Drug Abuse

• DRUG OF ABUSE


  • A. CNS Stimulants
  • B. CNS Depressant
  • C. Hallucinogens
• CNS Stimulants


  • I.Methylxanthine
  • II.Nicotine
  • III.Varenicline
  • IV.Cocaine
  • V.Amphetamines
• Methylxanthines


  • Caffeine -1,3,7 trimethylxanthine
  • Theophylline-1,3 dimethylxanthine
  • Theobromine-3,7 dimethylxanthine
• Methylxanthines MOA


  • Inhibits phosphodiesterase
  • Increases cAMP and produces adrenergic effect
  • Adenosine receptor antagonist
  • Increases Ca++
• Methylxanthines EFFECTS


  • CNS Stimulation
  • Induces diuresis
  • Heart stimulation
  • Bronchodilation (Theophylline)
  • Off-label used for Bronchial asthma
  • Low doses: Insomnia, agitation, palpitations
  • High doses: Seizures and arrhythmia
• THEOBROMINE: DO NOT GIVE TO CATS AND DOGS
• THEOBROMINE EFFECTS


  • Vomitting
  • Diarrhea
  • 50g - Death
• NICOTINE


  • Source: Tobacco, Cigarettes
  • Tolerance and dependence
  • Second only to caffeine as a CNS stimulant and second only to alcohol to number one abused drug
  • Withdrawal: Tremors,HTN,irritability
• CNS STIMULATION: #1 - Caffeine, #2- Nicotine
• Most Abuse Drugs: #1 - Alcohol, #2 - Nicotine
• Varenicline


  • A partial agonist of acetylcholine receptors in the CNS
  • Produces less euphoric effects than nicotine
  • Useful as an adjunct in the management of smoking cessation in patients with nicotine withdrawal symptoms
• Cocaine


  • Prevents reuptake of NE from presynaptic terminals
  • A schedule II drug by U.S DEA
  • Depletes dopamine levels with chronic use
  • Has local anesthetic action
• Amphetamines MOA


  Promotes release of NE
• Amphetamines Administration


  • PO
  • IV
  • Smoked
• Amphetamines Indications


  • ADHD
  • Obesity
  • Narcolepsy
• Amphetamines SIDE EFFECTS


  • Insomnia
  • Hyperactivity
  • Hallucinations
  • Seizures
  • Tachycardia
  • HTN
  • STIMULATION
• Amphetamines Types


  • Methylphenidate
  • Phentermine
  • Methamphetamine
  • Methylenedioxymethamphetamine
• CNS DEPRESSANTS


  • I.Ethanol
  • II. Opium derivatives
• Opium derivatives


  • A.Strong agonist
  • B.Weak Agonist
  • C.Mixed agonist/Antagonist
  • D.Opium Antagonist
• Ethanol


  • Widely abused substance
  • Lower doses: stimulant effect
  • Higher doses: depressant effect
• Ethanol Effects


  • Slurred speech
  • Unbalanced gait
  • Impaired judgement
  • Ataxia
  • Respiratory depression
• Ethanol Adverse Effects


  • Wernicke-Korsakoff Syndrome (Wet Brain)
  • Encephalopathy and psychosis
  • Alcoholism
  • Fetal Alcohol Syndrome
• Opium


  • From Papaver somniferum
  • A narcotic drug
  • Acts on different receptors such as mu (most effect), kappa (Additional analgesia), delta (Additional analgesia)
• Opioid Uses


  • Analgesic
  • Anti tussive
  • Antidiarrheal
• Opioid Antidiarrheals


  • Codeine
  • Dextromethorphan
  • Loperamide
  • Atropine + Diphenoxylate (Lomotil)
  • Paregoric (Camphorated tincture of opium)
• Opioid Poisoning Triad


  • Respiratory depression
  • Pin-point pupils
  • Coma
• Morphine


  • Prototype
  • IV, oral
  • Effects: Histamine release, Emesis, Cardiovascular effects, Depression of cough center, Respiratory depression, Euphoria, Analgesia, Miosis
• Morphine Side effects


  • Tolerance - Increase the amount
  • Dependence
• Meperidine (Demerol)


  • A synthetic opioid structurally unrelated to morphine
  • Weak serotonin reuptake inhibitor
  • Side effects: Seizures, fever
  • CI: MAOI - Increases Serotonin "Serotonin Syndrome"
• Methadone


  • Equal potency to morphine but less euphoric effect
  • Longer duration of action
  • Used in controlled withdrawal of Heroin and morphine users
  • Can also produce dependence like morphine
• Heroin


  • Diacetyl morhpine
  • 3x potent than morphine
  • Hydrolyzed to mophine
  • No medical use in the US
• Fentanyl (Sublimaze)


  • Related to meperidine
  • 100x potent than morphine
  • Used epidurally,IV, or intrathecally
  • Neuroleptanesthesia (Droperidol + Fentanyl + Nitrous Oxide)
• Codeine


  • Methylmorphine
  • Antitussive
  • Replaced with dextromethorphan
• Buprenorphine


  • Acts like morphine
  • Has major use in opioid detoxification
• HALLUCINOGENS


  • Marijuana
  • Phencyclidine
  • Lysergic Acid Diethylamine
• Marijuana


  • From Cannabis sativa
  • Smoked
  • DRONABINOL - synthetic used for chemotherapy induced N/V
  • Street names: Smoke,weed,mary jane,blunt,dope,herb ,joint
  • Features: Blood shot eyes, Delta-9-tetrahydrocannabinol (hallucinogen effect), Cannabinolic acid (responsible for sedative effect)
• Marijuana Uses and effects

  • Analgesic
  • Anti emetic
  • Euphoriant
  • Increase appetite
  • Decrease muscle strength and motor activity
• Marijuana Adverse Effects


  • Tachycardia
  • Hypotension
  • Conjunctivitis
• Phencyclidine


  • Street name: PCP, Angel dust
  • A ketamine analogue that induces Dissociative anesthesia
• Lysergic Acid Diethylamine


  • Street name: LSD, Acid
  • An Ergot Derivative - Ergotamine
  • Induce hallucinations with brilliant colors
  • Has serotonin agonist activity