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Neurotoxic Drugs

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What protein is altered with cocaine and methamphetamine use?
no known active metabolites, neurotoxicity is uncommon, rapid onset and short-acting
What are the 4 positives to using fentanyl or sufentanil as opioids?
dopamine, norepinephrine and serotonin
Cocaine affects which three transporters?
euphoria; seizures
With chronic cocaine use, you develop tolerance to ________ but sensitivity to _______.
mu; morphine
Cocaine decreases pain through ____ receptor; causes increased ____.
step-wise in mild neurotoxicity; abruptly in severe life-threatening neurotoxicity
How should the opioid be discontinued?
MI, stroke, pulmonary hypertension, dilated cardiac muscles, immune system alterations, and periodontal disease
Examples of medical complications with meth use?
HIV
Use of Meth increases risk of transmission of ________.
Fentanyl or sufentanil
Use _____ or _____ in opioid neurotoxicity to treat pain.
Benzodiazepines (clonazepam, lorazepam, and midazolam)
What class of drugs is used to decrease neuromuscular irritability?
Blocks K and Na channels (local anesthetic) , as well as membrane transporters for norepinephrine, dopamine, and serotonin
Mechanism of Cocaine?
1. stop opioid or reduce dose; 2. start new opioid; 3. treat jerking with benzo's
3 steps to tx of opioid neurotoxicity?
cocaine has brief duration while meth may last days or weeks
Difference between cocaine-induced psychosis and meth-induced psychosis?
Synergistic; dopamine receptors
Neruotoxicity of meth and HIV are ________ B/C _________
ketamine
What do you give in a pediatric opioid overdose?
blocks re-uptake of neurotransmitters; blocks re-uptake and causes release
Cocaine _________ while amphetamines __________ and _________.
dopamine
Meth users show a decreased level of _____ transporters.
it decreases the dopamine in the nigrostriatal tract, which increases the risk of parkinson's
How does meth use relate to parkinson's disease?
psychoses that mimic schizophrenia
Long-term meth users may develop what?
dopamine and norepinephrine
Crystal Meth affects what two neurotransmitters?
5x morphine
The potency of hydromorphone = ?
cocaine; dopamine and norepinephrine
Short term medical complications of meth are similar to ______; they are mediated through the release of _______ and ________.
opioid-induced myoclonus
Sudden, brief shock-like involuntary movements, best seen while sleeping, high incidence, most recognized with metabolites = ?
puts glutamate back into the synapse, so the withdrawal is less severe
Mechanism of N-acetylcysteine treatment for cocaine addiction?
delirium, myoclonus/seizures, allodynia/hyperalgesia, or rapidly increasing the dose makes things worse
4 things to notice with opoid-induced neurotoxicity?
neurotoxicity
What are the most harmful and devastating effects of methamphetamine use?
development of resistance because people don't adhere to antiretroviral therapy
What is the largest risk factor concerning HIV and meth use?
hydromorphone; neurotoxic, no analgesic
H3G is a metabolite of _______ and has ____ effects.
myoclonus, hyperalgesia, delirium, grand-mal seizures
Opoid Toxicity = ?
dopamine and serotonin
Ecstasy affects what two transporters?
euphoria, arousal, paranoia, aggression, increased HR and sex drive, decreased sleep and apetite
What are the acute effects of methamphetamine?
Hydrate to clear the opioid and metabolites
After stopping the neurotoxic opioid, _________

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