3350 drugs of abuse and stimulants

dissociative drugs of abuse

phencyclidine, dextromethorphan, ketamine

opioids of abuse

heroin, oxycodone

depressant drugs of abuse

alcohol, GHB, barbiturates, benzodiazepines

psychedelics of abuse

LSD, mescaline, psilocybin

psychostimulants of abuse

methamphetamine, cocaine (numbs local area and vasoconstricts)

miscellaneous drugs of abuse

nicotine, marijuana, nitrous oxide

nicotine

#1 culprit for preventable illness and premature death

nicotine mechanism of action

activation of nicotinic receptors→sympathetic CV stimulation, parasympathetic GI motility and increased gastric acid secretion, CNS stimulation

nicotine physiological effects

increased HR, cardiac output, bp, gastric acid secretion and GI motility, increased alertness, suppression of appetite, activation of pleasure system, birth defects, premature birth, SIDS

acute effects of nicotine OD

mix of cholinergic and anticholinergic effects

N&V, pallor, increased salivation, HR increase and then decrease, hypotension, diarrhea, confusion, agitation

chronic effects of nicotine use

damage to nearly every organ, cancer, staining of teeth and nails, premature aging, CV disease, lung disease, elevated LDL, tolerance, physical dependence, abstinence syndrome

symptoms of nicotine abstinence syndrome

nervousness, irritability, hostility, increased appetite

nicotine-based agents for smoking cessation

nicoderm patch, nicorette gum or lozenge, nicotrol nasal spray or inhaler

smoking→OD

chew gum slowly, don’t chew lozenges bc increases rate of absorption

nicotine-free agents for smoking cessation

varenicline (partial agonist of nicotinic neuronal receptor)

bupropion (NE/DA reuptake inhibitor)

marijuana

schedule I but shifting to schedule III

marijuana mechanism of action

agonist of cannabinoid CB1 (body) and CB2 (immune system) receptors of endocannabinoid system, THC causes euphoria

pharmacokinetics- smoking marijuana

absorbed from lungs, effects occur in 20-30mins and last 2-3hrs

pharmacokinetics- ingesting marijuana

effects occur in 30-50mins and last up to 12hrs, high first pass metabolism

adverse effects of high amounts of marijuana

panic attacks, confusion, paranoia

adverse effects of chronic marijuana use

anti-motivational syndrome, reduced brain volume, lung cancer, COPD, asthma, bronchitis, sinusitis, cannabis hyperemesis syndrome

CNS stimulants

increase overall excitation by stimulating excitatory neurons

CNS stimulants effects

increased wakefulness and productivity, decreased appetite, anxiety, jitteriness, insomnia, chest pain, palpitations, arrhythmias, seizures, sudden cardiac death, risk of MI and stroke with long-term use

CNS stimulants therapeutic use

narcolepsy, ADHD, neonatal apnea, headache from caffeine withdrawal

drugs for ADHD and narcolepsy

amphetamines, amphetamine-like drugs, nonstimulants

amphetamines

Adderall, dextroamphetamine, lisdexamfetamine, methamphetamine

Adderall

amphetamine, racemic mixture of levo and dextro

dextroamphetamine

amphetamine, active isomer

lisdexamfetamine

amphetamine, pro-drug

methamphetamine

amphetamine, dextro and methyl group

amphetamines mechanism of action

reverse transporter DAT/NET and inhibit storage VMAT to increase circulating DA and NE, sympathetic effects

taking break to support growth sometimes recommended

amphetamines adverse effects

insomnia, restlessness, loquaciousness, tolerance, abuse (schedule II), physical dependence, dysrhythmias, angina, HTN, paranoid psychosis, weight loss

amphetamine-like agents

methylphenidate, dexmethylphenidate

methylphenidate

amphetamine-like drug, mixture of levo and dextro

dexmethylphenidate

amphetamine-like drug, active isomer

amphetamine-like drugs mechanism of action

reverse transporter DAT/NET and inhibit storage VMAT to increase circulating DA and NE, sympathetic effects

amphetamine-like drugs adverse effects

insomnia, restlessness, loquaciousness, tolerance, abuse (schedule II), physical dependence, dysrhythmias, angina, hypertension, paranoid psychosis, weight loss

nonstimulants

atomoxetine, alpha 2 agonists

alpha 2 agonists

guanfacine, clonidine

nonstimulants therapeutic use

ADHD, not as effective as stimulants

nonstimulants mechanism of action

increases NE by selectively inhibiting reuptake

nonstimulants adverse effects

GI upset, reduced appetite, dizziness, somnolence, mood swings (monitor for suicidal ideation)

pharmacokinetics of nonstimulants

short half-life, immediate and extended/sustained release formations

methylxanthines

caffeine, theophylline

caffeine therapeutic uses

treats neonatal apnea, promotes wakefulness

caffeine mechanism of action

adenosine receptor antagonist, enhanced calcium permeability in sarcoplasmic reticulum, increased cAMP through blockade of PDE

caffeine therapeutic effects

CNS activation, stimulation of heart, central vasoconstriction, peripheral vasodilation, bronchodilation

caffeine adverse effects

tolerance, dose-dependent CNS activation (nervousness, insomnia, tremors, convulsions), dose-dependent stimulation of heart (risk of dysrhythmias), reproduction (crosses placenta, can cause low birth weight)