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IVMS-CNS Pharmacology Intro to Drugs of Abuse I

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  • 1. CNS Pharmacology- Introduction to Drugs of Abuse I Clinical: E-Medicine Article Injecting Drug Use Prepared and Presented by: Marc Imhotep Cray, M.D. Professor Pharmacology
  • 2. Definitions I. Drug abuse II. Drug dependence A) Psychological dependence B) Physiological dependence III. Drug addiction IV. Drug tolerance 2
  • 3. I. Drug abuse Inappropriate and usually excessive, self- administration of a drug for non-medical purposes  Almost all abused drugs exert their effects in the CNS  Drugs with high abuse potential have a tendency to induce compulsive drug-seeking behavior  Preoccupation with the procurement and use of the drug may be so demanding as to decrease the users productivity.  In addition, prolonged abuse may cause chronic toxicity 3
  • 4. II. Drug dependence Repetitive use of substances that produce an optimal state of well being because of their positive reinforcing effects in the CNS A) Psychological dependence. B) Physical dependence. 4
  • 5. II. Drug dependence A) Psychological Dependence  Motivational component: great subjective need, compulsion, drive to get the drug  Will take drug periodically  Although physical dependence for a drug may not occur, “drug-seeking behavior” is present  Habituation; Just "like" the drug; Drug effects serve as “positive reinforcers” No tolerance increase 5
  • 6. II. Drug dependence B) Physiological Dependence  The body needs the drug for normal physiological function  Tend to increase dose because of tolerance.  Physical withdrawal symptoms (negative reinforcement)  Predictable group of signs and symptoms resulting from abrupt removal of a drug  Psychological dependence is also present 6
  • 7. III. Drug addiction  The drug-use and drug-seeking behavior of dependent individuals is maintained by the reinforcing central activity of the drug despite its negative social, psychological and physical consequences  Physiological effects, including negative reinforcers such as symptoms of withdrawal may also be involve.  High tendency to relapse 7
  • 8. IV. Drug tolerance  After chronic use, the same amount of drug is insufficient to cause the desired effect and thus, more drug is used  A compensatory responseDrug Dose Normal Tolerance 8
  • 9. IV. Drug tolerance cont. A) Innate Tolerance 1. Sensitivity 2. Insensitivity B) Acquired Tolerance 1. Pharmacokinetic or metabolic 2. Pharmacodynamic or functional 3. Learned or behavioral 9
  • 10. V. Cross-dependence  When a drug is administered to achieve the same outcome as that of another drug  i.e. heroin  methadone In a heroin user, methadone can be substituted for heroin in preventing the withdrawal syndrome 10
  • 11. VI. Cross-tolerance  When an individual has become tolerant to a drug and requires higher than normal doses of a second drug to have its effects i.e. Barbiturates  BDZ Amphetamine  Cocaine BARBs  Anesthetics 11
  • 12. VI. Cross-tolerance  In general there is cross-dependence and cross-tolerance between drugs of the same class, but not between drugs in different classes There is some cross-tolerance btw sedative-hypnotics and volatile intoxicants; thus a person tolerant to barbiturates will require more anesthesia than a non-tolerant person  LSD type drugs (tryptamine group) and phenylethylamines have cross-tolerance for each other but not with other hallucinogens 12
  • 13. VII. Co-administration/Co-abuse  Drugs of abuse are used in combination with other drugs from one or more categories  Alcohol is used, for example, with almost everything else  Smoking (nicotine intake) is prevalent in patients using other drugs  Be aware of the possibility of combination of drugs when treating intoxication, withdrawal or overdose, each drug will require a specific treatment 13
  • 14. Take home Point Because of the diverse character of these drugs, there is no “single reason” for their use, nor is there an “addictive personality". IT IS NOT NECESSARY TO HAVE A PREEXISTING EMOTIONAL OR PSYCHIATRIC PROBLEM TO BECOME DRUG DEPENDENT!!! 14
  • 15. VIII. Toxicology A) Tissue and organ toxicity - Usual dose vs overdose - Acute use (respiratory depression - narcotics, coma-barbiturates; cardiovascular effects and seizures- cocaine;arrhythmias-volatile intoxicants) - Chronic use (alcohol, tobacco) 15
  • 16. VIII. Toxicology B) Psychic toxicity - Acute use (bad trips, flashbacks - hallucinogens; CNS stimulants). - Chronic use (alcohol, hallucinogens, stimulants => reality distortion). 16
  • 17. VIII. Toxicology C) Behavioral toxicity - Amotivational syndrome, loss of productivity loss of psychomotor control, accidents, violence - Acute use (alcohol, stimulants, PCP) - Chronic use (alcohol, CNS depressants, stimulants, hallucinogens, PCP) 17
  • 18. VIII. Toxicology D) Associated Diseases - Infections, AIDS, venereal diseases, tobacco-related fires, toxicity due to bad batches of drug (MPTP, PCP congeners), car accidents, big machinery accidents, other accidents, violent death 18
  • 19. Also see: Mouse Party University of Utah, Genetic Science Learning Center The Science of Addiction University of Utah, Genetic Science Learning 19
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  • 47. Drugs and Neurotransmitters & Mental Disorders Interactive Tutorials and Animation Learning Tools  Psychotropic Medications and Neurotransmitters Wisconsin Online  Alcohol and the brain from PBS  The Effect of Drugs and Disease on Snaptic Transmission Harvard Education  Nicotine Patch by Nucleus Communications  GABA Inhibition of Glutamate Bay Area Pain Medical Associates  Acute Pain Bay Area Pain Medical Associates  How Drugs Affect Neurotransmitters INMHA 47
  • 48. Drugs and Neurotransmitters & Mental Disorders Interactive Tutorials and Animation Learning Tools  Schizophrehia UNIVERSITY OF CENTRAL LANCASHIRE  Epilepsy UNIVERSITY OF CENTRAL LANCASHIRE  Pharmacologic Action of Meth RnCeus.com  How is Pain Produced University of Edinburgh  How Much Alcohol can YOU TAke BBC  The Brain: Understanding Neurobiology Through the Study of Addiction National Institutes of Health  The Science of Addiction University of Utah, Genetic Science Learning Center  Stimulants and Antidepressants Dr. Ian Winship of the University of Alberta  Tranquilizers and CNS Depressants Dr.Ian Winship of the University of Alberta  Genetics of Addiction Genetics Science Learning Center 48
  • 49. eMedicine Articles on Addiction  Alcohol-Related Psychosis  Alcoholism  Amphetamine-Related Psychiatric Disorders  Caffeine-Related Psychiatric Disorders  Cannabis Compound Abuse  Cocaine-Related Psychiatric Disorders  Hallucinogens  Inhalant-Related Psychiatric Disorders  Injecting Drug Use  Nicotine Addiction  Opioid Abuse  Phencyclidine (PCP)-Related Psychiatric Disorders  Sedative, Hypnotic, Anxiolytic Use Disorders  Stimulants  Substance-Induced Mood Disorders: Depression and Mania 49