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Pharma doa

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    Pharma doa Pharma doa Presentation Transcript

    • Drugs of abuse
    • Drugs of abuse
      • def. drugs or chemicals which are taken repeatedly in a pattern & amount that interferes with one’s health or normal function
      • used for a variety of reasons; they have multiple effects, usually producing a feeling of well-being in the user  repeated use  higher & higher dose needed to replicate the feeling  emotional dependence, & in some, true physical dependence
    • Classification of d s oa
      • Opiates & Opioids : morphine, codeine, heroin, meperidine (Demerol), hydromorphone
      • Sympathomimetic stimulants : cocaine, amphetamines, metamphetamines, MDMA
      • Depressants : barbiturates, benzodiazepines, ethyl alcohol
      • Hallucinogens : LSD, mescaline, MDMA,
      • Others : PCP, marijuana, nicotine
    • Classification of drugs of abuse
      • CNS actions
      • Stimulants : amphetamine, caffeine, nicotine, cocaine -
      • Depressants : barbiturates, benzodiazepines, ETOH
      • Analgesics : narcotics (opiates & opioids)
      • Sedative–Hypnotics : relaxants, induce sleep: alcohol; anti-anxiety agents-tranquilizers; nonbarbiturates- Halcion, Quaalude; long-acting barbiturates – Phenobarbital; short-acting barbiturates - Seconal
    • Drugs of abuse
    • Legal classification
      • Schedule 1: high abuse, no recognized medical use, lack of safety
      • Schedule 2: high abuse, medical utility, high dependency risk
      • Schedule 3: lower abuse, medical utility, moderate dependency risk
      • Schedule 4: limited abuse, high medical utility, limited dependency risk
      • Schedule 5: minor problems
    • Drugs of abuse
      • Schedule 1:
        • Heroin
        • LSD
        • MDMA
        • Marijuana
        • Methaqualone
      • Schedule 2:
        • Opium
        • Morphine
        • Coca
        • Cocaine
        • Methadone
        • Methampethamine
      • Schedule 3:
        • Amphetamine
        • Barbiturates
        • Valium
        • Xanax
        • Anabolic steroids
        • Codeine
      • Schedule 4:
        • Chloral hydrate
        • Meprobamate
        • Paraldehyde
        • phenobarbital
      • Schedule 5: limited amts
    • DEFINITIONS
      • Positive reinforcement : release of positive reinforcement neurotransmitters e.g. dopamine, endorphins
      • Tolerance : reduced effect with repeated use of the drug  need for progressively higher doses to produce the same effect; due to down-regulation of receptors, changes in receptors, exhaustion of neurotransmitters, increased metabolic degradation, physiological adaptation
      • Cross-tolerance : for drugs of the same class
    • DEFINITIONS
      • Dependence - compulsion to take the drug repeatedly
      • Psychological dependence – positive reinforcement causes a compulsion to take the drug
      • Physical dependence – negative reinforcement – distress upon stopping the drug (withdrawal) is the main reason for continuing to take it
      • Cross-dependence – different drugs within a pharmacological class can generally maintain physical dependence produced by another member
    • DEFINITIONS
      • Sensitization – craving for the drug
      • Withdrawal – symptoms are opposite to the acute effects of a drug
      • Detoxification – used to treat physical dependence
        • “ cold turkey” – abrupt stoppage of the drug
        • “ warm turkey” – gradual reduction in drug dosage
    • Psychomotor stimulants
      • Drugs:
        • Cocaine
        • Amphetamine(s)
        • Methylpenidate
        • Ephedrine
        • Cathinone
      • Effects
        • Mood elevation
        • Wakefulness; increased alertness, restlessness
        • Heightened energy
        • Mild to moderate anorexia
        • Sleep disturbance
    • Psychomotor stimulants
      • mechanism of action: indirect agonists – increase synaptic activity of the monoamines
      • withdrawal syndrome: lethargy. Depression, hypersomnia, craving
      • Cocaine –
        • available as leaves, paste, salt, smokeable base –
        • can be chewed, inhaled, snorted, rubbed on mucosa (e.g. gums)
        • metabolized in plasma, Liver
        • “ crack baby”
    • Amphetamines
      • shabu (Metamphetamine) & ecstasy (MethyleneDioxyMetAmphetamine)
      • metabolized by Liver or excreted unchanged
      • effects:
        • increased wakefulness,
        • anorexia,
        • Sympathomimetic: mydriasis, vasoconstriction, tachycardia, hypertension, hyperthermia, hyperventilation,
        • Vivid hallucinations & paranoid ideation
        • Euphoria, sense of well-being, self-confidence
    • opiates
      • Opium – papaver (poppy plant)
      • Opiate alkaloids – morphine & Codeine
      • Semi-synthetic opioids – Heroin (diacetylmorphine)
      • Synthetic opioids –
        • phenylheptamines (Methadone),
        • phenylpiperidines (Fentanyl, Meperidine),
        • morphinans (Levorphanol),
        • benzomorphans ( Pentazocine)
      • Opium creates a psychic screen between the mind and the body of the smoker, so that pain becomes an abstraction, without the sharpness of physical sensation...The anesthesia produced by opium may be described as a sort of cerebral intoxication, a psychic fog between oneself and external reality that diminishes the outer world. The smoker forgets he has a body. His mind escapes the prison of the flesh and the material world, and is removed to the periphery of reality by the centrifugal force of opium. He escapes not only his own body, but also the physical world in which his body exists. Opium plays a siren's tune on the piano off his nerves, and as he listens, the smoker forgets about the passage of time, and he also forgets about hunger, thirst, fatigue and sleep." Nguyen Te Duc, ( Le Livre de l'opium )
    • opiates
      • opioid receptors:
        • mu,
        • delta,
        • kappa
      • Endogenous opioids:
        • endorphins,
        • enkephalins,
        • dynorphins,
        • endomorphins
    • opiates
      • Opioid antagonists:
        • naloxone,
        • naltrexone
      • physiologic effects –
        • analgesia,
        • miosis,
        • constipation,
        • cough suppression
    • opiates
      • Chronic use:
        • Tolerance
        • Sensitizations
      • Physical dependence
      • Pharmacological Tx of Opioid abuse:
        • Substitution: Methadone, Buprenorphine
        • Opioid antagonist: Naltrexone
    • marijuana
      • delta-9-tetrahydrocannabinol (THC)
      • in the resin of Cannabis sativa
      • Cannabinoid receptors
      • Endogenous cannabinoids
      • Acute effects: euphoria & exhiliration; relief of anxiety, disinhibition, time distortion, hunger/thirst, bloodshot eyes, attention & memory impairment, motor impairment
    • marijuana
      • Therapeutic uses: Dronabinol (Marinol)
      • Antiemetic/antinausea – esp. in CA chemoTx
      • Appetite stimulant
      • Antispasmodic
      • Reduction of intraocular Pressure - in Glaucoma
      • Analgesia – in tic doloreaux
      • Bronchodilation – in asthma
      • Neuroprotective – in seizures
    • Psychedelics / hallucinogens
      • Serotonin-like: LSD
      • Catecholamine-like:
        • Mescaline
        • Methoxyamphetamines: MDMA
      • Anticholinergic
        • Atropa belladona
        • Datura stramonium
        • Mandragora officinarum
        • Scopolamine, Hyoscyamine, Atropine
      • Dissociatives
        • Phencyclidine (PCP, angel dust)
        • Ketamine
    • CAFFEINE & XANTHINES
      • Coffee : Coffea arabica & C. robusta
      • Tea: Camellia (Thea) sinensis
      • Chocolate: Theobroma cacao
      • Cola: Cola acuminata
      • Effects:
        • Bronchodilation
        • Increased HR, BP
        • Arousal
      • High dose: caffeinism, panic attacks; tremors
    • nicotine
      • Nicotiana tabacum (Tobacco)
      • Receptors: nicotonic ACh receptors
      • Effects
        • Psycomotor activity
        • Alertness attention
        • Cognitive function
        • Sensorimotor performance
        • Fluid retention
        • Tremors
        • Increased respiration
    • nicotine
      • Withdrawal: craving, dysphoria, anxiety, irritability, restlessness, impatience, anger, increased appetite, insomnia
      • Toxicity: cigarette smoke
      • Cancer: mouth, throat, larynx, lungs, bladder, pancreas, uterus,
    • Cns depressants & alcohol
      • Ethyl Alcohol: Acetaldehyde
        • 10 gm in 12 oz beer, 4 oz unfortified wine, or 1.5 oz 80-proof liquor
        • rapidly absorbed in the stomach & small intestines
        • Metabolized by the liver at the rate of 10gm/hr
          • Acute intoxication: mainly affects the CNS & Stomach
          • 20-30mg/dL= powerful depressant effect on cortical inhibitory centers= loss of inhibitions= “party” syndrome; Euphoria; disordered cognitive & motor functions
          • 100mg/dL= legal level of intoxication= Ataxia
          • 200-250mg/dL= narcosis= drowsiness
          • 300-400mg/dL= coma; profound anesthesia; death
        • Chronic Alcoholism: induces injuries in all tissues
        • Liver - most commonly & severely affected= fatty change, acute hepatitis--- Cirrhosis
        • CNS – Wernicke’s encephalopathy- ataxia, global confusion, ophthalmoplegia, loss of neuropil & demyelination (vit B1 def) & Korsakoff syndrome- profound memory deficit both recent & remote; cerebellar degeneration; cerebral atrophy
        • Fetal Alcohol Syndrome: microcephaly, cardiac defects, mental deficiency, facial malformations
        • Misc.: neuropathies; congestive cardiomyopathy; ↑frequency of cancer in the larynx, oropharynx, esophagus, rectum, lung
    •  
    • Cns depressants
      • Drugs:
        • Bromide, Chloral hydrate
        • Barbiturates
        • Methaqualone
        • Benzodiazepines
      • sedative effect
      • toxicity: respiratory depression
    •  
    • Dangerous drugs act
      • Republic Act 6425: DANGEROUS DRUGS ACT OF 1972
      • RA 9165: an act instituting the COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002, repealing RA 6425, as amended, providing funds therefor, and for other purposes
    • Declaration of policy
      • It is the policy of the State to safeguard the integrity of its territory and the well-being of its citizenry particularly the youth, from the harmful effects of dangerous drugs on their physical and mental well-being, and to defend the same against acts or omissions detrimental to their development and preservation. In view of the foregoing, the State needs to enhance further the efficacy of the law against dangerous drugs, it being one of today's more serious social ills.
      • Toward this end, the government shall pursue an intensive and unrelenting campaign against the trafficking and use of dangerous drugs and other similar substances through an integrated system of planning, implementation and enforcement of anti-drug abuse policies, programs, and projects.
    • Declaration of policy
      • The government shall however aim to achieve a balance in the national drug control program so that people with legitimate medical needs are not prevented from being treated with adequate amounts of appropriate medications, which include the use of dangerous drugs.
      • It is further declared the policy of the State to provide effective mechanisms or measures to re-integrate into society individuals who have fallen victims to drug abuse or dangerous drug dependence through sustainable programs of treatment and rehabilitation.
    • Drug testing
      • random urine sample
      • other fluids: blood, sweat, saliva, milk;
      • other tissue: hair
      • ‘ screen’ : opiates, benzodiazepines, barbiturates, cannabinoids, amphetamines, cocaine, methadone, buprenorphine
    • Length of time drugs are detected in urine
      • Alcohol – up to 1 day
      • Amphetamines (incl. Ecstasy) – 1 to 3 days
      • Barbiturates – 1 to 3 days
      • Benzodiazepines – 1 to 3 days
      • Cannabis – up to 2 weeks
      • Cocaine – 1 to 3 days
      • Codeine; Dihydrocodeine – 1 to 2 days
      • Heroine, Morphine – up to 1 day
      • Methadone – 1 to 3 days
    • Thank you !