Neurotransmitters and Receptors
Where benzodiazepines bind
GABAA neurotransmitter receptors at the α+/γ2– interfaces
PCP, fentanyl, alcohol, cannabis, cocaine
Of these five substances of abuse intoxication with this one is most likely to lower seizure threshold
cocaine
The 3 FDA approved treatments for OUD listed based on lowest K1 value (lowest to highest)
naltrexone-buprenorphine-methadone
The spirit of motivational interviewing, reflected by the acronym PACE
partnership
acceptance
compassion
evocation
These three benzodiazepines are metabolized primarily through conjugation and do not have active metabolites, therefore, the half-life remains relatively the same even in the setting of liver disease.
L – Lorazepam
O – Oxazepam
T – Temazepam
Varenicline is a partial agonist at this receptor
Nicotinic acetylcholine
This illicit drug is a noncompetitive antagonist at the glutamate NMDA receptor known for its dissociative properties
PCP
What the drug does to the body
pharmacodynamics
This medication helps mitigate withdrawal symptoms by acting on the Locus Ceruleus and decreasing norepinephrine
clonidine
dexmedetomidine
This medication for AUD is safe to use in mild-moderate liver disease with close monitoring
Naltrexone
mu
kappa
delta
opioid receptor-like-1 (ORL1)
Herbal substance that produces both stimulant and opioid like effects
kratom
What the body does to the drug
pharmacokinetics
opthalmoplegia, ataxia, and confusion and it's correct treatment (be specific)
Wernicke Encephalopathy
Thiamine 500 mg IV TID for 2-3 days
Of the medications used to treat OUD, this one(s) is metabolized in the liver
naltrexone, buprenorphine, methadone
The 2 receptors phenobarbital binds to that helps mitigate symptoms of alcohol withdrawal
GABA-A receptor agonisim
NMDA receptor weak antagonism
Mo Y, Thomas MC, Karras GE., Jr. Barbiturates for the treatment of alcohol withdrawal syndrome: a systematic review of clinical trials. J Crit Care. 2016;32:101-107.
Co-use of these 2 substances of abuse results in an active metabolite with direct cardiac toxicity
cocaine
alcohol
Cocaethylene is a compound that is formed in the liver through a chemical reaction involving cocaine and alcohol.
The half-life of phenobarbital
100 hours (80-120)
active metabolites phenylethylmalonamide and p-hydroxyphenobarbital
The gold standard treatment for stimulant use disorder
NNT as low as 3
Contingency management
FDA approved medication for AUD NOT metabolized in the liver
acamprosate
Cocaine increases circulation of this class of neurotransmitters
catecholamines (dopamine, epinephrine, norephinephrine)
conjunctival injection, increased appetite, dry mouth, tachycardia
cannabis intoxication
Bioavailability of 1) sublingual buprenorphine 2)sublingual naloxone
1. 35 %
2. 3% (can be as high as 10 in some people)
Greater than 20% of regular users of this substance report daily cystitis symptoms
Ketamine
The most sensitive biomarker for alcohol use
peth