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Lecture 91: Toxicology: Legal Drugs of Abuse
Nervous System Part III
39
Medical
Professional
03/21/2011

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Term
What is cocaine used for medically?
Definition
anesthetic and vasoconstrictive for nosebleeds

(no longer for facial and scalp lacerations because too well absorbed)
Term
What is the primary and secondary effects of cocaine?
Definition
Primary: block NE reuptake

Secondary: marked release of NE
Term
Which class of drugs should be avoided while treating toxic effects of Cocaine? Why?
Definition
Beta blockers

creates unopposed alpha stimulation which leads to greater ischemia

should also avoid HALOPERIDOL because lowers threshhold for seizures
Term
How is cocaine a psycho stimulant?
Definition
stimulates limbic system and produces pleasurable effects by blocking DA reuptake in the nucleu accumbens
Term
How do you get crack and free-base?
Definition
Cocaine doesn't light so a proton is removed so it can be smoked

(ammonia and diethy ether are used for free-base and baking soda for crack)
Term
What are the metabolites for cocaine and how are they broken down?
Definition
Ecgonine methyl ester (EME)-esterases
Bensoylecgonine (BE)-nonenzymatic
Term
A drug screen for cocaine detects what? for how long?
Definition
Benzoylecgonine (BE) in the urine for 48-72 hrs
Term
What prolongs the metabolism of cocaine and why?
Definition
Pancuronium

neuromuscular blockers (and ester anesthetics) compete for plasma cholinesterase which decreases EME and decrease cocaine metabolism
Term
What is a potent precipitant of convulsions because of its longer half life that cocaine?
Definition
cocaethylene
Term
What are 3 cardiac effects from myocardial ischemia?
Definition
increased myocardial oxygen demand from hypertension and tachycardia

coronary artery spasms from adrenergic effects

dilated cardiomyopathy with chronic use
Term
What are some other clinical manifestations of cocaine? (3)
Definition
Crack lung:pulmonary effects from deep valsalva maneuver

Rhabdomyolysis:breakdown of skeletal muscle releasing myoglobin leading to renal failure

ichemic bowel
Term
What should be used for the treatment of cocaine?
Definition
Benzodiazepines
Oxygen
Nitroglycerin
Term
What is MDMA?
Definition
Ecstasy
an amphetamine analog
stimulant and hallucinogenic properties
causes serotonin release
Term
What is a Mickey Finn?
Definition
sedative hypnotic made of chloral hydrate
Term
What are some effects of opioids?
Definition
miosis
bradycardia
hypothermia
decreased bowel signes
altered mental status
unresponsiveness
Term
What has potency 80 times that of morphine and causes less hypotension and less histamine release with chest wall rigidity?
Definition
fentanyl
Term
What is the opiod antidote?
Definition
Naloxone aka Narcan
Term
Who are at risk for delayed and prolonged toxicity from packet leak or rupture?
Definition
packers
Term
What is WBI?
Definition
Whole Bowel Irrigation

mechanical flushing of the GI with polyethylene glycol
Term
Combinations of what case serotonin syndrome?
Definition
meperidine(demorol) or dextromethorophan with MAOIs may prodeuce serotonin syndrome because they exert effects on serotonin receptors
Term
What are symptoms of serotonin syndrome?
Definition
muscle rigidity, hyperthermia, and AMS
Term
What are the active metabolites of caffeine?
Definition
theophylline and theobromine
Term
Why does the heart pound after a significant dose of caffeine?
Definition
caffeine's blockade of A1 adenosine receptors in the heart
Term
What is the molecular mechanism of caffeine?
Definition
increase in the extracellular concentration of dopamine in the nucleus accumbens
Term
What is the pathway for caffeine?
Definition
antagonist of adenosine (A2A) > decreases adenylyl cyclase activity > decreases cyclic AMP > decreases protein kinase A > positive feedback causes increase in DARPP > increase in DA levels
Term
What increases theophylline metabolism?
Definition
smokers, phenytoin, pheobarbital, rifampin, atkins diet
Term
What are some effects of Methylxanthine toxicity?
Definition
N/V, gastritis, increasing pepsin and gastric acid, rhabdomyolysis, tremor myoclonis, hypokalemia, hyperglycemia
Term
What is an important methylxanthine toxicity point?
Definition
caffeine penetrates CNS better than Theophylline and theobromine so it promotes seizures
Term
What is absinthe derived from?

What is the toxic component that the FDA measures levels of?
Definition
Artemisia absinthium
wormwood

Thujone
Term
What are the effects of Peyote Lophophora Cactaceae?
Definition
contains mescaline

psychedlic, kaleidoscopic colors, hallucinations, distorted perception of time
Term
What is a brand of neutral grain spirit that is available in concentrations of 75% and 95% alcohol?
Definition
Everclear
Term
What is the leading cause of morbidity and mortalitiy in the US?
Definition
alcoholism
Term
What is Ginseng Abuse Syndrome?
Definition
long term use of ginseng causes hypertension, insomnia, anxiety, and morning diarrhea
Term
where do you find mepherdrone and methylenedioxypryrovalerone (MDPV)?
Definition
bath salts
they inhibit DA and NE reuptake and have cocaine-typ and amphetamine-like effects
Term
Which drug has atropine and alkaloid as active ingrediants, hallucinogenic, and gives feeling of flying?
Definition
Belladonna
Term
Which flower has similar effects to LSD when taken in the hundreds?
Definition
morning glory
Term
What is a potent k-opiod receptor agonist and may have potential as an analgesic or therapeutic tool for drug addictions?
Definition
salvia
Term
What has a stregnth between caffeine and amphetamine?

What is the most potent compound?
Definition
Khat plant

cathinone
Term
What is a legal stimulant that is structurally and pharmacologically similar to amphetamine?
Definition
ma-huang or ephedra
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