Addiction Studies Final

heroin class

C1

LSD class

C1

MDMA class

C1

PCP class

C1

cocaine class

C2

fentanyl class

C2

meth class

C2

morphine class

C2

hydrocodone class

C2

oxycodone class

C2

methadone class

C2

buprenorphine class

C3

dihydrocodeine/APAP-ASA class

C3

APAP/codeine class

C3

ketamine class

C3

tramadol class

C3

pentazocine/naloxone class

C4

promethazine with codeine class

C5

FDA-approved MOUD

methadone, naltrexone, buprenorphine

addiction definition

a set of psychological symptoms that demonstrate overall loss of control or obsessive-compulsive drug-seeking and continued use of a substance in spite of clearly adverse consequences

dependence defintion

increasing tolerance for a drug, withdrawal signs and symptoms when a drug is discontinued, or the continued use of a substance to avoid withdrawal

misuse definition

incorrect use of a med by patients, who may use a drug for a purpose other than that for which it was prescribed, take too little/too much of a drug, take it too often, or take it for too long

tolerance defintion

decreased effect of drugs due to use

nightshade (hallucinogens) class

belladonna alkaloids

mandrake root (hallucinogens) class

belladona alkaloidds

jimsonweed (hallucinogens) class

belladonna alkaloids

ketamine (hallucinogens) class

dissociative anesthetics

PCP (hallucinogens) class

dissociative anesthetics

Mexxy (hallucinogens) class

dissociative anesthetics

LSD (hallucinogens) class

tryptamine (serotonin like)

psilocybin (hallucinogens) class

tryptamine (serotonin like)

DMT (hallucinogens) class

tryptamine (serotonin like)

Ayahuasca (hallucinogens) class

tryptamine (serotonin like)

bromo-dragonfly (hallucinogens) class

phenethylamine (dopamine like)

mescaline (hallucinogens) class

phenethylamine (dopamine like)

2-CB (hallucinogens) class

phenethylamine (dopamine like)

NBOMe (hallucinogens) class

phenethylamine (dopamine like)

nutmeg (hallucinogens) class

phenethylamine (dopamine like)

sub amphetamines (hallucinogens) class

phenethylamine (dopamine like)

cathinones (hallucinogens) class

phenethylamine (dopamine like)

benzyl and phenyl (hallucinogens) class

piperazine

low dose PCP effects

intoxication with extreme numbness

staggering

unsteady gait

slurred speech

bloodshot eyes

unbalance

moderate dose PCP effects

analgesia and anesthesia

high dose PCP effects

convulsions

highest dose PCP effects

psychosis/schizophrenia

PCP general effects

RED DANES

rage, erythema, dilated pupils, delusions, amnesia, nystagmus, excitation, skin dryness

DMT slang terms

deems

elf spice

da monkey train

businessman's special

giggle stick (weed + DMT)

MDMA slang terms

escatasy

XTC

X

E

molly

empathy

sassyfras

adam

MDMA MOA

5HT/NE/D releasing agent

hallucinogen natural resources

Nightshade - tomatoes, potatoes, eggplant, peppers, tobacco plant, capsaicin

Jimsonweed

Psilocybin - shrooms caps and stems

Ayahuasca - banisteriopsis caapi vine and psychotria viridis leaf

Mescaline - cacti

Nutmeg

cathinones - Khat

shrooms clinical trials

depression, opioid use disorder

MDMA clinical trials

PTSD

ketamine clinical trials

pain management, depression

empathogen/enactogen

psychoactive substance producing experiences of emotional communion, oneness, relatedness, emotional openness

entheogen

psychoactive substance employed in culturally sanctioned visionary experiences in ritual or religious contexts

smurfing

turning pseudoephedrine into meth

fenethylline prodrug characteristics

co-drug of amphetamine (25%) and theophylline (14%)

methylphenidate MOA

NE/D re uptake inhibitor d(transporters allosteric modulator (NDTI))

amphetamine MOA

NE/D transporter antagonist, VMAT inhibitor (stimulate NE/D release), 5HT re uptake inhibitor

OTC NRT gum and lozenge dosages

2 or 4mg every 1-2hrs for the first 6 weeks

OTC NRT patch dosage recommendations

7, 14, or 21mg 24hr release patch

CBD product types

inhaled, oral, topical

CB1 receptor location

CNS

CB2 receptor location

immune system and GI tract

THC MOA

partial agonist of CB1 and 2

CBD MOA

CB1 antagonist, CB2 negative allosteric modulator

dronabinol (Marinol and syndros) indication

CINV/Aids-anorexia

cannabidiol (epidiolex) indication

pediatric epilepsy conditions

inhaled cannabis onset

immediate

oral cannabis onset

15mins for SL spray, 1-6hrs for others

cannabis drug-drug interactions

CYP-450 (watch with NTI meds)

protein binding (>90%) - cyclosporine, levothyroxine, phenytoin, tacrolimus, valproic acid, warfarin

sedatives - opioids, benzos, anticholinergics

kratom MOA

low dose (1-5g) - stimulatory and antidepressant

high dose (>5g) - opioid agonist, alpha-2 agonist

primary psychoactive component of kratom

mitragynine

effects of kratom

primary effect - seizures

continuous vomiting/nausea

hallucinations/psychosis

sweating

dizziness

tremors

increased urination

constipation

diaphoresis

pruritus

salvinorin MOA

potent kappa opioid agonist, D2 partial agonist, endocannabinoid modulator

ibogaine MOA

potent serotonin reuptake inhibitor, moderate kappa opioid agonist, weak mu opioid agonist

benzo overdose treatment

flumazenil 200ug q1-2min until successful (max 3mg/hr)

monitor for withdrawal upon admin and need for re-admin

phenibut MOA

GABA structural analog (GABA B receptor agonist), nootropic (cognition-enhancing)

phenibut structure

beta-phenyl-amino-butyric acid

beta-phenyl-GABA

R-enantiomer is active

phenyl allows crossing BB

GHB prodrug mechanism

GABA-B agonist, GHB agonist

GHB oxybate prescription products

sodium GHB (sodium oxybate, xyrem)

potassium GBH (potassium oxybate)

GHB oxybate uses

cataplexy associated with narcolepsy, excessive daytime sleeping, alcohol use disorder (rare)

rohypnol name

flunitrazepam

rohypnol MOA

GABA modulator that causes sedation within 30mins lasting 8-12hrs

NIAA binge drinking definition

a pattern of drinking that brings BOC levels to 0.08g/dL; typically occurs after 4 drinks for women and 5 drinks for men, over 2 hrs

SAMHSA binge drinking definition

>/= 5 alcoholic drinks for males (4 for women) on the same occasion at least 1 day in the past month

SAMHSA heavy alcohol use definition

a) binge drinking on 5 or more days in the past month

naltrexone (ReVia) counseling points

· Abstinence from alcohol is not required

· Effective for patients with a lot of cravings

· Effective in preventing relapse into heavy drinking in patients not abstinent

· CI - people using opioids, severe liver pathology, kidney impairment

· Patients should carry ID noting that they are utilizing naltrexone in case of injury where opioid treatment may be utilized

naltrexone injectable ER (Vivitrol) counseling points

· Must not be actively drinking at time of injection

· Must be taken 7-14 days after last opioid ingestion to prevent withdrawal

· Cost >1k/month

disulfiram (antabuse) counseling point

· Avoid alcohol in all forms

· Medication compliance is extremely important

· Clinically reduces drinking days

· Does not reduce cravings

· May take at bedtime if experience drowsiness ADE

acamprosate (capral) counseling points

· Utilized for patients who are abstinent with severe withdrawal symptoms, and have difficulty maintaining

· Better effect with acamprosate and naltrexone together

· Do not use with severe renal impairment

· Can cause diarrhea, itching, depression, insomnia, rare cardiomyopathy

thiamine and folic acid counseling points

· Chronic alcoholism interferes with absorption

· Thiamine prevents Wernicke-Korsakoff syndrome, an often-fatal encephalopathy

· Ensure folic acid is in multivitamin and prevent complications such as megaloblastic anemia

sudden sniffing death

· Irregular/rapid heart rhythms --> fatal heart failure within mins of prolonged sniffing

· Can result from a single session of inhalant use by an otherwise healthy person

· Associated particularly with the abuse of aerosols (butane, propane)

nitrates concerns

· Visual yellow spot with purple radiations

· Swallowing causes effects similar to cyanide inhibiting hemoglobin transport of oxygen (hypoxia)

narcan dosing

4mg

rivive dosing

3mg

pocket naloxone dosing

1 swab

prescriber DEA red flags

· Out of area patients

· Out of pocket only paying patients

· Prescribing the same (high) quantities controls to most/every patient

· High number of prescriptions in general issued per day

· Prescribing of the same combinations of high abuse drugs

dispensers DEA red flags

· Dispensing a high ratio of controlled to non-controlled drugs

· Dispensing high volumes of controlled substances generally

· Dispensing identical prescriptions prescribed by the same prescriber to many patients

· Dispensing to out-of-area patients

· Dispensing to multiple patients with the same last name or address

· Filling sequentially numbered controlled substance prescriptions from the same prescriber

· Filling prescriptions for controlled substances for one patient from multiple practitioners

· Dispensing for patients seeking early prescription fills/refills

urine drug testing

· GC-MS or LC-MS

· Definitive

· Laboratory, highly specific and sensitive

· Result in hours or days

· Measures all drug/metabolite concentrations

· Definitive idenitification and analysis

· False-positive/negatives are rare

· $$$