Misuse, Abuse, and Illicit Drugs

Controlled Drug and Substances Drug Act

Regulates the possession, sale, manufacture, disposal, production, import, export, and distribution of certain drugs. Refills can not be given on narcotics

III

Phase _____ of drug development is where duration/long term Impacts – efficacy, benefits, long term adverse effects are studied.

Narcotics

Substances that bind to opiate receptors in the CNS and ANS. Cause euphoria and analgesia

Morphine

derived from opium, potent analgesic but causes nausea and pruritus. * The drug of choice for chest pain secondary to MI due to its ability to slow heart rate.

Codeine

derived from opium, is used in Tylenol 3 (acetaminophen and codeine).

Heroin

semi-synthetic form of opium derived from morphine. Extremely addictive so generally not used therapeutically.

Meperidine

synthetic form of opium. Rapid onset, effects felt within 15-20 minutes.

Dilaudid

synthetic form of opium. “Super clean”, almost no reaction with other medications. Often first choice analgesic as there is no nausea/vomiting.

Percodan

Oxycodone with aspirin. Given orally only

Percocet

Oxycodone with acetaminophen. Given orally only

Narcotics

Side effects of __________ include

Tolerance that develops in the liver, not at the receptor level.

Miosis/contraction of pupils

Mild hypotension with tachycardia and decreased respirations

Narcotics

Withdrawal of _________ are the opposite of their therapeutic effects and include tearing, perspiration, restlessness, irritability, stomach cramps, hand/leg tremors (kicking the habit). Withdrawal is NOT deadly

MONAT

Protocol when patient presents with MI

M-morphine (decreases myocardial oxygen demand)

O -oxygen

N – nitro

A – aspirin

T – TPA (evaluate after given other things)

Hallucinogens

Are both CNS stimulant and depressant. Most are plant derivatives. No tolerance develops.

Psychedelics

mind-manifesting hallucinogens

Psychotogenic

psychosis generating hallucinogens

Lysergic Acid Diethylamide (LSD)

Psychedelic, causes altered perception of reality, hallucinations, changes in thought processes. Limited medical use; primarily used for research and experimental therapeutic purposes.

Amphetamines

Class of psychoactive substances known for their stimulant effects on the central nervous system.

-  end in -dream

-  All amphetamines cause weight loss

-  Some shady weight loss supplements have them as unlisted ingredient

Dextroamphetamines

subclass of amphetamines, potent stimulant effect on CNS.

Methamphetamines

subclass of amphetamines, extremely potent CNS stimulant, much more addictive than regular psychotics

Methylphenidate

amphetamine sold under brand name Ritalin, used to treat ADDs. Paradoxical effect, enhance the reticular activating system (RAS) which helps to focus attention and filter out extraneous stimuli.

Nicotine

stimulant that inc HR & BP, constricts peripheral blood vessels, lowers oxygen carrying capacity of hemoglobin (Carbon monoxide in smoke binds with Hgb)

Stimulant

withdrawal of _________ includes severely depressed mood, prolonged sleep, apathy, irritability, disorientation

Fatty Liver Disease

excess fat in liver caused by alcohol use. Jaundice, dark urine

Alcohol Hepatitis

damage of the liver caused by alcohol use

Wernicke-Korsakoff’s Syndrome

-  Alcohol interferes with ability to utilize vitamins

-  Especially thiamin

-  Disorder affects short-term memory

-  Degree of memory impairment becomes extreme – unable to function

alcohol

Minor _______ withdrawal peaks at 24-36 hours. Coarse tremor, tachycardia, anxiety, mild autonomic hyperactivity, anorexia

alcohol

Major ______ withdrawal occurs at 24 hours, peaks at 50 hours. Causes pronounced ANS hyperactivity, fever, disorientation, diaphoresis, hallucinations

alcohol

Extreme ________ withdrawal causes grand mal seizures (tonic/clonic), delirium Tremors (DTs): day - Profound confusion, incontinence, frightening visual hallucinations, gross tremors, fever

Psychotherapeutic Drugs

used in the treatment of emotional and mental disorders

Anxiety Disorders

Unpleasant state of mind characterized by a sense of dread and fear. May be exaggerated responses to imaginary negative situations.

Affective Disorders

Changes in mood that range from mania (abnormally pronounced emotions) to depression (abnormally reduced emotions). Some patients may exhibit both mania and depression (bipolar disorder)

Psychosis

Severe emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in activities of daily living. Hallmark: loss of contact with reality. Schizophrenia, depressive and drug-induced psychoses.

Anxiolytic Drugs

Reduce anxiety by reducing overactivity in the central nervous system (CNS).

Benzodiazepines

Function: depress activity in the brainstem and CNS. Used for the short-term treatment of anxiety. Will get rid of problematic muscle spasms. Mixing with alcohol causes CNS depression and death. Overdoses do not exist; flumazenil can be used to reverse the effects.

Benzodiazepines

Adverse Effects: Overexpression of therapeutic effects. Decreased CNS activity, sedation, amnesia, hypotension, drowsiness, loss of coordination, dizziness, headaches, nausea, vomiting, dry mouth, constipation

Alprazolam

Brand name Xanax. Benzodiazepine used to treat panic disorders, anxiety disorders, anxiety caused by depression. May result in confusion, ataxia, headache

Diazepam

Brand name Valium. Benzodiazepine used to treat anxiety disorders or alcohol withdrawal symptoms. May result in headache, confusion, slurred speech, and others

Lorazepam

Brand name Ativan. Benzodiazepine used to treat anxiety disorders in adults in children who are at least 12 years old. Used to treat or prevent alcohol withdrawal Comes in sublingual form, is the first choice medication for seizures. Can also be given intramuscularly and intravenously; useful for the treatment of agitated patients.

Buspirone Hydrochloride

Miscellaneous anxiolytic, Unknown mechanism of action. Administered on a scheduled basis. Used to treat generalized anxiety. Adverse effects: paradoxical anxiety, blurred vision, dizziness, headache, nausea

Mood-Stabilizers

Class of drugs that stabilize mood. Lithium carbonate and lithium citrate. Other drugs may be used in conjunction including benzodiazepines, antipsychotic drugs, antiepileptic drugs, dopamine receptor agonists

Lithium

drug of choice for treatment of mania. Only for bipolar disorder, does not work on other types of depression. May cause dysrhythmia.

Tricyclics

Have largely been replaced by SSRIs as first-line antidepressant drugs. Considered second line drugs when SSRIs or other newer generation antidepressants fail. Indicated for neuropathic pain, insomnia, childhood enuresis, obsessive compulsive disorders (OCDs), anorexia. Can result in sedation, impotence, orthostatic hypotension. Very easy to overdose with, no specific antidote.

Amitriptyline (Elavil)

Oldest and most widely used of all the tricyclic antidepressants. Originally indicated for depression, but commonly used to treat insomnia and neuropathic pain. Contraindications are known drug allergies, pregnancy, and recent myocardial infarction. Adverse effects include dry mouth, constipation, blurred vision, urinary retention, and dysrhythmias. Very easy to overdose.

Monoamine Oxidase Inhibitors

Class of drugs rarely used for depression, used for Parkinson’s disease. Ingestion of foods high in tyramine (think charcuterie board) while on MAOIs has the potential to cause a hypertensive crisis.

Second Generation Antidepressants

Class of drugs indicated for Depression, BPD, obesity, eating disorders, OCD, panic attacks or disorders, social anxiety disorder, post-traumatic stress disorder, premenstrual dysphoric disorder, myoclonus, and various substance misuse problems such as alcoholism. Side effects include insomnia (partly caused by reduced REM sleep), weight gain, and sexual dysfunction

Bupropion

Only antidepressant that doesn’t affect the user’s libido, commonly used for men.

Prozac

was the first SSRI, most commonly used for kids

Zoloft

very popular, used to be the first choice now the second choice, low side effects

Paxil

very strong, if you’re going on ____ you’re not going back off it. Never first/second line.

Luvox

not on the market anymore, problems with blood

Celexa

came to market before Escitalopram oxalate.

Escitalopram oxalate

same as drug effect as Celexa, different isomer. First choice antidepressant

Serotonin Syndrome

Caused by buildup of serotonin in body by SSRI’s. Symptoms include delirium, agitation, tachycardia, sweating, myoclonus, hyperreflexia, shivering, coarse tremors, extensor plantar muscle reactions.

Bupropion Hydrochloride (Wellbutrin)

- Originally indicated for treatment of depression; now also indicated as an aid in smoking cessation

- Sometimes added as an adjunct antidepressant for patients experiencing sexual adverse effects secondary to SSRI therapy

-  Zyban®: approved for smoking cessation treatment and was the first nicotine-free prescription medication used to treat nicotine dependence

Duloxetine Hydrochloride

Indications: depression, generalized anxiety disorder (GAD), and pain resulting from diabetic peripheral neuropathy or fibromyalgia, chronic back pain, and osteoarthritis

 

Adverse effects: dizziness, drowsiness, headache, GI upset, anorexia, and hepatotoxicity.

Drug interactions: SSRIs and triptans (increased risk of serotonin syndrome) and alcohol (increased risk of liver injury)

 

Can worsen uncontrolled angle-closure glaucoma.

Fluoxetine

Prototypical SSRI, trade name Prozac

Indications: depression, bulimia, OCD, panic disorder, and premenstrual dysphoric disorder

Contraindications: known drug allergy and concurrent MAOI therapy

Adverse effects: anxiety, dizziness, drowsiness, insomnia, and others

Mirtazapine

Trade name Remeron

Promotes the presynaptic release of serotonin and norepinephrine in the brain. Causes sedation Indications: depression (including that associated with BPD), sexual adverse effects in male patients receiving SSRI therapy (reduction), and an appetite stimulant.

Contraindications: drug allergy and MAOIs

Adverse effects: drowsiness, abnormal dreams, dry mouth, constipation, increased appetite, and asthenia

Drug interactions: additive CNS depressant effects with alcohol and cytochrome P-450 (CYP) inhibitors.

Antipsychotics

Class of drugs used to treat serious mental illness; drug-induced psychoses, schizophrenia, and autism. Also used to treat extreme mania (as an adjunct to lithium), BPD, depression that is resistant to other therapy, certain movement disorders (e.g., Tourette’s syndrome), and certain other medical conditions (e.g., nausea, intractable hiccups)

Antipsychotics

__________ work by blocking dopamine receptors in the brain (limbic system, basal ganglia), areas associated with emotion, cognitive function, motor function.

Schizophrenia

- Positive symptoms add something to the person (hallucinations, delusions, and conceptual disorganization)

-  Negative symptoms take something away from the person (apathy, social withdrawal, blunted affect, poverty of speech, and catatonia)

-  All antipsychotics show efficacy in improving the positive symptoms of schizophrenia.

- Conventional drugs are less effective in managing negative symptoms.

- Atypical antipsychotics have greater efficacy in treating both positive and negative symptoms.

Antipsychotics

Indications for ______________ include psychotic illness, most commonly schizophrenia, anxiety and mood disorders, Examples include prochlorperazine (antiemetics).

Antipsychotics

Adverse effects of ___________ include

CNS: drowsiness, neuroleptic malignant syndrome (NMS), extrapyramidal symptoms (EPS): pseudo parkinsonism-akathisia, acute dystonia treated with benztropine (Kynesia®) and trihexyphenidyl hydrochloride, tardive dyskinesia.

NMS: Potentially life threatening - high fever, unstable blood pressure, myoglobinuria

EPS: Involuntary muscle symptoms to those of Parkinson’s disease. Akathisia (distressing muscle restlessness). Acute dystonia (painful muscle spasms) - treated with benztropine (Cogentin®) and trihexyphenidyl (Artane®).

Tardive dyskinesia, involuntary contractions of oral and facial muscles, choreoathetosis (wavelike movements of extremities) occurs with continuous long-term antipsychotic therapy. Insulin resistance, weight gain, changes in serum lipid levels, cardiometabolic syndrome.

Haloperidol

Indications: long-term treatment of psychosis

Contraindications: hypersensitivity, Parkinson’s disease, large amounts of CNS depressants taken oral, intramuscular. Useful in treating patients with schizophrenia who were nonadherent to their drug regimen.

Oral, intramuscular (useful in treating patients with schizophrenia who were nonadherent to their drug regimen)

Atypical Antipsychotics

The mechanism of action for ____________ is to block specific dopamine receptors: dopamine-2 (D2) receptors. Also block specific serotonin receptors: serotonin-2 (5-HT2) receptors. This is responsible for their improved efficacy and safety profiles

Clozapine

Selectively blocks the dopaminergic receptors in the mesolimbic region of the brain. Associated with minor or no EPS. Adverse effects: blood dyscrasias

Risperidone

Indication: schizophrenia (including negative symptoms). Adverse effect: minimal EPS at therapeutic dosages of 1 to 6 mg/day. Oral and long-acting injectable forms

St. John’s Wart

Herbal product used for depression, anxiety, sleep disorders, nervousness. May cause GI upset, fatigue, dizziness, confusion, dry mouth, photosensitivity. Severe interactions if taken with MAOIs and SSRIs; many other drug interactions. Food–drug interaction with tyramine-containing foods

Wernicke-Korsakoff’s Syndrome

Neurodegenerative disorder that is caused by a severe thiamine (vitamin B1) deficiency. Most common in severe alcohol abusers.