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