Drugs of Abuse LOs

• Drug abuse definition

  The use of a drug in a manner that is detrimental to the health or well-being of the drug user, other individuals, or society as a whole
• Drug addiction defnition

  An extreme pattern of drug abuse in which an individual is continuously preoccupied with drug procurement and use and thus neglects other responsibilities and personal relationships
• Drug dependence definition

  1. A condition in which an individual feels compelled to repeatedly administer a psychoactive drug
  2. Physical: continuation of drug use required to prevent withdrawal symptoms
  3. Psychological: Caused by positive reinforcement of drug use that results in neuronal activation in the nucleus accumbens, mediated by a common neuronal pathway, leading to behavioral reinforcement of drug use
• Drugs of abuse

  1. Not restricted to the use of illegal drugs
  2. Can also occur with prescription drugs
  3. Prescription pain relievers now account for more deaths in the U.S. than from deaths caused from heroin or cocaine combined
• Emergency treatment of alcohol intoxication

  Supportive care
• Emergency treatment of benzodiazepines

  Flumazenil IV
• Emergency treatment of opioids

  Naloxone
• Emergency treatment of amphetamine base stimulants

  • Lorazepam for agitaiton
  • Haloperidol for psychosis
  • Supportive care
  • Monitor cardiac function
• Emergency treatment for cocaine

  • Lorazepam for agitation or seizures
  • Support vital functions
• Treatment for nicotine/smoking cessation

  • Nicotine products
  • Varenicline
  • Bupropion SR
• Nicotine products for smoking cessation

  1. Available as inhaler (rx), nasal spray (rx), chewing gum (OTC), lozenge (OTC), and transdermal patch (OTC)
  2. Adverse effects: irritability, tremors, intestinal cramps, diarrhea, increased HR and BP, withdrawal sx (anxiety, restlessness, difficulty concentrating, headaches, insomnia)
• Vernicline for smoking cessation

  1. Partial agonist at neuronal nicotinic acetylcholine receptors in the CNS, produces less euphoric effects than nicotine, lessens rewarding effects of nicotine if a person uses tobacco concurrently
  2. Adjunct therapy for smoking cessation in patients w/ withdrawal symptoms
  3. Adverse effects: suicidal thoughts, vivid nightmares, mood changes, n/v, constipation, fluctuance
  4. BBW: serious neuropsychiatric events reported, so all patient being treated w/ varenicline should be observed for neuropsychiatric symptoms, sx can occur during tx or after d/c
• Treatment for alcohol withdrawal

  Benzodiazepines (mainstay)

  • Chlordiazepoxide, diazepam, and lorazepam m.c

  Disulfiram

  • Leads to adverse effects (flushing, nausea, vomiting, tachycardia) if used with alcohol
  • Combination can be dangerous

  Naltrexone

  • Opiate antagonist that can help reduce craving for alcohol, number of binge-drinking days, and number of drinks consumed with binge-drinking
  • Does not cause adverse effects if pt uses alcohol

  Acamprosate

  • Structurally similar to GABA and glutamate, help maintain abstinence in those who start drugs after stopping drinking