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Controlled Substance Act (1970): Regulates the manufacture, distribution, & dispensing of drugs that have potential for abuse
FEDERAL SCHEDULES OF CONTROLLED SUBSTANCES
SCHEDULE I SCHEDULE II
-No accepted medical use in US -High abuse potential -Heroin, LSD, Marijuana, Mescaline -Substances w/ therapeutic ability -High abuse potential -Analgesics, Morphine, Fentanyl, Meperidine, Methadone, Oxycodone, Amphetamines, Cocaine, Pentobarbital -Substances w/ less abuse potential than those in I&II -Moderate abuse potential (Buprenorphine) -Mixtures of limited, specified quantities of codeine, for example, w/ uncontrolled active ingredients (Tylenol 3) -Substances w/ less abuse potential than those in III -Limited abuse potential -Dextropropoxyphene, Pentazocine, Diazepam, Pemoline, Benzodiazepams (sedatives) -Substances w/ less abuse potential than those in IV -Subject to state & local regulation, Rx may not be required -Antidiarrheal & cough-suppressant preparations w/ limited, specified quantities of, for example, Codeine or Dihydrocodeine
1. Addiction – primary, chronic, neurobiologic disease w/ genetic, psychosocial & environmental factors influencing its development & manifestations; characterized by impaired
over drug use, compulsive use, continued use despite harm & craving
2. Physical Dependence – state of adaptation manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing
blood level of drug, and/or administration of antagonist
3. Tolerance – state of adaptation in which exposure to a drug induces changes that result in a diminution of 1+ of drug’s effect over time 4. Variables Influencing Likelihood of Abuse: - Drug: availability, cost, purity, potency, mode of administration - User: risk taker, metabolism, experience, background - Environment: social settings, education, peer groups/friends
5. Detoxification of Heroin Addicts: - Methadone – used for detoxification/maintenance b/c cross-dependence exists; replaces heroin on mu receptor, longer duration, thus addict doesn’t experience heroin w/d or when ↓ dose - LAAM – longer duration than methadone, severe cardiac-related adverse events (QT interval prolongation, cardiac arrest) - Buprenorphine – partial agonist at mu receptor, lower ceiling so ↓ chance of respiratory depression, sublingual administration = rapid absorption, combo w/ Naltrexone - Naltrexone – Opioid adjunct for heroin dependency and alcoholism - Clonidine – adrenergic agonist
BP. anti-cancer chemotherapy. similar PD. short duratioin -Indirectly ↑ release of DA. respiratory failure -No antidote. cardiopulmonary depression. paranoia. perforation of nasal septum 4. arrythmias. bronchitis. hepatotoxicity. arousal. coma & convulsions leading to epilepticus. stroke. slows thinking. extinction 4. ↑ potency. ataxia -Long Duration – perceptual & psychic effects. Hyperthermia. subarachnoid hemorrhage -Tx. panic. irritability. sense of well being. numbing. jaw/teeth pain -Tx Benzodiazepine OD -Relaxation. weak. 1h nasal -Metabolized by esterases in serum & liver forming metabolites (benzoylecgonine. sweating. perentreral -Rapid Onset – dizzy. drug-craving. xerostomia. memory loss -Effects vary w/ pt. chronic cough. antiglaucoma. impairs short-term memory. ↑ respiratory rate. confusion. auditory & visual hallucinations. cramps. progressive deterioration of respiration & BP. anxiety. irritability. Short Duration -Peak plasma levels 35-90m Intranasal. convulsions. delusions. volatile mood. stereotypy -Necrotizing arteritis – renal failure. ecgonine) -Cocaethylene – active/toxic metabolite when coabused w/ EtOH. exhaustion. depression.1° cause of death -Hallucinogen persisting perception disorder -OD – coma. mydriasis. dysphoria. anxiety. euphoria. hallucinations. moderate exhilaration -↑ BP. Excited Delirium – psychosis accompanied by agitation & hyperthermia 7. Withdrawal – crash. psychotic rxn -Errors in judgment . dose -Short-term tolerance -Little or no withdrawal & physical dependence -Psychological & physical dependence -Tolerance to the sedative effects. mydriasis. loss of inhibitions. hypertension. 5m IV/Inhaled -Duration – 20-40m IV/Inhaled. amnesia. violence. nausea. seizures. headaches 2. elation. hypoxia. cerebral infarction. MI. impaired motor coordination. alertness. depression. symptomatic tx -Adverse psychological rxns -Panic rxn. -Benzodiazepine receptor antagonist -Rapidly absorbing/acting hypnotic. agitation. Others – sexual dysfunction. confusion. headache. confusion. paranoia 2. socially withdrawn. weakness. dizziness. volatile moods. delirium. feelings of enhanced well-being. nauseated. loss of smell. sleepwalking. inhaled -Rapid Onset. hyperphagia. vasoconstriction. fatal cardiac arrest. tremor. restlessness. bradycardia COCAINE -Naturally occurring alkaloid -Inhaling produces ↑ blood levels. muscle pain. neurotoxic -Modulates central 5-HT systems (agonist) -Oral. NE -Local anesthetic by inhibition of voltage-gated NA channels -Euphoria. hallucination. IV. agitation. HR. euphoria. restlessness. psychosis. numb. tremors. anxiety. CV – tachycardia. 5-HT. euphoria. headaches. compulsive behavior. environment. analgesic. CV effects. euphoria. constipation -Oral. tranquility. depression. relaxation. antispasticity 1.DRUGS OF ABUSE (2/2) DRUG MARIJUANA PD/PK -THC. intracerebral hemorrhage. cyanosis. tx symptoms only -Psychosis. inhaled (hydrochloride free base form) -Very Rapid Onset. tremor. nausea/vomiting. sensitization 3. necrosis. seizures. hyperthermia. anxiety. short half life -Oral. mydriasis. physical & psychological dependence. insomnia. overt violence -Withdrawal – dysphoria. longer acting. gastric lavage. tolerance. Neuroendocrine Effects -Nasal. ataxia. hypothermia. depression. Tx for Dependency – behavioral. and some amnesia. coma. sleep aid. compulsive behavior. Mydriasis. elation. tachycardia. psychological & physical dependence. arrhythmias. emphysema 1. akathesia. hypersomnia. Addiction & Dependence – binging. depression. vomiting. anorexia. paranoia. personality changes. alveolar hemorrhage. respiratory arrest 5. restlessness. Pulmonary – congestion. GI effects 6. maintenance of respiration LSD -Fungus from grains -Very Potent -High therapeutic index BENZODIAZEPINE: ALPRAZOLAM FLUNITRAZEPAM FLUMAZENIL GHB -Endogenous NT -Anesthetic. hunger. shock. euphoria. akathisia. synthetic THC used for nausea & vomiting. OD – death due to cardiac arrhythmias. persistent vegetative states -Synergy w/ other CNS depressants . death from cerebral anoxia due to respiratory failure -Lethal if combo w/ other CNS depressants -Tx – Flumazenil. Nasal Use – chronic rhinitis. disinhibition. headache. fatigue. slurred speech. CNS – psychosis. rage -Effects similar to EtOH: drowsiness. tricyclics may work -Binging. stimulates appetite. mydriasis. no tolerance to respiratory depressant effects -Withdrawal –seizures. acute depression. convulsions. drowsiness. ecstasy. delta-9-tetrahydrocannabinol = active ingredient bind to CB1 receptors in the brain -Anandamide – endogenous ligand for CB receptors -Rapid onset -Inhibits reuptake of DA. tachycardia. IV. confusion. longer ½ life -Excreted in urine -Releases DA/NE -Alertness. endogenous opioids & growth hormones -Loss of bladder control.acidify urine. Long Duration -Methamphetamine – derivative. nausea. ↑ BP. stroke 3. insomnia CLINICAL INFO -Dronabinol – slow acting. Psychological Effects – euphoria. cerebral hemorrhages -Decreased growth in children -OD – CNS & CV stimulation. paranoia. anuria. antiepileptic. reaches brain faster AMPHETAMINES TOXICITY -Long-term use can cause ↑ HR. body building supplement. tolerance/cross tolerance -Chronic use anxiety. edema.
depression -OD – unconsciousness.recreational intoxicant -Used to tx cataplexy in pt w/ narcolepsy -Low therapeutic index -Physical Dependence -Withdrawal – anxiety. tremor. vomiting. deaths . insomnia.