Date post: | 23-Nov-2014 |
Category: |
Documents |
Upload: | benjamin-prabhu |
View: | 184 times |
Download: | 0 times |
DRUGS OF ABUSE
EVELYN B. YUMIACO M.D.DEPARTMENT OF PHARMACOLOGY
SCHOOL OF MEDICINEANGELES UNIVERSITY FOUNDATION
HISTORY
3500 BC EGYPTIAN RITUALS1600 BC ANALGESIC AND PAIN KILLER1869 COCAINE1898 HEROIN (BAYER)
1930 MARIJUANA
DANGEROUS DRUGS ACT OF 1972 (RA 6425 )
PROHIBITS THE • IMPORTATION• SALE, ADMINISTRATION, DELIVERY, DISTRIBUTION
AND TRANSPORTATION OF PROHIBITED DRUGS• MAINTENANCE OF DEN, DIVE, RESORT FOR USERS
– EMPLOYEES AND VISITORS OF DRUG DEN– MANUFACTURE OF PROHIBITED DRUGS
• POSSESSION OR USE OF PROHIBITED DRUGS• CULTIVATION OF PLANTS WHICH ARE SOURCES OF
PROHIBITED DRUGSRECORDS OF PRESCRIPTION, SALES, PURCHASE,
ACQUISITION AND DELIVERY OF PROHIBITED DRUGS– UNLAWFUL PRESCRIPTION OF PROHIBITED DRUGS– UNNECESARY PRESCRIPTION OF PROHIBITED DRUGS– POSSESSION OF OPIUM PIPE AND OTHER PARAPHERNALIA
DANGEROUS DRUGS BOARD• POLICY MAKING, STRATEGY FORMULATING BODY IN THE
PLANNING AND FORMULATION OF POLICIES AND PROGRAMS ON DRUG PREVENTION AND CONTROL
• COMPOSITION– SECRETARY OF DEPT OF JUSTICE– DOH– DND– DF– DOLE– DILG– DSWD– DFA– DEPED– CHAIR NATIONAL YOUTH COMMISSION– DIRECTOR GENERAL PHIL DRUG ENFORCEMENT AGENCY– CABINET SECRETARIES– PRESIDENT OF IBP– NGO– NBI– CHIEF PNP
DEFINITION• DANGEROUS DRUGS REFERS TO:• PROHIBITED DRUGS
– OPIUM AND ITS ACTIVE COMPONENTS AND DERIVATIVES SUCH AS HEROIN AND MORPHINE
– COCA LEAF AND ITS DERIVATIVES PRINCIPALLY COCAINE, ALPHA AND BETA EUCAINE
– HALUCINOGENIC DRUGS– MESCALINE, LYSERGIC ACID DIETHYLENEAMIDE (LSD)– INDIAN HEMP AND DERIVATIVES
• REGULATED DRUGS– SELF INDUCING SEDATIVES SUCH AS SECOBARBITAL,
PHENOBARBITAL, PENTOBARBITAL, BARBITAL, AMOBARBITAL AND OTHER DRUGS CONTAINING BATBITURIC ACID AND SALT OR ISOMER OF AMPHETAMINE SUCH AS BENZEDRINE OR DEXBENZEDRINE AND HYPNOTIC DRUGS SUCH AS METHAQUALONE, NITRAEPAN
• INDIAN HEMP• MARIJUANA• EVERY KIND, CLASS , GENUS OR SPECIES
OF THE PLANT CANNABIS SATIVA INCLUDING C. AMERICANA, HASHISH, BHANG, GUAZA, CHURRUS, CANJAB WHETHER DRIED, FRESH, FLOWERING OR FRUITING TOPS, SEEDS
• NARCOTIC DRUGS REFERS TO:– ANY DRUG WHICH PRODUCES
INSENSIBILITY, STUPOR, MELANCHOLY OR DULLNESS OF MIND WITH DELUSION , MAY BE HABIT FORMING SHALL INCLUDE OPIUM, DERIVATIVES AND SYNTHETIC OPIATES
• OPIUM REFERS TO – THE COAGULATED JUICE OF PAPAVER
SOMNIFERUM
• HALLUCINOGENIC DRUGS– DRUGS THAT PRODUCE PERCEPTUAL
DISTORTION– ILLUSION– HALLUCINATION– PARANOIA– MINIMAL EFFECT ON MEMORY AND
ORIENTATIONGOODMAN GILMAN
CLASSIFICATION
• DRUGS THAT ACTIVATE Gio COUPLED RECEPTOR
• DRUGS THAT MEDIATE EFFECTS VIA IONOTROPIC RECEPTOR
• DRUGS THAT BIND TRANSPORTER OF BIOGENIC AMINE
DRUGS THAT ACTIVATE Gio COUPLED RECEPTOR
• OPIOIDS• CANNABINOIDS• GHB• HALLUCINOGEN
– LSD– MESCALINE– PSILOCYBIN
OPIOID
• REFERS TO ALL COMPOUNDS RELATED TO OPIUM
• OPOS= JUICE• DERIVED FROM JUICE OF OPIUM
POPPY (PAPAVER SOMNIFERUM)
CAPSULE OF PAPAVER SOMNIFERUM WITH LATEX
POPPY CULTIVATION
OPIATES• DRUGS DERIVED FROM OPIUM• ENDOGENOUS OPIOID PEPTIDES
– ENKEPHALINS (LEU ENKEPHALIN, MET ENKEPHALIN)– ENDOPHIN 1,2– DYNORPHIN A,B
• NATURAL PRODUCTS– MORPHINE– CODEINE– THEBAINE
• SEMISYNTHETIC DERIVATIVE– BUPRENORPHINE– CODEINE– DIHYDROCODONE– HEROIN (MOST WIDELY USED)
• JUNK, H, SMACK, SKAG, HORSE, – DIPIPANONE– FENTANYL– METHDONE– NALBUPHINE– OXYCODONE– PENTAZOCINE– PETHIDINE– TRAMADOL
ABSORPTION
• CODEINE• OXYCODONE
– LOWER FIRST PASS EFFECT • MORPHINE
– HIGH FIRST PASS EFFECT
• ROUTES OF ADMIN• NASAL ROUTE
– BYPASS THE FIRST PASS EFFECT– BUTORPHANOL
• BUCCAL – FENTANYL LOZENGE
• TRANSDERMAL– STABLE BLOOD LEVEL, BETTER PAIN CONTROL– FENTANYL
• RECTAL• PAIN CONTROLLED ANALGESIA (PCA)
DISTRIBUTION
• DRUG CONCENTRATION IN THE SKELETAL MUSCLE IS LOW
• HIGH CONCENTRATION IN HIGHLY PERFUSED AREAS– BRAIN– LUNGS– KIDNEYS– LIVER – SPLEEN
METABOLISM
• CONVERTED TO POLAR METABOLITES IN THE LIVER
• HEROIN HAS NO INTRINSIC ACTION AT OPIOID RECEPTOR– METABOLITES
• 6 MONO ACETYL MORPHINE • MORPHINE
EXCRETION
• POLAR METABOLITES ARE EXCRETED IN THE URINE
MECHANISM OF ACTION1. RECEPTORTYPES
– MU 1,2– DELTA 1,2– KAPPA 1,2,3– ORPHANIN OPIOID RECEPTOR LIKE SUBTYPE( ORL1)
2. CELLULAR ACTION– CLOSE CA CHANNELS ON PRESYNAPTIC NERVE
TERMINAL LEADING TO DECREASE RELEASE OF NEUROTRANSMITTERS
– OPEN K CHANNELS LEADING TO HYPERPOLARIZATION AND INHIBITION OF POST SYNAPTIC NEURONS
MECHANISM OF ACTION
TOLERANCE– GRADUAL LOSS OF EFFECT WITH
REPEATED USE
PHYSICAL DEPENDENCE– WITHDRAWAL SYNDROME DEVELOPS
WHEN A DRUG IS STOPPED OR AN ANTAGONIST IS ADMINISTERED
TOLERANCE AND DEPENDENCE
• PERSISTENT ACTIVATION OF MU RECEPTORS
• UPREGULATION OF CAMP?• DOWN REGULATION OF MU
RECEPTORS• DYSFUNCTION BETWEEN THE
RECEPTOR, G PROTEIN, 2ND MESSENGER
OPIOID RECEPTORSANALGESIA
SUPRASPINAL M,K,D ANALGESIC
SPINAL M,K,D ANALGESIC
PSYCHOMIMETIC K INCREASE
RESPIRATORY M DEC
GIT M,K DEC TRANSIT
FEEDING M,K,D INC FEEDING
SEDATION M,K INC
DIURESIS K INC
OPIOID RECEPTORSHORMONE REGULATIONPROLACTIN M INCREASE RELEASEGH M,D INCREASE RELEASENEUROTRANSMITTERACH M INHIBITDOPAMINE M,D INHIBITISOLATED ORGAN BIOASSAY GUINEA PIG ILEUM M
DECREASE CONTRACTION
MOUSE VAS DEFERENS D DECREASE CONTRACTION
EFFECTS
CNS
• ANALGESIA– REDUCE THE SENSORY AND AFFECTIVE
COMPONENT• EUPHORIA
– PLEASANT FLOATING SENSATION WITH LESS ANXIETY AND DISTRESS
• SEDATION– DROWSINESS AND CLOUDING OF MENTATION
• RESPIRATORY DEPRESSION– INHIBIT BRAINSTEM RESPIRATORY MECHANISM– INCREASE ALVEOLAR PCO2– DOSE RELATED– C/I– ASTHMA– COPD– COR PULMONALE– INC ICP
• COUGH SUPPRESSION– INCREASE THRESHOLD FOR STIMULATION OF NEURON
IN THE MEDULLARY COUGH CENTER– DIRECT INHIBITION OF COUGH REFLEX IN THE
MEDULLARY CENTER– DEPRESS THE CNS AND INHIBIT THE COUGH CENTER– MAY LEAD TO ACCUMULATION OF SECRETION AND
OBSTRUCTION
• MIOSIS– CONSTRICTION OF PUPILS
• TRUNCAL RIGIDITY– DECREASE THORACIC COMPLIANCE
AND VENTILATION• NAUSEA /VOMITING
– ACTIVATE CRTZ• TEMPERATURE
– M= HYPERTHERMIA– K=HYPOTHERMIA
PERIPHERALCVS• BRADYCARDIA• NO MAJOR EFFECT ON RHYTHM• HYPOTENSION
– DUE TO PERIPHERAL AND VENOUS DILATATION– DUE TO RELEASE OF HISTMINE
• CNS DEPRESSION OF VASOMOTOR MECHANISM• MEPERIDINE
– TACHYCARDIAGIT
– CONSTIPATION– DECREASE TONE AND HCL
• BILIARY– CONTRACT SM LEAD TO BILIARY COLIC– CONTRACTION OF SPHINCTER OF ODDI
LEADING TO REFLUX OF BILIARY AND PANCREATIC SECRETION
• RENAL– DECREASE RENAL PLASMA FLOW– ENHANCE TUBULAR NA REABSORPTION
• UTERUS– PROLONG LABOR– REDUCE UTERINE TONE
• NEUROENDOCRINE– STIMULATE ADH– PROLACTIN– SOMATOTROPIN– INHIBIT LH
• PRURITUS– FLUSHING AND WARMING– HISTAMINE RELEASE
SPECIFIC AGENTS
STRONG AGONIST• PHENANTRENE
– MORPHINE– HYDROMORPHONE– OXYMORPHONE– HEROIN (DIACETYL MORPHINE)
• PHENYLHEPTYLAMINE– METHADONE
• PHENYLPIPERIDINE– FENTANYL
• MORPHINAN– LEVORPHANOL
MILD TO MODERATE AGONIST
• PHENANTRENE– CODEINE– OXYCODONE
• PHENYLHEPTYLAMINE– PROPOXYPHENE
• PHENYLPIPERIDINE– DIPHENOXYLATE– DIFENOXIN– LOPERAMIDE
MIXED RECEPTOR ACTION
• PHENANTRENE– NALBUPHINE– BUPRENORPHINE
• MORPHINANS– BUTORPHANOL
• BENZOMORPHAN– PENTAZOCINE
MISCELLANEOUS
• TRAMADOL– BLOCKADE OF SEROTONIN REUPTAKE– WEAK MU RECEPTOR AGONIST– MAY CAUSE SEIZURE
• ANTITUSSIVE– DEXTROMETHORPHAN
• DERIVATIVE OF LEVORPHANOL• NO ADDICTIVE PROPERTY
– LEVOPROPOXYPHENE• DERIVATIVE OF DEXTROPOPOXYPHENE• NO OPIOID EFFECT
– CODEINE
HEROIN
• 1 MIL ADDICTS IN THE USA• 1 OUT OF 4 USERS BECOME
ADDICTED• NO LEGAL SUPPLY FOR CLINICAL
USE• AS PURITY INCREASES LEVEL OF
DEPENDENCE IS HIGH• IV, SMOKED, NASAL (SNORTED)
HEROIN
• INJECTION• WARMTH, HIGH INTENSE PLEASURE
(RUSH = SEXUAL ORGASM)• ONSET = LESS THAN 1 MIN• DURATION OF EUPHORIA= LESS THAN 45
SEC – MINUTES• FOLLOWED BY SEDATION AND
TRANQUILITY= 1 HOUR• TOTAL DURATION OF EFFECT 3-5 HRS
HEROIN
• AFTER INJECTION• MALE = DOCILE, COMPLIANT • WITHDRAWAL= AGGRESSIVE ,
IRRITABLE• HEROIN + FENTANYL• HEROIN + COCAINE (SPEEDBALL)
HEROIN
MORTALITY• INVOLVEMENT IN CRIME• INFECTION
• NON STERILE NEEDLE• SHARING OF PARAPHERNALIA
– SKIN ABSCESS– ENDOCARDITIS– PULMONARY INFECTION (TB)– HEPATITIS C– AIDS
HEROINMETHODS TO DETOXIFY1. GIVE PRESCRIPTION OPIOID THEN
GRADUAL TAPER2. CLONIDINE ALPHA ADRENERGIC AGONIST
(DECREASE ADRENERGIC NEUROTRANSMISSION)
3. ACTIVATION ENDOGENOUS OPIOID WITHOUT MEDICATION (ACUPUNCTURE, CNS ELECTRICAL STIMULATION)
4. RAPID ANTAGONIST UNDER GA
HEROIN
• CHARACTERISTICS OF WITHDRAWAL– PUPILLARY DILATION– SWEATING– PILOERECTION– TACHYCARDIA– VOMITING, DIARRHEA– INCREASE BP– YAWNING– FEVER
CANNABINOIDS
• MOST COMMONLY USED ILLEGAL DRUG IN THE USA
• REFERS TO – INDIAN HEMP– CANNAVIS SATIVA
• MAJOR ACTIVE CONSTITUENTS– CANNABINOIDS ( >60)– DELTA 9 TETRAHYDROCANNABINOL (THC)
• MOST IMPORTANT
CANNAVIS SATIVA
• MARIJUANA (HERB FORM)– GRAY GREEN DRIED AND CRUSGHED FLOWER HEADS AND
SMALL LEAVES OF CANNABIS PLANT• MARIHUANA• GRASS• DOPE• BLOW• SKUNK• WEED• POT• HEMP• BHANG• GANJA• 5% THC
• HASHISH (RESIN FROM)– REFER TO THE CANNABIS RESIN ALONE AFTER REMOVAL
FROM THE PLANT– HASHISH AL KIEF = HERB OF PLEASURE– 20% THC
• HASH OIL– CONCENTRATED RESIN EXTRACT– MOST POTENT FORM OF CANNABIS– 60% THC
MARIJUANA HASHISH
• MARIJUANA HERB ROLLED INTO CIGARETTES OR MIXED WITH TOBACO ALSO CALLED– SPLIFFS, JOINTS, REEFERS
• SYNTHETIC CANNABINOID DERIVATIVE– DRONABINOL– NABILONE
PROVIDES LOW DOSE SERVINGS
SMOKING PIPE
SMOKING PIPE
JOINT
KINETICS• THC DISSOLVES IN PULMONARY SURFACTANT• HIGHLY LIPID SOLUBLE PENETRATES CNS• ONSET MINUTES• PEAKS IN 1-2 MIN• T1/2 4 HRS• ORAL DOSE EXTENSIVE FIRST PASS EFFECT• DISTRIBUTES INTO ADIPOSE TISSUE THEN
RELEASED SLOWLY• METABOLISM CCUR IN THE LIVER• URINE TEST POSITIVE FROM 31.5- 95 DAYS
DYNAMICS
• CB1 (CNS) AND CB2 (PERIPHERAL TISSUES)
• INHIBIT THE RELEASE OF GLUTAMATE AND GABA THROUGH PRESYNAPTIC INHIBITION
EFFECTS• EUPHORIA• RELAXATION• WELL BEING• GRANDIOSITY• ALTERED PERCEPTION OF TIME PASSAGE• PERCEPTUAL CHANGES• “HIGH”= 2 HRS= IMPAIRMENT OF
COGNITIVE FXN, PERCEPTION, MEMORY, LEARNING , IMPAIRMENT OF COORDINATION
ACUTE ADVERSE EFFECTS• ANXIETY, CONFUSION, DROWSINESS, PANIC
REACTION, PSYCHOSIS• PSYCHOMOTOR IMPAIRMENT, ATAXIA, MEMORY
LOSS• TACHYCARDIA, PALPITATION, POSTURAL
HYPOTENSION, FLUSHING• COUGH, SORETHROAT, BRONCHOSPASM• DELAY GASTRIC EMPTYING, NAUSEA, DRY
MOUTH, INCREASE APETITE (HUNGER)• RED EYES• CAN PPT RECURRENCE OF SCHIZOPRENIA• “AMOTIVATIONAL SYNDROME”= DROP OUT
FROM SOCIAL ACTIVITY AND SHOW LITTLE INTEREST IN SCHOOL
LONG TERM USE
• BRONCHITIS• CANCER• OLIGOSPERMIA• GYNECOMASTIA, DECREASE LIBIDO• INSOMIA, DEPRESSION, SOCIAL
WITHDRAWAL, DECREASE MENTAL PERFORMANCE, REDUCE DRIVE, DEPENDENCE, WITHDRAWAL SYMPTOMS
• NO EVIDENCE OF BRAIN CELL DAMAGE
• BENEFITS– ANTICONVULSANT– MUSCLE RELAXANT– DECREASE IOP
MARIJUANA
• WITHDRAWAL (THOSE WHO ARE USING DAILY THEN SUDDEN STOP)– RESTLESSNESS– IRRITABILITY– MILD AGITATION– INSOMNIA– SLEEP EEG DISTURBANCE– NAUSEA– CRAMPING
LSD
• OTHER NAMES– ACIDS– TRIPS– LYSERGIC ACID DIETHYL AMIDE – LYSERGIDE
• FROM ERGOT (CLAVICEPS PURPUREA)• MOST POTENT HALLUCINOGENIC DRUG• SOLD ILLEGALLY AS STAMP SIZE PAPER
WITH LSD
CLAVICEPS
BLOTTER PAPER IMPREGNATED WITH LSD
KINETICS
• ABSORBED BY MOUTH RAPIDLY• EFFECTS SEEN IN 30-90 MIN• LAST 3-12 HRS, T1/2 3 HRS• ELIMINATED VIA THE LIVER
MECHANISM
• INTERACT WITH SEROTONIN RECEPTOR IN THE CNS (5 HT2A)
• COUPLES WITH Gq WITH IP3
EFFECT
• INDUCE PERCEPTUAL SYMPTOMS– SHAPE AND COLOR DISTORTION
• PSYCHOSIS LAST 2 DAYS• SCHIZOPRENIC EPISODES• SOMATIC SYMPTOMS• TOLERANCE• DOES NOT INDUCE DEPENDENCE OR
ADDICTION
SIGNS OF INTAKE• PUPILLARY DILATION• INCREASE BP• INCREASE HR• FLUSHING • SALIVATION• LACRIMATION• HYPERREFLEXIA• “BAD TRIP”= SEVERE ANXIETY, INTENSE
DEPRESSION, SUICIDAL THOUGHTS
ADVERSE EFFECTS
• COMMON– ADRENERGIC FLIGHT OR FIGHT– EXHAUSTION, TIREDNESS, WEAKNESS– HEADACHE , DISORIENTATION,
CONFUSION– ANXIETY, PSYCHOSIS, HALLUCINATION
ADVERSE EFFECT
• RARE ACUTE– ATAXIA, CONVULSION– HYPERPYREXIA
POST EXPOSURE– FLASHBACKS– DEPRESSION, INSOMINA
INCREASE
GAMMA HYDROXYBUTYRIC ACID
• OTHER NAMES– GBH– LIQUID X– LIQUID ECSTASY– FANTASY– GCLUB DRUGDATE RAPE DRUGGRIEVOUS BODILY HARM
• USED FOR DRUG FACILITATED SEXUAL ASSAULT
• ODORLESS WHITE POWDER• SOLUBLE IN WATER• T ½ 30 MIN
MECHANISM
• 2 BINDING SITES– GHB– GABA B
• INHIBIT DOPAMINE RELEASE
ADVERSE EFFECTS• DROWSINESS, HYPNOSIS, CONFUSION,
COMBATIVENESS• HEADACHE, TUNNEL VISION, DEPRESSION, COMA• ATAXIA, MYOCLONIC MOVEMENTS, SEIZURE ,
TREMORS• BRADYCARDIA, CARDIAC ARREST,
HYPOTENSION• NAUSEA, VOMITING, DIARRHEA• URINARY AND FECAL INCONTINENCE• HYPOTHERMIA
MEDIATE EFFECTS VIA IONOTROPIC RECEPTOR
• NICOTINE• BENZODIAZEPINE• ALCOHOL• KETAMINE • PCP• INHALANTS
ETHANOL
• DEPRESSANT– SLEEP – SEDATION
• LOW DOSE – SUPPRESSION OF INHIBITORY SYSTEM– IMPAIRS RECENT MEMORY– BLACKOUT– RELIEVE ANXIETY
KETAMINE/ PHENCYCLIDINE
• OTHER NAMES– ANGEL DUST– PCP– HOG– SPECIAL K– CLUB DRUG
• BLOCK ACTION OF NMDA AND GLUTAMATE RECEPTORS
• PRODUCE VIVID DREAMS AND HALLUCINATION• PRODUCE LONG LASTING PSYCHOSIS LIKE
SCHIZOPHRENIA• DOES NOT CAUSE DEPENDENCE OR ADDICTION
ADVERSE EFFECTS
• HYPERTENSION• TACHYCARDIA• SWEATING• BRONCHOSPASM• BIZARRE AND DANGEROUS
(ASSAULTIVE) BEHAVIOR
• OVERDOSE IS TREATED WITH LIFE SUPPORT
• NO ANTAGONIST TO PCP EFFECT
INHALANTS• NITRATES• KETONES• HYDROCARBON• SNIFFING
– INHALATION FROM AN OPEN CONTAINER• HUFFING
– SOAKING CLOTH IN VOLATILE SUBS• BAGGING
– BREATHING IN /OUT OF PAPER OR PLASTIC BAG
• ALTERED FUNCTION OF IONOTROPIC RECEPTORS AND ION CHANNELS THROUGHOUT THE CNS
• MOST HAVE UNKNOWN MECHANISM• NITRATES
– BIND TO NMDA RECEPTORS• AMYL NITRATE
– SMOOTH MUSCLE RELAXATION– ERECTION
NMDANa
Ca Ca
VDCC
Depolarization
Ca Na
(-) GLU
K Na
CaATP
N methyl d aspartateVoltage activated Ca chanAminomethylisoxazole propionic acid
AMPA
GLUTAMATE
M
Ca
Activation PROTEASE/LIPASE/NO
FREE RADICAL
ER
BIND TRANSPORTER OF BIOGENIC AMINE
• COCAINE• AMPHETAMINE• ECSTACY
COCAINE
• ERYTHROXYLON COCA• T1/2 COCAINE= 50 MIN• URINARY METABOLITE = FOUND IN URINE
AFTER 2-5 DAYS (UP TO 10 DAYS)• BLOCK THE UPTAKE OF
– NE (TACHYCARDIA, HYPERTENSION, ARRYTHMIA
– SEROTONIN (HALLUCINOGEN, ANORIXIGENIC, HYPERTHERMIA)
– DOPAMINE (EUPHORIA, ABNORMAL MOVEMENTS, PSYCHOTIC EPISODES)
ERYTHROXYLON COCA
LEAVES AND BERRIES
• OTHER EFFECTS– AROUSAL – INCREASE ALERTNESS– SELF CONFIDENCE AND WELL BEING– IRRITABILITY– PARANOIA– INCREASE VIOLENCE
• HIGH ADDICTION POTENTIAL (23 MIL AMERICANS)
• TOXICITY– PROLONGED AND INTENSE ORGASM– ASSOCIATED WITH PROMISCUOUS SEXUAL ACTIVITY– LONG TERM USE = DECREASE SEXUAL DRIVE– ANXIETY– DEPRESSION– PSYCHOSIS
• INCREASE RISK– ISCHEMIC STROKE– MI– SEIZURE, CEREBRAL VASOCONSTRICTION– ARRYTHMIA– MYOCARDITIS– AORTIC DISSECTION
• OVERDOSE– HYPERTHERMIA– COMA– DEATH
COCAINE
• WITHDRAWAL– DYSPORIA– DEPRESSION– SLEEPINESS– FATIGUE– COCAINE CRAVING– BRADYCARDIA
DAT
COCAINE
DOPAMINE
DAT
AMPHETAMINE
DOPAMINE
VMATA
DAT= DOPAMINE TRANSPORTERVMAT = VESICLE MONOAMINE TRANSPORTER
AMPHETAMINE AND OTHER AGENTS
• AMFETAMINE (AMPHETAMINE)• METAMFETAMINE = ICE• METHYLENEDIOXYAMFETAMINE=MDA• METHYLENEDIOXYMETAMFETAMINE=
MDMA ( ECSTASY)
MECHANISM
• AMPHETAMINE– DEPLETE VESICULAR TRANSMITTERS
• MDMA– HIGH AFFINITY TO SEROTONIN TRANSPORTER– INCREASE EXTRACELLULAR CONC OF
SEROTONIN– REPETITIVE ADMINISTRATION MAY LEAD TO
DEPLETION– MAY BE NEUROTOXIC
AMFETAMINE METAMFETAMINE ECSTASY
ADMIN INJ, NASAL INJ, NASAL INJ, NASAL
FORM POWDER POWDERCRYSTALTABLETS
TABLETS
HALF LIFE 12-13 HRS 10-12 HRS 8-9 HRS
ALL PURPOSE STIMULATION
CNS STIMULANTS EMOTIONALMYSTICAL EFFECTS
PERIPHERAL ACTION
MOST POWERFUL CNS STIMULANT ACTION
SEROTONINERGIC EFFECT
DEPENDENCE POTENTIAL
HIGH HIGH LOWER
MDMA PILLSMDMA FACTORY
ADVERSE EFFECT• MINOR ADVERSE EFFECT• MYDRIASIS, PHOTOPHOBIA, BLURRED
VISION, HEADACHE, NUMBNESS• ANOREXIA, SWEATING• TACHYCARDIA, PALPITATION• TREMOR, ATAXIA• CONFUSION, ANXIETY• SEIZURE• MAY CAUSE IRREVERSIBLE BRAIN
DAMAGE
• KHAT– PLANT FROM YEMEN, EAST AFRICA– ALKALOIDAL CATHINONE SIMILAR TO AMPHATAMINE
• CAFFEINE– MILD STIMULANT– INCREASE NE AND DOPAMINE RELEASE– ENHANCE NEURAL ACTIVITY– COMPETITIVE ANTAGONIST OF ADENOSINE– CAN LEAD TO CAFFEINE WITHDRAWAL
• FATIGUE, SEDATION• HEADACHE• NAUSEA
–
REFERENCES
• PHARMACOLOGY BY KATZUNG• DRUGS OF ABUSE BY SIMON WILLS• COMPREHENSIVE DRUG EDUCATION
BY SORIANO• GOODMAN GILMAN