Transcript SPECIFIC DRUGS

SPECIFIC DRUGS
The Major (vs. minor) Stimulants
Cocaine and Amphetamines
Major Stimulants - Cocaine
* Free association
COCAINE
* What is coke and where does it come from?
 coca leaf / coca bush
 Incas and Spanish
 Freud
 American history (VIP usage)
Major Stimulants - Cocaine
 street cocaine: coca paste and hydrochloric acid =
type of salt--powder sniffed or snorted
more addictive uses:
can inject it if mix with water -- IV quicker action
 smoking: freebase - powder and ether
 crack - dissolve cocaine salt in baking soda solution,
boil off water, left with rock
 Cocaine - ETOH combo (coca-ethylene)
- may alter metabolics of
cocaine, which may be more cardiotoxic via increased half-life of cocaine
Major Stimulants - Speed
Amphetamines
• ephedrine, principal chemical in these drugs, has been
known for thousands of years; used as Chinese medicinal
herb
• ephedrine first isolated in late 1800's, and synthesized in
1920s when it was named “amphetamine”
• first medically used in 1920's for treating obesity,
narcolepsy, colds, and much later ADHD
• used to enhance performance, decrease fatigue – sport &
military applications (e.g., go and no-go pills)
U.S. Banned Ephedra in 2004
• used primarily for weight loss and body
building in the U.S.
• linked to 155 deaths and dozens of heart
attacks and strokes.
• Derived from a plant (powdered and then
put in pills)
• Contains ephedrine & pseudoephedrine
ephedra ban, cont…
• side effects can be life threatening even for a
healthy individual (constricts blood vessels, raises
blood pressure).
• FDA was aware of a problem for 8 years, however
the high profile death of Baltimore Orioles pitcher,
Steve Bechler stimulated concern from the FDA
as well as many others.
• 1st government ban on a dietary supplement
Major Stimulants - Cocaine
Prevalence
1998
2010
Cocaine
(Crack)
Cocaine
(Crack)
Past month
.8%
(.2)
.6%
(.1)
Past year
Lifetime
1.7%
10.6%
(.4)
(2.0)
1.8%
14.7%
(.3)
(3.6)
 cheapness of crack--national crisis
 shift of users from college educated to high school dropouts
smoking cocaine becoming more popular, especially among young
users
Non-medical Use - Stimulants
Past Month Prevalence – 2010
http://www.samhsa.gov/data/NSDUH/2k10NS
DUH/2k10Results.htm#Fig2-2
*ages 12 and older, from NSDUH
Major Stimulants
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Neurotransmitters and behavioral pharmacology
cocaine inhibits reuptake of monoamines, especially dopamine,
resulting in what?
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amphetamines cause neurons to discharge more dopamine into
syn gap as well as blocking reuptake
* animals self-administer coke and rapidly escalate their doses.
Prefer coke to food, sex....
* compared to amphetamines and heroin, animals increase dose
more rapidly-resulting in death
* from CT scan studies of subjects while using coke, 90 different
parts of the brain are “turned on”
Major Stimulants
Effects of the Major Stimulants
Desired effects: stimulant of CNS; a local anesthetic (cocaine); a vasoconstrictor
alertness, energy, physical performance; increase confidence, euphoria, aggression
Negative effects
– arrhythmia
– anxiety
– irritability/restlessness
*SX lead to use of other drugs to calm down
(examples: alcohol; used with heroin = speedball)
– paranoia - not associated with duration or amount used; gets worse as use continues;
usually drug-related paranoia with delusions (not bizarre)
- 68% of hospitalized clients had transient paranoia
– tolerance established to euphoria, but not to heart rate - leading to cardiac problems
-kindling: need less of drug upon repeated exposure; occurs with intermittent, binge use; may lead to
panic attacks or psychosis; environmental conditions may contribute
Overdose
formication syndrome: SX-itching; craving, insects
- paranoid delusions
- convulsions, seizures
• Withdrawal SXs Crashing and craving
Major Stimulants
Medical Effects
Lungs: chest pain, SOB, hemoptysis (blood from lungs
coughed up)
Nose: ulcers, congestion, nosebleeds, septal perforation
(from nasal sprays to relieve nasal dripping)
Cardio: narrowing of coronary arteries, high
myocardial oxygen demand, irregular heart beat
CNS: seizures (can occur seconds to minutes after use);
intercranial hemorrhage, CT: local cerebral infarcts,
mild cognitive impairment in heavy users
Major Stimulants
Fetal Exposure during Pregnancy - initial fears were that “crack babies” would have
severe irreversible brain damage
Cocaine exposure during pregnancy does produce:
-lower birth weight babies, decreased fetal growth; prematurity
-these outcomes may also be due to poor nutrition, other substance use, or poor or no
prenatal care.
- current environment critical as well, even more predictive of problems such as IQ
deficits
Controlling for environmental influences after birth, we still see later in kids:
1. difficulty concentrating and blocking out distractions
EX. Animals exposed in the womb show abnormal brain development in areas
associated with attention processes
EX. Trouble paying attention to correct tone
2. increased impulsivity and aggressiveness: these kids may have a higher arousal
threshold, but when aroused may be harder to control
3. increased anxiety and depression
4. increased irritability as babies compared to babies exposed to alcohol, tobacco or
otherdrugs
The Case of Methamphetamine
(speed, crystal, crank, ice)
How is it made ?
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Anhydrous nitrate
Ephedrine
Red Phosphorous
Lithium
Antifreeze
Lantern fuel
Methods of use
… not a great injectionable drug
Abscesses caused by “cranking”
(injecting Meth intravenously)
Meth needle marks
Stages of use
• Rush ( 20 – 40 minutes)
• Binge High ( 3 days )
• Crash
Short term effects
anxiousness and nervousness
incessant talking
extreme moodiness and irritability
purposeless, repetitious behavior, such as
picking at skin or pulling out hair
• sleep disturbances
• false sense of confidence and power;
aggressive or violent behavior
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Dilated pupil - stimulant
intoxication
Effects of Abuse
Dental problems caused by Meth