Vioxx and Bextra
COX2 inhibitors taken off the market b/c of increased rates of CAD and stroke that were not reported and were covered up
Celebrex
only selective COX2 inhibitor left on market b/c they correctly reported increased risk of CAD and stroke
NSAIDs and Tylenol
work peripherally as analgesics, but Tylenol does not treat inflammation
non-traditional pain relievers
TCAs, CCBs, B-blockers, etc.
drug abuse
a behavior that all people are capable of doing; most people have done it whether they know it or not
drug addiction
a disease that requires genetic disposition and the volition to activate it
many people participate in substance abuse, but…
it is usually short term and people will voluntarily quit
alcoholism and drug addictions are…
compulsions characterized by the inability to stop despite the desire to do so and the presence of severe consequences
one cannot distinguish between abuse and addiction by the drug effects…
b/c they are the same either way; e.g. alcohol poisoning can occur the first time you drink or after you are addicted
to diagnose addiction
look at family history, compulsion (their control over their behavior)
They must be taken drug despite the negative consequences and want to stop
genetics of addiction
substance abuse can lead to addiction, but most be genetically predisposed; as confirmed by twin studies and genetic studies revealing protection genes and genes of increased susceptibility
Physiology studies shown initial brain response differences in response to first use of drug from those with addictive potential and people who don’t
curing drug addiction focus
don’t focus on drug b/c many addicts can switch to another drug so the behavior should be focused on
regardless of drug, the same addiction behavior is present, which is…
people have a need to change the way they feel
cocaine and all -caine drugs
shut down nerve transmission of pain impulses by blocking sodium channels
methamphetamine
stimulant with similar properties to epinepherine
drug addiction features
compulsive thoughts that dwell on using drug, adverse consequences to drug use, and inability to stop on own will
Shame, denial, and compulsion
drug addiction requirements
genetic predisposition, desire to abuse drugs to alter the way one feels, and a set of life circumstances
Many people have the genetic predisposition to abuse but never will because they never have the means or opportunity to try the drug
stimulant drugs of abuse
amphetamine and cocaine
depressant drugs of abuse
alcohol, opioids, and benzodiazepines
hallucinogen drugs of abuse
LSD (lysergic acid, or just “acid”), mescaline (derived from peyote plant), and psilocybin in mushrooms (mushroom alkaloids)
cannabinoid drugs of abuse
marijuana and hashish
inhalant drugs of abuse
nitrous oxide (laughing gas) and solvents like glue, gasoline, and pain thinner
most abused drugs
tabacco is one, then alcohol, and marijuana, but most abused Rx drug are Vicodin and benzodiazepines
child oxycodone deaths
kids will chew OxyContin instead of swallowing so they get full drug amount all at once instead of extended release and overdose
opioids for heart attacks
morphine can be given to treat anxiety and pain because pain and anxiety increase HR which increases O2 demand of heart which makes MI even worse; also morphine is a good venodilator to increase venous capacity and reduce load on heart from less blood it has to move
helpful opioid effects
constipation is evident from any opioid, which can be used to treat diarrhea (Lomotil used)
they also are used to suppress coughs (codeine used)
Lomotil
mild opioid effect used to treat diarrhea; mixed with atropine to prevent abuse
unhelpful opioid effects
can trigger addiction cycle in susceptible individuals; development of tolerance, nausea/vomiting, and respiratory depression
Antabuse
disulfiram; prevents elimination of acetaldehyde which causes hangover symptoms so ingestion of alcohol causes very quick acting and long-lasting hangover
naltrexone with alcoholism
reduces alcohol cravings for people who have quit drinking
naltrexone for opioids
antagonizing the mu receptors blocks the effects of heroin or other opioids in the brain so there is no euphoria (no pleasure is produced)
naloxone imbedded in opioids
some opioids are made with naloxone in it to prevent crushing tablets and abuse
Narcan
naloxone; pure mu rc antagonist used for overdoses b/c it has a very short 1/2 life, so can’t be used for maintenance; given by IV
detoxification
difficult process with unpleasant physical symptoms for addicts getting off drugs; includes headache, insomnia, nausea
Opioids are not usually given unless medically necessary to keep patient out of danger
methadone
opioid used to help transition through detox; slowly tapers patients off over a few weeks
naltrexone
used in maintenance phase as long-term mu rc antagonist that has long 1/2 life so one can have effects lasting all day and used orally.
opioid anti-abuse drugs
Narcan (naloxone) used for emergency overdose treatment
methadone is used for detox help if needed for weaning
naltrexone used for prophylactic maintenance
methadone can be used for detoxification or maintenance
detoxify is for someone who plans on becoming abstinent
maintenance is for someone who plans on using it for the rest of their lives for harm reduction
harm reduction
Many mentally ill, poverty stricken addicts are hopelessly stuck in the addiction cycle and will never get out so recovery is not goal
Just get daily doses of methadone so they don’t need to score heroin during the day to prevent crime and disease (from buying drugs and dirty needles)
amphetamines
stimulant; Rx forms are used to treat hyperactivity in children (ADHD)
cocaine
highly addictive stimulant (crack is inexpensive yet highly addictive form of drug derived from powdered cocaine)
LSD
lysergic acid; acid; has chief ingredient of mescaline
cannabinoids
mimic action of similar endogenous substances (endocannabinoids) that bind to cannabinoid receptors in humans
tobacco
nicotine inside of it is most common drug of abuse and addiction worldwide
Xanax
alprazolam; commonly abused benzodiazepine
Valium
diazepam; commonly abused benzodiazepine
opioid side effect that causes death in overdose
respiratory depression
Suboxone
buprenorphine and naloxone together; starting to replace methadone and naltrexone in clinics for maintenance and detox b/c it offers mixed agonist effects