Analgesia

Relief from pain.

Analgesic

Substances that inhibit the body's reaction to pain or perception of pain.

Dysphoria

A feeling of discomfort or unpleasantness.

Emesis

Vomiting.

Endogenous

Naturally occurring within the body.

Endorphins

Neuropeptides produced within the CNS that interact with opioid receptors to produce analgesia.

Hyperalgesia

An abnormally painful response to a stimulus; a sensitization process by which opioids, paradoxically, cause pain hypersensitivity.

Physical Dependence

A condition in which the body requires a drug in order to avoid symptoms associated with withdrawal or the abstinence syndrome.

Tolerance

The ability of the body to alter its response or adapt to drug effects so that the effects are minimized over time, producing a rightward shift in the dose-response curve.

Somatic Pain

Nociceptive pain resulting from injury to skin, muscles, bones, joints, or ligaments.

Visceral Pain

Nociceptive pain resulting from injury to internal organs.

Mu-Opioid Receptor (μ)

A $G_{i/o}$-coupled receptor mediating supraspinal and spinal analgesia, euphoria, sedation, respiratory depression, miosis, constipation, urinary retention, and physical dependence.

Kappa-Opioid Receptor (κ)

An opioid receptor primarily mediating spinal analgesia, sedation, dysphoria, and psychotomimetic effects.

Delta-Opioid Receptor (δ)

An opioid receptor that modulates analgesia and mood, as well as contributing to stimulation of the chemoreceptor trigger zone causing nausea and vomiting.

Opioid Reward Pathway Mechanism

Activation of mu-opioid receptors on GABAergic interneurons in the ventral tegmental area (VTA) reduces GABA release, disinhibiting dopamine neurons and increasing dopamine transmission to the nucleus accumbens.

Tachyphylaxis

A rapidly diminishing response to successive doses of a drug, rendering it less effective.

Equianalgesic Opioid Rotation Protocol

A clinical process of calculating total 24-hour opioid consumption, converting to an equianalgesic dose of a new opioid, and reducing the dose by 25% to 50% to account for incomplete cross-tolerance.

Naloxone (Narcan)

An opioid antagonist that competes with and displaces opioids from receptors to reverse life-threatening respiratory depression, with an intranasal onset of 8 to 13 minutes and a half-life of 2 hours.

Nalmefene (Opvee)

An intranasal opioid antagonist with a rapid onset (2.5 to 5 minutes) and a half-life of 11 hours, providing a longer duration of action than naloxone.

Suboxone (Buprenorphine/Naloxone)

A combination medication for OUD where buprenorphine acts as a high-affinity partial mu agonist with a ceiling effect on respiratory depression, and naloxone is added sublingually to prevent parenteral misuse.

Methadone (Dolophine)

A full opioid agonist with an extremely long half-life used for pain management and OUD maintenance, preventing the rapid peak-and-trough cycles seen with short-acting opioids.

Naltrexone (Vivitrol)

An opioid antagonist indicated for alcohol use disorder and relapse prevention in opioid dependence, administered as a 380 mg deep intramuscular gluteal injection every 4 weeks after an opioid-free period of 7 to 10 days.

Emergency 72-Hour Rule (21 CFR 1306.07(b))

A federal provision allowing a non-OTP practitioner to dispense (not prescribe) up to a three-day supply of narcotic medication to manage acute withdrawal while arranging patient referral.

Opioid Risk Evaluation and Mitigation Strategy (REMS)

An FDA-required safety program for opioid analgesics to manage serious risks by encouraging prescriber education, patient counseling, and Medication Guide distribution.

Neonatal Opioid Withdrawal Syndrome (NOWS)

A drug withdrawal syndrome occurring in newborns exposed to opioids in utero, managed first-line with nonpharmacologic care (Eat, Sleep, Console) and second-line with opioids like morphine, methadone, or buprenorphine.

Sedative

A substance or drug that produces a calming effect and reduces arousal or activity.

Hypnotic

A substance or drug that promotes the initiation or maintenance of sleep.

Insomnia Disorder

Persistent difficulty initiating sleep, maintaining sleep, or waking too early, resulting in daytime impairment despite adequate opportunity for sleep.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

The standard first-line treatment for chronic insomnia disorder prior to or alongside adjunct pharmacotherapy.

GABA-Benzodiazepine Receptor Complex

A ligand-gated chloride channel complex where benzodiazepines, z-drugs, and barbiturates bind allosterically to enhance chloride influx, hyperpolarizing neurons and causing CNS depression.

Z-Drugs (Non-Benzodiazepine Hypnotics)

Schedule IV sedative-hypnotics (zolpidem, eszopiclone, zaleplon) acting on GABA receptors, carrying a boxed warning for complex sleep behaviors like sleepwalking and sleep driving.

Suvorexant (Belsomra)

A dual orexin (hypocretin) receptor antagonist that inhibits wakefulness signaling, contraindicated in narcolepsy.

Ramelteon (Rozerem)

A non-controlled selective melatonin receptor agonist used for sleep-onset insomnia without abuse potential.

Disulfiram (Antabuse)

An alcohol use disorder medication that inhibits acetaldehyde dehydrogenase, causing acetaldehyde accumulation and severe hangover/emesis when alcohol is consumed.

Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar)

A clinical assessment scale measuring symptoms such as nausea, tremors, sweating, anxiety, and sensory disturbances to guide symptom-triggered benzodiazepine dosing during alcohol withdrawal.

Amphetamine Mechanism of Action

CNS stimulation caused by direct stimulation of dopamine and norepinephrine receptors, stimulation of vesicular release, and inhibition of monoamine reuptake transporters at the nerve terminal.

Modafinil (Provigil)

A Schedule IV central nervous system stimulant and wake-promoting agent indicated for narcolepsy and shift work sleep disorder that works in part by decreasing GABA neurotransmission.

Atomoxetine (Strattera)

A non-controlled selective norepinephrine reuptake inhibitor (NRI) indicated for ADHD.

Viloxazine (Qelbree)

A non-controlled once-daily extended-release norepinephrine reuptake inhibitor approved for ADHD in patients 6 years and older.

Guanfacine (Intuniv)

A non-controlled selective alpha-2A adrenergic receptor agonist that decreases sympathetic outflow and enhances prefrontal cortex signaling to improve delayed neuronal firing, memory, and behavior in ADHD.

Cannabinoid

A pharmacologically active chemical compound obtained from the cannabis plant, such as psychoactive THC or non-psychoactive CBD.

Tetrahydrocannabinol (THC) vs. Cannabidiol (CBD)

THC is the principal psychoactive cannabinoid in marijuana acting on cannabinoid receptors, whereas CBD is a non-psychoactive component.

Lysergic Acid Diethylamide (LSD)

A hallucinogenic drug that interacts with presynaptic and postsynaptic 5-HT2A receptors, producing sensory distortions, altered consciousness, and synesthesia.

Phencyclidine (PCP)

A hallucinogenic NMDA glutamate receptor antagonist that causes dissociation, CNS stimulation/depression, analgesia, slurred speech, ataxia, and body image distortions.

Synesthesia

A perception distortion produced by hallucinogens like LSD where sensory experiences blend, such as seeing sounds or hearing visual images.