Pharm Ch 37,38,39 drugs of abuse
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| what ntran ant of brain affected in addiction | dopa major transmitter --- remodeling in synapse leads to addictive behavior. Reward circuit affected and remodeled changes remain after drug stop
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| drug classes to facilitate acute withdrawal | Beta blockers, A-2 agonist combats SNS response to withdrawal (minimizes increases in BP, tachy, sweating, etc)
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| Drug for aversion | disulfiram - MUST avoid all alcohol sources
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| MOA disulfiram | stops ETOH metab mid-way by irreversible inhibition of ALDEHYDE DEHYDROGENASE --> accumulation of acetylaldehydes (hangover sxs even fatal)
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| mixed opioid agonist/antagonist (2) used to decrease craving, blocks the high from drinking ETOH | naltrexone, buprinorphine
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| what is the drug used to maintain abstinence (decrease the frequency of ETOH consumption) | acamprosate - which is best choice in this class
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| what long acting opioid agonist might be useful in detox | methadone
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| what opioid antagonist MIGHT be used in conjunction with buprinorphine | naloxone
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| OTC forms of nicotine replacement | gum, lozenge, transdermal
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| RX forms of nicotine replacement | inhaler, nasal spray (this admin most closely increases serum nicotine to equal cigs)
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| what are 2 antidepressants that have off-label uses for smoking cessation | buproprion (atypical) and nortripyline (TCA)
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| New drug for smoking cessation - | varenicline
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| varenicline MOA | nicotine agonist binds where tobacco nicotine binds. also prevents tobacco nicotine from binding here.
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| SEs of varenicline | GI - n/flat/c/xerstomia
1% suicidal idealations, sleep dist. psychosis
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| Dosing for varenicline | start low and taper up to minimize SEs
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