12. Neurotransmitter
s
⢠Acetylcholine - voluntary movement of the muscles
⢠Norepinephrine - wakefulness or arousal
⢠Dopamine - voluntary movement and emotional arousal
⢠Serotonin - memory, emotions, wakefulness, sleep and
temperature regulation
⢠GABA (gamma aminobutyric acid) - motor behaviour
⢠Glycine - spinal reflexes and motor behaviour
⢠Neuromodulators - sensory transmission-especially pain
13. Neurotransmitte
rs
⢠Can either be excitatory or inhibitory
⢠Effect of drugs will either increase a
reaction or allow for an unwanted
reaction to be prolonged
14. Why?
⢠Gain for the individual
â Loss of pain
â Feeling of euphoria
â Heightened sensory experience
â Sedation
16. Terminolog
⢠y
Abuse â impairs a personâs functional ability
⢠Addiction â compulsion that leads to
detriment
⢠Dependence
â Physical â withdrawal if substance not
given
â Psychological â feel need substance to
function
⢠Tolerance â need more of substance to obtain
effect
21. Opiu
m
⢠Comes from the poppy plant
⢠Opi â âdrunkenâ; Um â âmindâ
⢠Early references from 879 BC
⢠Popular 17th & 18th centuries in China as madak -
mixed w/tobacco & smoked
⢠Opium dens en vogue
⢠Addict more socially acceptable than alcoholic
⢠Known as a painkiller & sedative
22. Opiu
m
⢠Binds to opioid receptors (releases endorphins)
â Activates the Îź-receptor which leads to:
⢠analgesia, sedation, reduced blood pressure,
itching, nausea, euphoria, decreased respiration,
miosis (constricted pupils) & decreased bowel
motility
⢠Tolerance develops over time
⢠Overdose will lead to respiratory depression
⢠Tx â naloxone blocks receptor
23. Opiu
m
⢠Examples of opioids
â Morphine â good for coronary pts
â Codeine
â Tincture of Opium
⢠Used to treat diarrhea
⢠Synthetic opioids: fentanyl,
propoxyphene (Darvocet)
25. Cocain
â˘
e
Derived from leaves of coca plant
⢠Originally used by the natives of South America (esp.
Peru)
â Chewing gave a feeling of strength and energy; appetite
suppressant
⢠Spaniards took back to Europe, alkaloid isolated by
Germans in 1855
⢠Quickly used medicinally as an anesthetic &
commercially (Vin Mariani & Coca-Cola)
⢠Outlawed in 1914 w/concern about addictive
properties
26. Cocain
e
⢠Binds to DA reuptake channels
⢠DA related to reward centers
⢠CNS stimulant, anesthetic
⢠Effect can last 20 minutes to several hours
⢠Hyperactivity, restlessness, increased BP,
increased HR and euphoria; enhanced
sexual interest & pleasure
27. Cocain
⢠Placental abruption
e
⢠OD can be fatal 2o to:
â Tachyarrhythmias (24x inc. in risk for AMI during 1st hour)
â Elevated BPâs
â Hyperthermia (inc. heat w/vasoconstriction)
â SZâs lead to medullary depression
⢠Tolerance develops
⢠Depressive âcrashâ after chronic use
⢠Used in medicine as an anesthetic in dental &
ophthalmological surgeries
29. Personal
Bong
Way to enjoy the Tractor
Parade with the kids...
30. Cannab
⢠is
Originated in the Himalayas
⢠Used in bonfires during religious
ceremonies
⢠Spread around the world esp. in the 60âs &
70âs counterculture
⢠Hashish popular in Middle East while MJ
popular in U.S. as a recreational drug
⢠Assassin comes from âhashashinâ Islamic
militant sect
31. Cannabi
s
⢠Active ingredient â THC (tetrahydrocannabinol)
⢠Binds to cannabinoid receptors CB1 in brain (euphoric
effects) CB2 in spleen (anti-inflammatory effects)
⢠Anti-emetic, analgesic at low doses, relaxation;
euphoria; altered space-time perception; alteration of
visual, auditory, and olfactory senses; disorientation;
fatigue; & appetite stimulation
⢠No fatalities have ever been recorded; no CB1 receptors
in the medulla; however...
32. Cannab
is
⢠Used medically
â Glaucoma
â Multiple sclerosis pain
â Anti-emetic in CA pts
â Appetite stimulant
â Touretteâs Syndrome
34. Peyote
⢠Discovered by the indians of Northern Mexico (Mescal)
& the Navajo of the SW U.S.
⢠Used in religious ceremonies for centuries
â Gives âdeep introspectionâ & insight; auditory & visual
hallucinations
⢠By federal law, only legal for Indians performing
âlegitimateâ ceremonies
⢠Mescaline active ingredient â effect lasts up to 12 hours
⢠Non-addictive properties
36. Psilocyb
e
⢠Mushrooms used in ceremonies date to
7000 BC
⢠Used by Mayans in 500 BC, named
teonanacatl ("flesh of the gods"), healing,
divination & communication with spirits
⢠Plant is ingested
⢠Effects last 4 â 6 hrs
⢠Visual & auditory hallucinations
39. Tobacc
o
⢠1 BC â Inhabitants of the Americas use tobacco by smoking,
chewing & as enemas
⢠Mayans move to SE region of NA, pipe smokers & cigar smokers
(sikâ ar)
⢠Columbus given a gift of dried leaves which were âprizedâ; crew
throws them away
⢠1st smoker jailed by the Spanish Inquisition as the smoke from
his nose & mouth scares neighbors
⢠Monk w/Columbus on 2nd trip brings tobacco to Europe
⢠Snuff & chew habits observed by Vespucci
⢠Tobacco trade routes established
40. Tobacco
⢠Nicotine active ingredient
⢠T1/2 about 60 minutes
⢠Activates nicotinic acetylcholine receptors
â Increased adrenaline => inc. HR, inc. BP, inc.
SBG
â Feeling of both relaxation & invigoration
â Temporary increase of basal metabolic rate
⢠Increased DA => reward centers
⢠Increased glutamate => memory loop
41. â˘
Tobacco each cigarette
40 â 60 mg thought to be lethal,
smoked delivers 1 mg, higher if ingested
⢠OD â NV, HA, SOB, palpitations, SZâs,
weakness
⢠Not carcinogenic
⢠Thought to be responsible for SIDS
⢠Schizophrenics thought to self-medicate
⢠Used as Tx for addiction, ulcerative colitis &
SZâs
⢠Tx â Wellbutrin ď Zyban
45. Heroin
⢠Created from Morphine in 1874
⢠Marketed by Bayer in 1898 as a
âcureâ for morphine addiction,
marketing blunder 1910 (heroin =>
MSO4)
⢠Banned in the U.S. 1914, except for
addicts; totally banned in 1924
46. Heroin
⢠Highly lipid soluble â able to rapidly cross
blood brain barrier
⢠Converted quickly to morphine â Îź opioid
receptors => release of neurotransmitters
(endorphins)
⢠Highly addictive, tolerance develops quickly
47. Heroin
⢠Snorting 10 â 15 minutes
⢠IM 5 â 8 minutes
⢠Inhaling âchasing the dragonâ within a minute
⢠IV 7 â 8 seconds
48. Heroin
⢠Sudden pleasurable feeling, warm flush, sedation
⢠Can react with nausea, vomiting, itching
⢠Inc. risk of HIV & Hep C from needles, bacterial
abscesses, heart valve damage (tricuspid), fetal
death/addiction
⢠OD â respiratory depression
⢠Can be poisoned by âcuttingâ agents
49. Heroin
⢠Withdrawal SSx: restlessness, muscle and bone pain,
insomnia, diarrhea, vomiting, cold flashes w/goose
bumps ("cold turkey"), & leg movements.
â Peak between 24 - 48 hrs after last dose; subside ~ week
⢠Tx â Narcan (Naloxone); dry to wet
50. Heroin
⢠Methadone
â Made in 1937 as an analgesic
â Derivative of morphine
â Replaces âneedâ for heroin
â $20 for 1 monthâs supply
â Can be taken orally
â Withdrawal more severe & prolonged, naloxone gtt
â Used in extreme & chronic pain conditions
52. Methamphetamin
es
⢠Made in 1919 in Japan
⢠WWII â Germans give to pilots in chocolate
bars
⢠Made in labs until 1980âs when ingredients
banned
⢠Pseudoephedrine & ephedrine principle
ingredients
⢠Still made in clandestine labs â highly
flammable
53. Methamphetamines
⢠Causes increase of norepinephrine & dopamine
⢠Blocks reuptake & breakdown of both
⢠Increased HR, BP, glucose release,
vasoconstriction
⢠Increased focus, mental alertness, appetite
suppressant
⢠Short term tolerance (2 â 3 days) due to
production overload
⢠Side effects: jitteriness, twitches, repetitive
motions (âtweakingâ), teeth grinding, insomnia,
ED
54. Methamphetamines
⢠âmeth mouthâ â dec. production of saliva
=> inc. thirst, met w/high sugar drinks =>
cavities & tooth decay
⢠âspeed bumpsâ â tracts, abscesses
⢠OD â arrhythmias, hyperthermia, stroke,
SZ
â Formication âskin crawlingâ, paranoia,
hallucinations, cognitive deficits
⢠Used medically for ADHD, wt. loss
56. PCP
⢠1950âs - Parke-Davis
pharmaceuticals
â Initially developed as anesthetic, but
too many SEâs (hallucinations, SZâs)
â Developed into a recreational drug
â Binds to NMDA receptor (ie: nicotinic
ACh receptor) & causes continued
firing
57. PCP
⢠Leads to psychotic symptoms (heightened
senses & experiences)
⢠Aggression or sexual frenzy, feeling of
âsuper powersâ
⢠Schizophrenic ideations - delusions,
hallucinations, paranoia, disordered
thinking
⢠Death by suicide or accidental injury
58. Ketami
ne Developed 1962, alternative
â˘
to PCP
⢠Given to soldiers in Vietnam
war
â Emergence phenomenon
⢠Use in Veterinary medicine
as analgesic & anesthetic
⢠Dissociative properties
similar to PCP but shorter-
lasting
⢠Popular at Raves
59. LSD â
lysergic acid diethylamide
⢠Developed in 1938
â Inventor discovered psychoactive
properties 5 yrs later
⢠1950âs use by intelligence
agencies
⢠Given free to researchers in the
60âs
â Harvard experiment lead to counter
culture
⢠Banned in U.S. 1967
60. LSD
⢠Highly potent â 20 â 30 Îźg for effect,
typical âhitâ 125 Îźg
⢠Acts on DA & serotonin receptors
⢠Psychological dependence, uterine
contractions
⢠SE â âbad trip,â distant flashbacks
⢠Tx w/BDZâs
⢠No known cases of OD
61. MDMA â
3,4-methylenedioxymethamphetamine
Ecstasy, XTC
Ecstasy, XTC
⢠Made in 1912, inventor died 1916,
not used by humans x 50 yrs,
production of styptic
⢠Used in the 1970âs for psychotherapy
â Made pts more communicative,
increased introspection, dec.
inhibitions
⢠Recreation use started in discos, gay
clubs, spread to raves
⢠Made illegal in 1985
62. MDMA â
3,4-methylenedioxymethamphetamine
Ecstasy, XTC
⢠Binds to receptors => inc. in DA, NE, & serotonin
â Leads to feelings of well-being, openness, dec. inhibitions,
visual enhancement
⢠Dehydration, inc. HR & BP, nystagmus, pupil dilation,
insomnia
⢠OD â similar to amphetamines â hyperthermia,
dehydration ď hyperpyrexia ď rhabdomyolysis ď
renal failure, arrhythmias, water toxicity ď
hyponatremia
64. Inhalan
ts
⢠Sniffing - open container
vapors
⢠Huffing - spray onto rag and
then place over nose/mouth
⢠Bagging - spray into bag and
then place over face/mouth
⢠Dusting - inhaling from
aerosols
65. Inhalan
ts
⢠Organic or chemical solvents enter
bloodstream
⢠Cause effects similar to EtOH intoxication
⢠Death can occur (Sudden Sniffing Death
Syndrome), suffocation
⢠Brain & organ damage, loss of smell,
respiratory problems
67. GHB Îł-hydroxybutarate
⢠Found naturally in the body â
protects cells from oxygen
deprivation
⢠Precursor to GABA
â Wakefulness, physical activity,
sleep
⢠1960âs synthesized
⢠Used â anesthetic, insomnia Tx,
depression
68. GHB
⢠Mode of action still not well-known
⢠Acts at GABA receptors => sedation
â Low dose:
⢠State of euphoria, inc. libido, inc. social interaction, intoxication
â High dose:
⢠Nausea, dizziness, sedation, amnesia, unconsciousness, dec. breathing,
visual changes
â Effects can last 1.5 - 3 hrs
⢠Deaths from oversedation, esp. when used w/EtOH
69. Bath Salts - Mephedrone,
MPDV
Sold over the counter as
âvanilla skyâ or âwhite knightâ
Increased in popularity 2011
Multiple reported cases of
overdose including some deaths
70. Bath Salts -
Mephedrone
Act as a âcocaine substituteâ
Pleasurable high, easy to overdose
Unknown additives
Triggers intense cravings, high
potential for abuse & addiction
71. Bath Salts -
Mephedrone
Visits to ED for
Chest pain
Elevated blood pressure
Tachycardia
Hallucinations
Agitation
Paranoia
72. Steroids
⢠Synthetic version of
testosterone
⢠Psychological dependence
due to body image
⢠Abuse dosage 10 â 100x
greater than medical Tx
uses
⢠Used for muscle-wasting
diseases, testerone-deficient
diseases
73. Steroids
SE:
Stunted growth in adolescents
Masculinization of women
Altered sex characteristics of men (gonadotrophy)
Risks
Premature heart attacks, strokes
Liver tumors
Kidney failure
Psychiatric phenomenon â steroid psychosis
HIV or hepatitis.
76. Beer
⢠Fermented beverages have been around since people
stopped being nomadic and settled in certain regions
⢠Beer invented in the Mesopotamia about 6,000 yrs ago
â Left people feeling "exhilarated, wonderful and blissful."
⢠Beer âbibereâ (L) = to drink
⢠Cerveza from the Greek goddess of agriculture, Ceres
⢠Chang = Tibetan beer
⢠Chicha = corn beer
⢠Kumis = fermented camel milk
77. Wine
⢠2700 BC wine symbols found in Egyptian
drawings
⢠No vineyards, but traded with other
cultures for grapes
⢠Soon developed their own lines of grapes
⢠Wine-making quickly spread
78. Tequila
⢠Mezcal wine made in 1521 from agave plant
⢠Originally for bandits & rancheros
⢠Tequila from Nahuatl word âplace of harvesting plantsâ
⢠Tequila village founded 1656, export grew in 1700âs along trade
route to ocean
⢠1758 â Jose Cuervo granted royal license to cultivate in region, 1880
selling 10,000 barrels/yr to local market alone
⢠1944 Mexican government began regulating
â Only beverages brewed in region could be called tequila
â Had to have at least 51% blue agave
â Top brands are 100% blue agave
79. EtOH -
Ethanol
⢠Ethanol very simple molecule
⢠Metabolized to acetaldehyde
⢠Enzyme (aldehyde dehydrogenase) in liver & GI tract
breaks down to acetic acid (non-toxic)
â By-product used for energy (NADH + H+) in electron transport
chain, lipogenesis, and pyruvic acid to lactic acid cycle
â Genetic defect in some Asian populations leads to EtOH
intolerance â facial flushing syndrome
â Women have less gastric aldehyde dehydrogenase
80. Acetaldehyd
⢠e bloodstream
Excess spills over into
â Inhibits mitochondrial fxns (DH)
⢠Dec. metabolism of acetaldehyde to acetic
acid, more acetaldehyde accumulates, &
causes further liver damage
⢠Dec. oxidation of fatty acids leads to
build-up
â Interferes with activation of vitamins (esp.
B)
88. EtOH
Intoxication
⢠State legal limits vary (0.08 â 0.10 mg/dl)
â 3 oz of ethanol in a 70 kg person
⢠= 12 oz wine, 8-12 oz bottle of beer, 6
oz of whiskey
â Occasional drinker will be inebriated w/a
level = 0.2, coma/death/resp. arrest at
levels of 0.3 â 0.4 mg/dl
â Alcoholics can reach levels of 0.7 mg/dl &
be functional
89. FAS
⢠Fetal alcohol syndrome
â Acetaldehyde crosses the placenta
⢠Most damaging in first trimester
â Even one drink per day can cause
â Growth & developmental defects, facial
dysmorphology (FAS facies),
malformations of brain, CV system &
reproductive organs
91. EtOH withdrawal
⢠Usually starts 3 â 4 days after last drink
â Mild symptoms
⢠Shakiness, anxiety, depression, fatigue, insomnia
â Moderate symptoms
⢠Headache, sweating, NV, tachycardia, tremor, clammy
skin
â Severe symptoms
⢠Agitation, fever, convulsions, delirium tremens
(confusion, hallucinations)
⢠Can be fatal
92. EtOH Tx
â Banana Bag
⢠Thiamine, folate, MVI in 1L of fluid
â Disulfuram (antabuse)
⢠Inhibits acetaldehyde dehydrogenase
⢠Negative reinforcement
93. CAGE questions
⢠Have you ever felt you should CUT down on your
drinking?
⢠Have people ANNOYED you by criticizing your
drinking?
⢠Have you ever felt bad or GUILTY about your
drinking?
⢠Have you ever had a drink first thing in the morning
(EYE OPENER) to steady your nerves or get rid of a
hangover?