Term
| What are examples of stimulants? |
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Definition
Cocaine;
Methamphetamine;
Dextroamphetamine;
Methylphenidate;
MDMA (Ecstasy) |
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Term
| what is the stimulant epidemic? |
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Definition
Stimulant “epidemics” driven by low perceived risk and increasing supply, occurred initially with cocaine, later with amphetamine, and again with cocaine in the 1980s.
Education can address perceived risk but law enforcement efforts to limit supply have not been particularly successful |
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Term
| What is cocaine dependence driven by? |
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Definition
| Cocaine dependence is driven largely by euphoria (positive reinforcement) and craving (negative reinforcement), which alternate to produce a cycle of addiction. |
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Term
| What does euphoria result from? |
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Definition
| Euphoria results from the acute pharmacological action of cocaine on pleasure circuits |
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Term
| What does craving result from? |
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Definition
| Craving appears to result in part from chronic neuroadaptations associated with cocaine exposure. Psychosocial and pharmacological treatments that diminish cocaine euphoria or reverse craving should promote recovery. |
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Term
| What neurological circuit does cocaine affect? |
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Definition
| the neural circuits involved in reinforcement. This is the dopamine (DA) system. The DA system originates in the ventral tegmental area (VTA) and connects to the nucleus accumbens, prefrontal cortex as well as hippocampus. This is the mesocorticolimbic system. Activation of the VTA results in the DA release in the nucleus accumbens and limbic system and the prefrontal cortex. This is associated with rewarding/reinforcing effects, not only for alcohol but for almost all abused drugs. |
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Term
| What does chronic cocaine exposure do? |
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Definition
| It disregulated the rewards pathways. |
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Term
| what is the most common illicit drug mentioned in ER reports? |
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Definition
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Term
| what are the toxic effects of cocaine? |
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Definition
Toxic effects result from vasospasm, producing ischemia or necrosis, electrophysiological disturbances, and hypertension.
Trauma is another common cause of the addiction resulting from the dangers of cocaine procurement. |
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Term
| what are cardiac complications? |
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Definition
Cardiac complications of cocaine use:
Angina
Myocardial infarction
Cardiomyopathy
Myocarditis |
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Term
| If an MI in a younger person, what do you expect? |
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Definition
| Myocardial infarction in a young individual without evident risk factors should always increase the index of suspicion for cocaine dependence. Sudden death can even occur with first time use, especially if cocaine is mixed with alcohol (due to the toxic effects of cocaethylene). |
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Term
| what are other Coke medical problems? |
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Definition
Other medical problems:
Hyperpyrexia
Intestinal ischemia
Renal failure
Perforated nasal septum
Low birth weight, spontaneous abortion |
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Term
| what is most common coke combo? |
|
Definition
Cocaine & alcohol
Most common cocaine combination
Reduces anxiety |
|
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Term
| what does cocaethylene do? |
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Definition
| Cocaethylene is psychoactive and cardiotoxic |
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Term
|
Definition
Intravenous cocaine & heroin (speedball)
Enhanced euphoria positive effects of both drug
Reduction of unpleasant cocaine effects
Medical complications associated with IV use |
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Term
| What is the clinical syndrome of cocaine? |
|
Definition
Cocaine Euphoria
Cocaine-Induced Craving
Cue-Induced Craving
Stress-Induced Craving
Baseline Craving
Cocaine Withdrawal
Hedonic Dysregulation
Hypofrontality |
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Term
| What is changed by chronic cocaine exposure? |
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Definition
| Neurotransmitter levels, receptor sensitivity and even the morphology of neurons within reward pathways are changed by chronic cocaine exposure. |
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Term
|
Definition
Brief duration
Gives way to craving in minutes
(even when levels are still elevated)
Lack of satiation - multiple doses
Binge pattern use
Intensely rewarding
Animals self-administer till death
Patients obsessed with euphoria
Distinctive features v. heroin/alcohol
Manic-like, racing thoughts, energy, vigilance
Psychomotor activation, environmental focus
Sexual arousal |
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Term
| Does Da increase or decrease |
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Definition
| increase DA releasing, and increase DA binding |
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Term
| Does glutamate neurotransmission increase of decrease? |
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Definition
|
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Term
| How do coke and meth increase DA levels? |
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Definition
| Cocaine and methylphenidate increase DA levels by binding the dopamine transporter (DAT). Amphetamine has the added effect of releasing DA. |
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Term
| How is DA in the NA abused? |
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Definition
| Naturally rewarding activities (sex, feeding) also release DA in the nucleus accumbens, demonstrating how stimulants hijack natural reward pathways. Stimulants increase sex drive, which leads to risky behavior and the spread of sexually transmitted diseases. Nearly all drugs of abuse release DA in the nucleus accumbens. |
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Term
| what is the siignature of drug reward |
|
Definition
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Term
| what are advantages of smoking crack? |
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Definition
The intrapulmonary administration of cocaine with crack delivers a rapid bolus of cocaine to the brain.
Smoking cocaine bypasses the venous system, providing more euphoria than oral, intranasal, and even intravenous cocaine. Smoking is certainly more socially acceptable than injecting to novice users. |
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Term
|
Definition
Cocaine-induced craving:
Glutamate depletion;
Cue-induced craving:
DA/glutamate activation;
Stress-induced craving:
CRF, NE & DA/glutamate activation;
Baseline craving :
DA/glutamate depletion? |
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Term
| What does limbic activation provide? |
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Definition
| Limbic activation provides a means of testing anti-craving medications in the laboratory under controlled conditions |
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Term
| What are symptoms of cocaine withdrawl? |
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Definition
Anergia
Depression
Bradycardia
Hyperphagia
Hypersomnia
Poor concentration
Psychomotor retardation
Cocaine withdrawal is not medically dangerous but severe withdrawal curiously predicts poor clinical outcome |
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Term
| what is hallmark of cocaine dependance? |
|
Definition
Denial!!! Denial, traditionally viewed as purely psychological, may result in part from prefrontal cortical dysfunction
and Poor decision making
Impaired ability to weigh risks against benefits
Dangerous risk tolerance
Poor impulse suppression
Cocaine becomes the first priority. |
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Term
| what are progressive complications of cocaine dependence? |
|
Definition
Death (MI, hyperthermia, hemorrhage, violence)
Medical (cardiac, seizures, stroke, renal)
Psychiatric (psychosis, depression, panic, suicide)
Legal (incarceration: possession, dealing, prostitution, theft)
Family (child neglect, violence, divorce)
Occupational (job loss: absenteeism, poor performance)
Financial (drug procurement, loss of income) |
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Term
| what is most important source of collateral info? |
|
Definition
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Term
| is indv drug counseling helpful? |
|
Definition
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|
Term
|
Definition
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|
Term
| Are there meds for cocaine dependence? |
|
Definition
| Not yet, with any proven efficacy |
|
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Term
| What are possible meds for cocaine dependnece? |
|
Definition
Possible medications include:
Modafinil - blocks euphoria;
Propranolol - reduces stress;
Baclofen - reduces cue-craving;
Topiramate - relapse prevention;
Disulfiram - reduces alcohol use, increases DA;
Cocaine vaccine - blocks euphoria |
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Term
| Which are considered DA/Glut enhancing agents? |
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Definition
| DA/Glutamate Enhancing Agents
Modafinil (glutamate-enhancing)*
Amantadine (releases DA)*
Disulfiram (?brain DA; ?DBH)*
<<< |
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Term
| What are Da/GLUT inhibt agents used for? |
|
Definition
relapse prevention:: DA/Glutamate Inhibiting Agents
Ondansetron (?DA release)
Tiagabine (?GABA uptake)
Baclofen (GABAB agonist)*
Topiramate (?GABA, AMPA blocker)* |
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Term
| which med promoted coke abstinance and attenuates coke euphoria? |
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Definition
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Term
| Disulfirim has been shown to do what? |
|
Definition
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|
Term
|
Definition
|
|
Term
| What is addiction driven by? |
|
Definition
|
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Term
| What do brain neuroadaptations contribute to? |
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Definition
| Brain neuroadaptations contribute to cocaine euphoria, cue-induced craving, hedonic dysregulation, and even denial |
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