T5L4 - Medical Marijuana
what do research say about MM in lateral sclerosis
open trial revealed moderate relief of symptoms but no clinical studies have tried to prove the potential of MM as disease-modifying therapies, as demonstrated in animal models of ALS
what is most commonly used for treatment for chronic pain not adequately relieved by opioids, adjuvant pain med, non-pharm Tx, or surgical intervention
MM
what are the evidence for use of MM in treatment of chenotherapy-induced n/v
MM are effective
what about MM and pregnancy
MM is not recommended and should not be used in pregnancy nor lactating women
precursor of anandamide
NAPE
what is the price range for cannabinoid vaporizer
$200-400
CB1 located where
-CNS -lungs -vascular system -muscle -GI tract -reporoductive organs
2 cannabinoid receptors created upon demand
-Endocannabinoid ligands anadamide (AEA) -2-arachidonoyl-sn-glycerol (2-AG)
preclinical studies show that basal activation of ___________ receptors constrains fear-related behavior and physiological stress resopnse
CB1
what are preclinical evidence of MM and seizure
-delta-9-THC have anticonvulsant effect in animal model -CB1 receptors are located in the CNS that associated with seizure
4 location where both CB1 and CB@ are located
-immune system -liver -bone marrow -pancreas
process of causing IBD
-immune system become unbalanced causing T and B lymphocytes to differentiate and proliferate -activated T cells release proinflammatory cytokines which stimulate macrophages, which, in turn, secrete their own proinflammatory cytokines -arrival of leukocytes from the mucosal and submucosal vasculature results in further chemo-and cytokine release -this infiltration of inflammatory cells and cycle of inflammatory result in tissue damage from the release of numerous toxic mediators -infiltration of commensal and pathogenic bacteria further damages and worsens the inflammatory state of the disease
indication for topical MM
-inflammation -allergic skin reactions -post herpetic neuralgia -localized muscle, tendon, joint pain
how about MM and glaucoma
-never demonstrated that MM decrease IOP -brief decreases in IOP limits the usefulness of MM. since the late 70s many highly effective drugs have been developed that act on multiple sites in the eye that are superior to cannabis
what clinical evidence are there about MM and seizure
-purified cannabidiol was effective in seizure -some cannabis extract of high ratio of CBD-THC showed effect
CB2 lcoated where
-spleen -bone -skin
what do clinical studies say about MM in IBS
-they have improve symptoms, abdominal pain relief, diarrhea relief, weight gain and improved appetite
these three are considered schedule 1 as having no accepted medical use
-whole plant marijuana -delta-9-THC -cannabidiol
MM peak plasma [ ] is ____________
1-6 hours
what is the temp range of Vocano Digit
104 - 446F
more AE are produced with hepatic metabolism of THC into _______________
11-OH-delta-9-THC
Nabilone is what schedule
2
inhaled MM absorb quickly and THC peak in ______________
2-10 ins
MM has elimination half-life of _____________
20-30 hours
how many state and DC have approved MM
29
dronabinol is what schedule
3
what temp is the sweet spot for vaporizing MM
338F
this form of MM is cannabinoids extracted into organic oils for oral consumptoms
Botanicals
2 main receptors that anandamide and 2-AG act on
CB1 and CB2
MM inhibit which receptor that is beneficial for patients with inflammatory bowel diseases
CB2 decrease visceral pain, inflammation, intestinal motility in the inflamed gut
that do preclinical studies say about MM and IBD
CB2 agonists limited immune cell recruitment, decrease cytokine and chemokine production and improved macroscopic and histological scores
what are some condition in which cannabis use is legalized
Chronic pain -Inflammatory—arthritis, IBD, fibromyalgia -Neuropathic—neuropathy or pain from peripheral and central nerve injury Nausea and vomiting Cancer cachexia and palliative care HIV/AIDs wasting and pain Multiple sclerosis Amyotrophic lateral sclerosis Hepatitis C virus Posttraumatic Stress Disorder Seizures Glaucoma
precursor of 2-AG
DAG
Nabilone contain what drugs
Delta-8-THC
which cannabis elicits psychoactive effects
Delta-9-tetrahydrocannabinol
research study on MM requires review by what 2 agencies
FDA DEA
clinical features of low [ ] of delta-9-THC intoxication
Enhanced sociability Sensitivity to colors, sounds & music Altered perception of time Increased appetite for sweet and fatty foods Relaxed, pleasurable "rush" or "buzz" Decreased short-term memory Dry mouth, impaired perception, and motor skills
if approved, the plant sources and drug must be supplied by what agency
National Institute on Drug Abuse (NIDA)
clinical features of high [ ] of delta-9-THC intoxicaiton
Panic attacks Paranoid thoughts Hallucinations Psychosis Higher odds for motor vehicle crashes Greater risk for occupational injury Interaction with alcohol--CNS depression and impairment
most research on cannabinoid is limited to what drugs
THC and its analogs rather than whole plant cannabis sativa L.
pure grain ethanol used to extract the cannabinoids
Tinctures
this form of MM is applied as drops or spray to the oral mucosa for absorption - buccal or sublingual space
Tinctures
whiting et al. screened 28 randomized trails for chornic pain patient and MM, what was the result
about 40% pain relief same for new england research, pain relief
why donabinol causes dizziness, dysphoria, sedation
absence of other cannabinoids in dronabinol results in metabolism of large percentage of THC into 11-OH-dleta-9-THC
marinol and cesamet are indicated to improve ____________ in patients with AIDS wasting
appetite
marinol and cesamet also improve _______ in cancer patients and can decrease ______________
appetite cancer-associated anorexia
this cannabinoid has clinically demonstrated beneficial properties without prossessing the psychoactive effect of THC
cannabidiol (CBD)
argument for topical MM
cannabinoids can penetrate directly to affected areas of skin to provide localized therapeutic benefit without the psychomimetic effects of THC
2 main subspecies of Cannabis Sativa L.
cannabis sativa cannabis indica
which form of MM ingestion is worse for the lung
combustion of plant parts through smoking result in products toxic to the lung
dissolved in shea butter and other proprietary materials and combined with other ingredients
cream
donabinol contain what drug
delta-9-THC oil capsule
this system seem to be involved with the pathogenesis of ALS
endocannabinoid system, this has CB2 positive receptors
T/F: there are clinical trialsthat demonstrate benefit of MM in n/v
false
which enzyme break down anandamide
fatty acid amide hydrolase
the dried botanical form of medical marijuana is mostly from what plant
flowers and leaves from female plants
the effect of Botanicals is delayed for how long
from 30 mins to 2-3 hours after consumption
what is the correlation between MM and mortality
general population MM use is not associated with an increased mortality
so what is the risk of using MM
increase rate of collisions, property damage, minor injuries, work accident, cognitive failures, problems with memory, attention or action so those people have high prevalence of drugged and drunk driving
mechanism of MM in spaticity
inhibiting excitatory glutamate release in the CNS, and increase inhibtiory GABA medicated output to the somatic motor nervous system
oral bioavai of MM is _________
low
why are cannabinoids active in humans and animals
mammals posses an endocannabinoid system with NT ligands and cannabinoid receptors, analogous to the endogenous opioid system
___________ and ________ are indicated for Tx of n/v in patients who do not respond to conventional antiemetic agents
marinol casemet
this brain stem are is responsible for respiratory and CV function. supports reports demonstrating the low toxicity of even very high dose of THC
medulla oblongata
which enzyme break down 2-AG
monoacylglycerol lipase
what they like the least about MM used for pain
mostly cost
what do research say about MM and hep C
no clinical studies have tried to prove the potential of MM to modify the disease in human or animal studies. MM is approved in many states for hep C patient, despite the absence of evidence
NOTE about topical MM
no studies have demonstrated the pharmacokinetics of transdermal cannabinoid absorption, or that afflictions are improved by localized application of cannabinoids to the area
NOTE: do not drive or operate machinery when using cannabis
ok
NOTE: drugs that activate CB1 receptors block anxiety, whereas high doses of THC and cannabinoids are anxiogenic and pro-psychotic
ok
NOTE: patients with cardiovascular disease or risk of stroke or MI may have increase risk of CV effect from MM, esp. when smoked
ok
counseling point for MM is next
ok
what do research say about MM in treating spacticity in patient with MS
paitent with MS treated with oral delta-9-THC experienced decrease of muscle spasticity, and decrease in pain
cannabimoids heated into coconut oil and combined with beeswax, cooled and applied to affected area of skin
salve
topical application of MM come in what 2 forms
salve creams
MM can be ingested in what 2 forms
smoked vaporized
what are clinical evident of MM and PTSD
some studies show benefit but no randomized placebo-controlled clinical trail conducted. further investigation needed
what do preclinical studies say about combining inactive doses of delta-9-THC with opioids
synergistic enhancement of opioid analgesia compared to opioid alone
how does MM reduce n/v from chemo
there are CB1 receptors in the GI plexus, myenteric plesus, as well as critical emetic center in the CNS both good for acute and delayed phased n/v
MM should be used with caution in what kind of patient
those with psychiatric disorders
the spacticity from MS is resulting from?
upper motor neuron lesion, expressed as intermittent or sustained involuntary activation of skeletal muscles
this MM route is the safest route to inhale plant materials
vaporized