Week 3 Pharm - Recreational Drugs

Alcohol

Alcohol

Most commonly used and abused psychoactive agent in the United States.

CNS Effects of Alcohol

Acute effects include general depression of CNS function and activation of the reward circuit. Chronic effects include Wernicke's encephalopathy and Korsakoff's psychosis.

Pathological Effects of Alcohol

Alcohol can depress respiration, cause nonviral hepatitis, erosive gastritis, diuresis, pancreatitis, and increase the risk of cancer and fetal alcohol syndrome.

Pharmacokinetics of Alcohol

Includes absorption, distribution, metabolism, and blood levels. Intoxication is defined as a blood alcohol level of 0.08% in the United States.

Alcohol Interactions

Alcohol can interact with CNS depressants, NSAIDs, acetaminophen, disulfiram, and antihypertensive drugs.

Alcohol Overdose

Acute overdose can cause vomiting, coma, hypotension, and respiratory depression. Treatment is similar to poisoning with other CNS depressants.

Precautions and Contraindications for Alcohol

Precautions include peptic ulcer disease, liver disease, pregnancy, epilepsy, and increased risk of breast cancer. Alcohol use disorder is a relapsing disorder.

Drugs for Alcohol Use Disorder

Benzodiazepines, carbamazepine, clonidine, atenolol, propranolol, disulfiram, naltrexone, acamprosate, B vitamins, thiamin, folic acid, cyanocobalamin, vitamin supplements, fluid replacement therapy, antibiotics.

Nicotine and Smoking

Nicotine is a highly addictive substance found in tobacco smoke. Smoking is the leading cause of preventable illness and premature death.

Pharmacokinetics and Effects of Nicotine

Nicotine stimulates nicotinic receptors, constricts blood vessels, accelerates the heart, increases gastric acid secretion, stimulates respiration, and has psychological effects.

Nicotine Dependence and Treatment

Nicotine can cause tolerance, dependence, and acute poisoning. Treatment options include nicotine replacement therapy (gum, patches, lozenges, inhaler), bupropion, and varenicline.

"5 A's" Model for Treating Tobacco Use and Dependence

Ask, Advise, Assess, Assist, Arrange follow-up contacts.

Major Drugs of Abuse

Opioids, psychostimulants, depressants, psychedelics, dissociative drugs, anabolic steroids, marijuana, LSD.

Opioids

Heroin, oxycodone, meperidine. Heroin is the opioid of choice for street use. Oxycodone is a controlled-release drug. Meperidine is often abused by healthcare providers.

Tolerance and Physical Dependence of Opioids

Prolonged use leads to tolerance. Physical dependence can cause withdrawal symptoms. Methadone and buprenorphine are used for detoxification and maintenance therapy.

General CNS Depressants

Barbiturates and benzodiazepines. Barbiturates can cause sedation, coma, and death. Benzodiazepines are Schedule IV drugs.

Benzodiazepines

Schedule IV drugs used for anxiety and insomnia. They can cause tolerance, physical dependence, withdrawal, and acute toxicity. Naloxone is not effective against benzodiazepine poisoning.

Barbiturates

Sedative drugs that are less safe than the drugs mentioned in the paragraph.

Overdose

Rare when taken alone and orally, but the risk increases with IV use or when combined with other depressants.

Tolerance

The need for higher doses of a drug to achieve the same effect over time.

Physical dependence

The body's reliance on a drug to function normally, leading to withdrawal symptoms when the drug is stopped.

Acute toxicity

Severe overdose symptoms, including hyperpyrexia, convulsions, and cardiovascular complications.

Flumazenil [Romazicon]

Medication used to reverse the effects of benzodiazepines, including overdose.

Psychostimulants

Drugs that stimulate the central nervous system, such as methamphetamines and cocaine.

CNS stimulants

Schedule II drugs with a high potential for abuse, including methamphetamines and cocaine.

Methamphetamines

A type of CNS stimulant that can cause arousal, euphoria, and hallucinations, but also adverse cardiovascular effects.

Cocaine

A CNS stimulant with similar effects to amphetamines, available in two forms:cocaine hydrochloride and "crack."

Local anesthesia

A numbing effect produced by cocaine, along with vasoconstriction and cardiac stimulation.

Chronic toxicity

Long-term effects of cocaine use, including nasal mucosa atrophy and lung injury.

Treatment of cocaine addiction

Options include an anticocaine vaccine, disulfiram (Antabuse), and various therapies and medications.

Marijuana

Cannabis sativa, a psychoactive substance with various routes of administration and effects.

Delta-9-tetrahydrocannabinol (THC)

The main psychoactive component of marijuana, responsible for its effects.

Behaviors

Euphoria, sedation, hallucinations, and altered perception are common effects of marijuana use.

Therapeutic uses

Marijuana can be used as an antiemetic, appetite stimulant, and for neuropathic pain.

Cardiovascular effects

Marijuana can increase heart rate and cause bronchodilation or airway constriction.

Tolerance and dependence

Long-term marijuana use can lead to tolerance and physical dependence, with withdrawal symptoms upon cessation.

Psychedelics

Drugs like LSD, mescaline, and psilocybin that alter thinking, feelings, perception, and the relationship to the environment.

Dissociative drugs

Phencyclidine (PCP), ketamine, and dextromethorphan, which can distort sight and sound and produce dissociation.

Inhalants

Drugs administered by inhalation, including anesthetics, volatile nitrites, organic solvents, and others.

Anabolic Steroids

Androgens taken to enhance athletic performance, with high risks for adverse effects.

Smoking cessation

Strategies to quit smoking, including counseling, nicotine replacement therapy, and support groups.

Nicotine chewing gum

Instructions for use, including chewing slowly for about 30 minutes and avoiding eating or drinking beforehand.

Treatment of cocaine addiction

The cornerstone is psychosocial therapy, including individual and group counseling.

Excessive use of marijuana

Manifestations can include impaired memory, slow reaction time, and altered judgment.

Ammonium chloride

A substance used to raise the pH of urine.

Slow, deep breaths

A breathing technique instructed to patients.

IV fluid bolus

A large amount of fluid administered intravenously to prevent hypotension.

Quiet room with dim lighting

A setting recommended for managing psychotic reactions caused by phencyclidine overdose.

Meperidine (Demerol)

The most commonly abused opioid by healthcare providers.

Oxycodone (OxyContin)

An opioid commonly abused by healthcare providers.

Hydromorphone (Dilaudid)

An opioid commonly abused by healthcare providers.

Morphine sulfate

An opioid commonly abused by healthcare providers.