D+B Final

o No cross tolerance and withdrawal o Fewer side effects o Less sedating o Long delay for relief of anxiety

§ How does Buspirone compare to benzodiazepines?

o Contains one or more ingredients that are intended to supplement the diet § Vitamins, minerals, herbs, amino acids, and some hormones

What is a dietary supplement?

14 grams of pure alcohol (1 shot, 1 beer, 1 glass of wine)

What is a standard drink in the US?

-Substance that comes from the tobacco plant --4000 substances o CO2, CO, ammonia, cyanide, acetone, acetaldehyde o Tar: sticky brown particulate matter generated by burning tobacco

What is a tobacco? What is in tobacco besides nicotine?

-Ethyl alcohol/ethanol -Alcohol proof: twice the % ethanol in the beverage -Made by: § Raw material that contains sugar is fermented into alcohol by yeast

What is alcohol? What is alcohol proof? how is alcohol made?

Used to treat MDD: § Dopamine-norepinephrine reuptake inhibitor -Taking it with an SSRI can act like a MAOI (blocks monoamine reuptake) without the increased risk that comes with them

What is an atypical antidepressant? Why is it sometimes used in conjunction with SSRIs?

· Ethanol is broken down to acetaldehyde by alcohol dehydrogenase (ADH) · Acetaldehyde is broken down to acetyl CoA by aldehyde dehydrogenase (ALDH) · Acetyl CoA is broken down into CO2+H2O

3 steps to alcohol metabolism

coffee: 8oz: 95 mg Tea: 8oz: 47 Energy drink: 8oz: 80

About how much caffeine is in a cup of coffee, tea, energy drink?

§ Fights fatigue and feel alert § Improved mood § Anxiety § Improve endurance (athlete performance)

Acute effects of caffeine?

§ Reduces reactivity to pain § increases heart rate (dose related increase) · tolerance to cardiovascular effects occurs rapidly § boosts appetite § Increases one's sense of well-being, euphoria § enhances sensory perception · Music food and sex are more absorbing · time seems long and drawn out) § impairs memory and concentration

Acute effects of marijuana (3-4)

§ Bipolar disorder: characterized by cyclical periods of mania and depression § Mania: a state of extreme euphoria, excitement, physical energy wild optimism, and rapid thoughts and speech

What is bipolar disorder and what is mania?

o Non-professional, peer operated, free, can attend indefinitely o Disease model § Cannot be cured § Always in recovery § Abstinence is the only solution o 12-steps o Paired with a sponsor who has completed the steps (sober role model) o Encourages participation in alcohol free pursuits o Spiritual foundation

Alcoholic Anonymous

Average cost to discover and develop a new drug: $.2-4.5 billion Approximate time: 20 years

Approximate time and cost to bring a new drug to market?

Precontemplation: no intention of changing behavior Contemplation: aware the problem exists but with no commitment to action Preparation: intent on taking action to address the problem Action: active modification of behavior Maintenance: sustained change, new behavior replaces old Relapse: fall back into old patterns of behavior

Be able to describe the stages of recovery

· May enhance sexual arousal but diminishes sexual performance · Diminishes sensory perception and judgements · When blood alcohol content (% of alcohol in the blood) is rising, a person may feel happy, relaxed, and confident, but when it is falling, they are more likely to feel angry and tired

Behavioral effects of alcohol?

inability to recall events that occurred while drinking, even with no loss of consciousness due to alcohol's inhibiting effects on the hippocampus

What is blacking out?

Consists of unremitting depression or periods of depression that do not alternate with periods of mania

What is major depressive disorder

§ CB1: mainly on axon terminals in CNS § CB2: mainly in immune system · When active, inhibit the release of many NTs (GABA)

Cannabinoid receptors: What are the subtypes? Where are they? How do they work?

o Cannabis Sativa (Tall, slender, lighter green leaves) § Higher (THC) to (CBD) ratio § More anxiety, more feelings of being "high" o Cannabis indica (shorter, bushier, darker) § Higher CBD to THC ration § More sedation, better at alleviating pain

Cannabis Sativa vs Indica

action-oriented form of therapy that focuses on changing maladaptive thought patterns and behaviors (combines thoughts, feelings, behaviors)

Cognitive behavior therapy

a process that systematically and safely withdraws people from drugs under the care of a physician

What is medical detoxification

Cotinine

What is nicotine's active metabolite?

Form of CBT that incorporates mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness

Dialectal behavioral therapy:

THC Is very fat soluble · Enters and stays in fatty (adipose) tissue for days · Enters and stays in the brain for a few hours · Metabolites can stay in the body for days or even weeks

Distribution of marijuana, how does fat solubility play a role?

§ Endocannabinoids: Anandamide and 2-AG Play a role in appetite and hunger and decrease responsiveness to pain

Endogenous endocannabinoids and potential functions

Nicotine is a stimulant drug found in tobacco, one of the most widely used drugs in the world

what is nicotine? is it a widely used drug?

§ 1:5 deaths related to smoking: · 1 cig=14 minutes off your life · Associated with cardiovascular disease (atherosclerosis and COPD) and cancer § Mainstream and secondhand smoke

Health consequences of tobacco?

Prescriptions drugs: order for and used by only one person OTC: may be used by more than one person for the same symptoms or problem (Directions must be followed carefully and correctly for both)

How are OTCs and Prescription drugs similar or different in the way they are used?

o GABA receptor agonist § When they bind, they enhance the affinity of the receptor for GABA, which increases the duration of time that the chloride channel is open, leading to neuronal inhibition

How do Barbiturates work at the receptor?

THC is a CB1 receptor agonist: § with similar effects on the neuron as endocannabinoids but binds for longer (longer duration) and more potent § Inhibits synaptic GABA release

How does THC work at the synapse?

§ GABA agonist: in the presence of alcohol GABA activity enhanced, and neuron is inhibited · in the ventral tegmental area of the midbrain: ethanol decreases GABA transmission which increases dopamine release § Glutamate antagonist: alcohol decreases glutamate activity, decreasing neuron excitation

How does alcohol affect GABA, Glutamate, and Dopamine? (pharmacodynamics)

§ Fatty liver: a reversible condition in which large vacuoles of fat accumulate in the liver § Alcohol hepatitis: inflammation of the liver due to excessive alcohol intake § Alcohol cirrhosis: chronic liver condition characterized by replacement liver cells with scar tissue, leading to loss of liver function

How does alcohol affect your liver? (Fatty liver, alcohol hepatitis, alcohol cirrhosis)

o Tolerance to sedative effects, not as much as anxiolytic 9anxiety reducing) effects

How does one build a tolerance to benzodiazepines?

o Both cellular (receptor changes) and metabolic (increase breakdown) mechanisms -usually doesn't build to anticonvulsant effects

How does tolerance build to barbiturates?

increased # of glutamate receptors

How does tolerance to alcohol develop?

§ Tolerance develops quickly to many of the effects, but not mood · Cellular: upregulation of adenosine receptor

How does tolerance to caffeine work?

Dopamine becomes overactive in the brain (high amounts of dopamine present)

How is dopamine affected in those with schizophrenia?

-Prescription and OTC drugs: FDA considers new drugs to be unsafe until they are proven safe through clinical trails -Dietary supplements: FDA considers dietary supplements safe until they are proven unsafe § FDA oversees manufacturing process: · Ensures that the label accurately reflects the substances in the supplement and that there are no drug-like claims on the label

How is the FDA regulation different for prescription drugs, OTCs, and supplements?

§ Primary: directed at those that have little to no experience with drugs, commonly used in elementary and middle schools § Secondary: directed at those that may already have some experience with drugs · The goal is to limit the drug use and keep them from trying other drugs · Commonly used in high school and college § Tertiary: directed at heavy drug users to get the person treatment, stop the use of the drug and prevent relapse

What is primary, secondary, and tertiary substance abuse prevention?

§ In-patient treatment programs: hospitals, clinics, chemical dependence cents (drug rehab centers)) · 30-90 days · 24-hour supervision and care · $$$$ § Out-patient treatment programs · Less time consuming and costly · Some are still intensive · Counseling and self-help groups

Inpatient versus outpatient treatment

§ Less addictive than other drugs of abuse, but can prove addictive in some individuals · Dependence is more likely in individuals who tried it before age 25 · Triggers release of dopamine in the reward pathway but much less than other drugs § Humans prefer substance with THC over placebos § Animals showed self-admin at low doses

Is marijuana a reinforcing drug?

o Correlation between heavy marijuana use and development of Schizophrenia (Sz) § Particularly when used at a young age o Diminished reaction time and coordination that can lead to collateral damage (car accident)

Know 1-2 possible negative health effects of marijuana

o alleviate pain o reduce nausea and vomiting o stimulate appetite o help with the muscle spasticity associated with multiple sclerosis o Use enables some people to minimize or eliminate their use of more harmful substances

Know 2-3 medicinal uses of marijuana

§ Mere exposure § Giving rational facts about drugs § Scare tactics § Presentations by law enforcement

Know some (3-4) factors that are a part of UNsuccessful prevention strategies.

§ Interactive sessions § Learning refusal skills § Role-playing § Trained facilitators and peer counselors § Learn relaxation and stress reducing techniques

Know some (3-4) factors that are a part of successful prevention strategies.

Active listening that encourages them to make the decision to quit by themselves while providing them support and information

Motivation interviewing:

· Nicotine replacement: to quit smoking · Bupropion (Zyban-AKA the antidepressant, Wllbutrin) o Dopamine and norepinephrine reuptake inhibitor · Varenicline (chantix): o Partial nicotine receptor agonist to aid in weaning one off nicotine, decreases withdrawal symptoms

Nicotine addiction treatment?

A potentially life-threatening reaction that can occur when medications cause large amounts of serotonin to accumulate in the body o Mental status changes o Autonomic instability o Neuromuscular abnormalities

What is serotonin syndrome? Why does it happen?

Food and drug administrationresponsible for protecting the public health by ensuring the safety, efficacy, and security of drugs

What is the FDA? What are they responsible for?

Below moderate amounts -moderate: (300-400mgs) -3-4 8oz cups of homebrewed coffee per day

What is the approximate average daily intake of caffeine in the US? How much is considered a moderate amount?

short-term tolerance progresses as the day develops, and later cigarettes have less effect

Nicotine tolerance

· THC: primary psychoactive substance in cannabis · Cannabidiol (CBD): biologically active (not psychoactive) compound found in cannabis o Antioxidant, anticonvulsant, anti-inflammatory, antianxiety, antipsychotic, and neuroprotective

THC VS CBD

· Naltrexone: long-acting opioid antagonist (not same as naloxone) · Methadone: long-acting opioid agonist, slow onset · Buprenorphine (Subutex) o Opioid partial agonist o Oral admin o Lessens withdrawals o No high o Self admin, no clinic o Can be misused, but fairly safe · Suboxone: buprenorphine and naloxone o Sublingual admin

Opioid addiction treatment

-adenosine receptor antagonist —Release dopamine and acetylcholine

Pharmacodynamics of caffeine?

1. Determine a drug target 2. Design a drug 3. Preclinical research § Using cells, animals, and computer models § Study the pharmacokinetics (and toxicity) 4. File investigation new drug application (IND) § must address data, Manufacturing information, and Clinical protocols and investigator information: 5. Clinical trials (3 phases): -phase 1: safety is the main concern (ADME, dosage range , side effects) -phase 2: safety and efficacy -phase 3: Double-blind and placebo-controlled study (close examination of side effects) 6. submit NDA: new drug application to FDA 7. post market surveillance

Phases of drug development

Programs in place for those seeking welfare, or adoption of a baby Benefits: -determine whether a drug has been used § in sports: can prevent the use of steroids / determine if NCAA rules have been broken Disadvantages: -Depending on the drug cannot determine when the drug has been used -Whether or not detection of a drug occurs depends on many factors drug, its frequency and duration of use, route of admin, individual differences in metabolism, tolerance -False positive and false negative

What reasons why a drug test might be done? What are the benefits of drug testing? What are the disadvantages of drug testing?

§ Absorption via 2 major routes: · Inhalation (joints, pipes, bongs, vaporizers) · Ingested (often dissolved in an oil/ fat) o Slower onset of effect, less predictability of action, and less user control

Routes of administration/ absorption for marijuana

§ Not spiritually based § Encourages personal responsibility § Places emphasis on self-reliance/determination and empowerment § Support complete recovery (discourage terms like alcoholic) · Goal can be to reduce or control drinking § Time limited involvement

SMART Program for alcohol abuse

a bridge between inpatient and outpatient

Sober living homes

Depressants

What category of drug is alcohol?

stimulants- found in caffeine

What class of drugs are xanthines?

Modafinil (Provigil): mild stimulant that helps with withdrawals

Stimulant addiction treatment (name one off-label use treatment)

Stimulant: stimulate central nervous system Depressant; inhibit central nervous system

Stimulant vs depressant drug?

· GABAa receptors have 5 subunits around a chloride conducting pore o when GABA binds to the receptor, the pore opens, chloride enters the cell, and the cell is inhibited

Structure of the GABA receptor

· Positive symptoms (addition of a behavior): o Hallucinations: sensory experiences without sensory stimulation o Delusions: false beliefs, persistent regardless of overwhelming evidence against them · Negative symptoms (behaviors reduced by schizophrenia) o Flat affect and less emotional range o Apathy and social withdrawal o Loss of sense of purpose · Cognitive symptoms: o Altered ability to learn, store, use, and remember information

Symptoms of Schizophrenia?

§ Lithium: a naturally occurring metallic element (a mineral salt) · Most effective drug for managing manic episodes o Unsure how it works

What drugs are used to treat bipolar disorder?

Antipsychotics first generation, second generation, and third generation

What drugs are used to treat symptoms of schizophrenia?

· the dose · how well It is absorbed into the bloodstream · a person's age, sex, race, and tolerance · other drugs that are taken concurrently · environment

What factors affect how alcohol is metabolized?

Abuse potential Medical value Potential for dependence

What factors are important to consider when scheduling drugs?

· Reinforcing and addictive effects are mediated through activation of the dopamine system of the midbrain · biologically and psychologically addictive

What factors make nicotine so addictive?

§ Withdrawal? Acetaldehyde? Dehydration? GI irritation? Blood sugar? § Increased congeners in a drink can increase the symptoms of hangover

What factors may play a role in a hangover?

§ Active ingredients and amount in each dose § Purpose and uses of product § Specific warnings, side effects, substances, or activities to avoid § Directions to use --> when, how much, and how often § inactive ingredients and storage info

What has to be on the OTC drug label

· Treatment of General AD · Partial agonist to serotonin receptor

What is Buspirone used for? What neurotransmitter does Buspirone affect and how?

severe and chronic condition characterized by disturbances in thought, perception, and behavior

What is Schizophrenia?

-Monoamine Oxidase Inhibitors: used to treat Major Depressive Disorder -Prevents dopamine, norepinephrine (NE) and 5HT break down -Side effects: Dry mouth. Nausea, diarrhea or constipation. Headache. Drowsiness. Insomnia. Dizziness or lightheadedness. Wine and cheese effect: hypertension crisis

What are MAOIs? How do they affect neurotransmitters? What are the side effects?

-Treat major depressive disorder -Block reabsorption of serotonin from the synapse Know a few side effects o Weight gain o Insomnia o Tremors o Dizziness o Constipation o Dry mouth

What are SSRIs? How do they work at the synapse? What are some side effects?

· Anxiety, insomnia, ulcers, heart palpitations, increase blood pressure · Decreased bone density (osteoporosis)

What are some bad health effects of caffeine consumption?

· May reduce the risk of: type 2 diabetes and liver disease, Parkinson's disease, dementia, heart disease, and cancer

What are some good health effects of caffeine consumption?

o reduce anxiety o Muscle relaxation o Increase sedation and sleep o Impair coordination

What are some of the acute effects of benzodiazepines?

· Anxiety · Difficulty sleeping · Tremors · Sweating · Headache · Nausea · Vomiting · Irregular heartbeat · Delirium tremens (DTs): may last 3-4 days o involves convulsions, disorientation, anxiety, and hallucinations

What are some with drawl symptoms of alcohol? (including delirium tremens)

w/in 6h of last cig · Headache, trouble concentrating, irritable, tired · CRAVING: can last months or years

What are some withdrawal symptoms of nicotine?

TCH: Tetrahydocannabinol CBD: Cannabidiol

What are the active components in marijuana called?

· Release of adrenaline · Increase blood pressure and heart rate · May increase short-term memory and attention · Suppresses appetite · Hand tremors

What are the acute effects of nicotine?

o Most common: generalized anxiety disorder o Social anxiety disorder o Panic disorder o Specific phobia

What are the different types of anxiety disorders?

· Characterized by excessive fear, feelings of apprehension, dread, and/or uneasiness causing functional impairment and significant distress · Anxiety seems greatly out of proportion for the situation at hand · Usually accompanied by some form of avoidance of certain stimuli or situations

What are the main features of an anxiety disorder?

Depressed mood Diminished interest --One of this must be present S: Sleep changes: increase during day or decreased sleep at night I: loss of interest G: guilt (worthless): depressed E: decreased energy (lack) C: reduced Cognition/ Concentration A: Appetite (wt. loss) P: psychomotor changes--> agitation (anxiety) or retardations (lethargic) S: Suicidality

What are the symptoms of major depressive disorder? (SIGECAPS)

· Treat anxiety · Treat epilepsy ·Treat insomnia · Seizures · Can be used as a surgical anesthesia

What are the various uses of barbiturates?

Headache, drowsiness, irritability, concentration problems, craving

What are the withdrawal symptoms of caffeine?

Treat Major depressive disorder ·Block reuptake of norepinephrine and serotonin

What are tricyclic antidepressants? How do they affect neurotransmitters?

· First generation antipsychotics: typical antipsychotics o Direct antagonists for dopamine D2 receptors o Side effects: § Parkinson's-like symptoms § Weight gain § Sedation § Tardive dyskinesia: involuntary movements, particularly of the face and jaw · Second generation antipsychotic: atypical antipsychotic o Block dopamine and serotonin 2A receptors o Side effects: § Significant weight gain (throughout lifetime, large amounts of weight gained) § Type 2 diabetes § Fewer motor side effects than first gen §Helps reduce negative symptoms · Third generation antipsychotic o Weak partial dopamine D2 agonist o May also act on serotonin o Side effects: § Fewer side effects than first gen § Helps reduce negative symptoms

What receptors do first generation, second generation, and third generation drugs target to treat schizophrenia? What are their side effects?

· Agonist: binds to nicotinic acetylcholine receptor o Nicotine has biphasic effect: § Binds to nicotinic cholinergic receptors and excites them § Then stays bound, which prevents neural transmission Effects

What receptors/ neurotransmitters does nicotine interact with?

o genetics, the strain's harvest time, growth methods, light levels, and curing process all play a role

What types of things affect the levels of THC in marijuana

Cons: -failed to stop alcohol consumption -Caused many groups and individuals to drink -Government lost millions in tax revenues -Many businesses had to close Pros: -Abuse and lack of family support decreased -Assault decreased -Disorderly conduct decreased

What were the pros and cons of prohibition?

o Minimal effects on respiratory center of brainstem o Less potential for abuse (However, they are not recommended for the elderly)

Why are Benzodiazepines considered safer than barbiturates?

Metabolism rate remains constant despite intake -zero order elimination

Why doesn't alcohol have a half-life?

§ Disulfiram/Antabuse: makes you feel sick when you use alcohol

alcohol addiction treatment?

· Slows electrical activity in the brain · Ethanol dilates blood vessels of the skin, increases salivation and gastric secretions of HCL, and increases urination

physiological effects of alcohol

§ Dose § Potency of the strain § Ratio of THC to CBD § User's previous experience, expectations, and mood § Environment in which it is used

the factors that affect how someone experiences marijuana