SUD for illicit drugs (stims, halluc,marij,inhal)

MOA of cocaine

NE and DA reuptake inhibitor (stimulant)

Describe cocaine’s CYP impact

Substrate of 3A4 (major)

Inhibits 2D6 (strong) and 3A4 (weak)

Effects of cocaine

euphoria, elation, grandiosity, ioquacity, alertness, mydriasis, change bp, tachycardia, sweat/chills, N/V, decreased fatigue, paranoia, aggression, motor agitation, nasal septum ulceration, hallucinations, kindling (potentiate psychosis)

Signs of cocaine toxicity

cardiac arrest, MI, stroke, arrhythmia, seizures, hyperthermia

s/s of cocaine withdrawal

depression, fatigue, nightmares, sleep disturbances, increased appetite, bradyarrhythmia, tremor

How to treat cocaine overdose

supportive care, lorazepam, haldol, or antiarrhythmic agents as needed for cardio complications

What is cocaine?

naturally occurring alkaloid that is rapidly metabolized to inactive metabolites (ecgonine methyl ester, benzoylecgonine, cocaethyline)

Cocaethyline is only produced when cocaine is in the presence of _______

ethanol

MOA of amphetamines

block reuptake of DA and NE, increase release of DA and NE, MOAi

effects of amphetamines

decreased fatigue, alert, wake, decreased appetite, increased activity, increased respiration, hyperthermia, irritability, insomnia, confusion, tremor, convulsions, anxiety, paranoia, aggression, stroke, MI, arrhythmia, meth mouth

s/s of amphetamine withdrawals

Fatigue, depression, cognitive impairment

Meth lab fires or explosions <3

How to treat amphetamine overdose

supportive care, haldol, or lorazepam

MOA of ecstasy MDMA

Is a derivative of amphetamine unknown MOA! Does destroy serotonin producing neurons in animals

effects of ecstasy MDMA

empathy, relaxation, party/rave, suppress need to eat/drink/sleep, euphoria, decrease inhibition, anxiety, paranoia, irrational, psychosis, touch, muscle tension, faint, chills, sweat, increase HR and BP, hyperthermia

MOA of PCP

DA, 5HT, and NE reuptake inhibitor

effects of PCP

Euphoria, delusion, hostility, hallucinations, emotional lability

Low doses: sedation, ataxia, nystagmus, slurred speech, paresthesia

High doses: increased HR/BP/temp, diaphoresis, muscle rigidity, seizure, coma

MOA of ketamine

Produces a cataleptic-like state in which the patient is dissociated from the surrounding environment by direct action on the cortex and limbic system. Releases endogenous catecholamines (epi, NE) which maintain blood pressure and heart rate. Reduces polysynaptic spinal reflexes.

What is ketamine a substrate of

2B6, 2C9, and 3A4

class of ketamine

Anesthetic CIII

effects of ketamine

increased BP/HR, hallucinations, vivid dreams, delirium, respiratory depression, hypertonia, dystonia, seizures, neuropathy, cardiac arrest, psychedelic effects.

How is cocaine use disorder treated?

bupropion, topiramate, modafinil, topiramate + MAS-ER, amphetamine formulations

How are ATS use disorders treated?

bupropion, bupropion + naltrexone, mirtazapine, topiramate, methylphenidate

MOA of LSD

stimulate presynaptic 5HT1a and 1b and post synaptic 5HT2

effects of LSD

mydriasis, increased temp/BP/HR, sweating, loss of appetite, sleeplessness, dry mouth, tremor, blurred vision, dizziness, weakness, hallucinations, sensory crossover, flashbacks, perceptual intensification, depersonalization

how to treat LSD overdose

supportive care and lorazepam or haldol

MOA of marijuana

cannabinoid receptors and release of dopamine

What is the active parent compound of cannabinoids?

delta-9-THC

effects of delta-9 THC

euphoria, disinhibition, impaired cognition (short-term memory, vigilance, divided attention, skills), bronchioles relax and enlarge, blood vessels dilate, blood shot eyes, pleasant sensations, more intense sensations, time passes slowly, hunger, thirst, dry mouth, tachycardia, fear, distrust, panic, decreased coordination, balance, decreased memory and reaction time, amenorrhea, respiratory complications, decreased testosterone, decreased spermatogenesis

what are inhalants

“huffing” includes glues, solvents, butane, gasoline, aerosols, toluene, benzene, methanol, trichloroethylene, trichloroethane, nitrous oxide, poppers/snappers are amyl nitrate and butyl nitrate

MOA of inhalants

rapidly absorbed via capillaries in the lungs and can penetrate the BBB

effects of inhalants

nausea, HA, deprive brain of O2, arrhythmia, suffocation, brain damage, neuropathies, encephalopathy, impaired pulmonary/renal/hepatic function, decreased BP, loss of coordination, slurred speech

What is cocathylene

cocaine + alcohol

what is a Q-Ball

quetiapine + cocaine

what is a Speedball

heroin + cocaine

What is Krokodil

homemade formulation of potent, short-acting opioid, desomorphine (derived from codeine but is impure and highly contaminated)

which drug contains solvents like gasoline and lighter fluid and potential contaminants such as iodine, hydrochloric acid red phosphorus?

Krokodil

ADRs of SQ Krokodil

local tissue damage such as ulcers, skin necrosis, infection

s/s of Krokodil overdose

slow shallow breathing, small pupils, slurred speech, pale face, blue lips/nails, choking/gurgling

What are bath salts

synthetic stimulants known as “cathinones” belong to phenylethylamine (meth, MDMA) — analog of naturally occurring substance

What are the amphetamine-like stimulatory effects seen with bath salts?

euphoria, energy, alert.

signs of bath salts intoxication

combativeness, hallucinations, agitation, paranoia, confusion, hallucinations, myoclonus, seizures

s/s of bath salt overdose 

tachycardia, HTN, agitated delirium, diaphoresis, mydriasis, hyperthermia

What are the most common causes of bath salt deaths?

arrhythmia, hyperthermia, intracerebral hemorrhage

Treatment options for bath salt overdose

IV benzos, fluid resuscitation, and sedation

What are synthetic cannabinoids

analogs of naturally occurring chemicals found in marijuana, including: tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabinol (CBN)

facts regarding synthetic cannabinoids

They are sold as “herbal products” in head shops and the internet. Were previously referred to as “legal highs” or “herbal highs”. They have cannabis-like effects

T/F: cannabinoid and cannabinoid receptor agonists are much more potent than THC, CBD, and CBN

true

effects of synthetic cannabinoids

red eyes, tachycardia, anxiety, aggressive behavior, paranoia, hallucinations, inability to speak, dystonia, short-term memory deficits, seizures (effects are much more pronounced than those observed after use of marjijuana)

What is Kratom?

Mitragyna speciosa Korth (a tree native to swampy regions of Asia and Africa). Is a legal plant product

MOA of Kratom

Activity at supraspinal mu and delta opiate receptors. May stimulate post-synaptic alpha-2 adrenergic receptors and/or block 5HT2A receptors. Is 13x more potent than morphine!!!!

effects of Kratom

Stimulant effects at lower doses: alertness, physical activity, talkativeness, social behavior, opiate effects at higher doses plus sedation and euphoria. Itching, sweating, dry mouth, constipation, increased urination, loss of appetite

T/F: Kratom cannot cause addiction, withdrawal, psychosis, or death

false

Facts regarding pregnanct/lactation and SUD:

should test meconium or infant hair, watch for HIV d/t risk with needle use, should be concerned with drug exposures, impurities, and what the drug is cut with

Babies exposed to methamphetamine abuse/crack-cocaine experience:

growth retardation, premature birth, developmental disorders, abruptio placentae, spontaneous abortion, fetal hypoxia, and may cause abnormal sleep, poor feeding, hypotonia, fever, or vomiting

Facts regarding fetal alcohol syndrome:

is the most common cause of mental retardation in developed countries - delays growth, learning, speech behavior, and causes cranio-facial abnormalities

facts regarding cigarettes/smoking and pregnancy/lactation:

Is dose-dependent! Can cause spontaneous abortion, low birth weight, and SIDS

facts regarding marijuana and pregnancy/lactation:

Decreases testosterone and spermatogenesis. In neonates, there may be deficits in memory or verbal ability, tremor, and increased startle reflex

which opiate is currently the standard of care for SUD in pregnancy/lactation

methadone (pregnancy class C)

T/F: Subutex is typically recommended over Suboxone for SUD in pregnancy/lactation

true

what pregnancy category is Subutex?

Category C

Describe neonatal abstinence syndrome:

40% require treatment, NAS less intense than methadone. Generally, appears within 2 days, peaks in 3-4, lasts 5-7

Nursing – not advised, not contraindicated