DRUG ABUSE • use of an illicit drug or the excessive or nonmedical use of a licit drug • denotes the

deliberate use of chemicals that generally are not considered drugs by the lay public but may be
harmful to the user • primary motivation is the anticipated feeling of pleasure derived from the CNS
effects of the drug DEPENDENCE • older term is physical OR physiologic dependence • state
characterized by signs and symptoms, frequently the opposite of those caused by a drug, when it is
withdrawn from chronic use or when the dose is abruptly lowered ADDICTION • older term is
psychological dependence • compulsive drug-using behavior in which the person uses the drug for
personal satisfaction, often in the face of known risks to health TOLERANCE • decreased response to
a drug, necessitating larger doses to achieve the same effect • etiology of tolerance o metabolic:
increased disposition of the drug o behavioral: ability to compensate for the effects of a drug o
functional: changes in receptor or effector systems involved in drug actions ABSTINENCE
SYNDROME/ WITHDRAWAL SYNDROME • signs and symptoms that occur on discontinuation or
withdrawal of a drug in a dependent person SUPPLEMENT: Dopamine Hypothesis of Addiction •
dopamine in the mesolimbic system appears to play a primary role in the expression of "reward" •
excessive dopaminergic stimulation may lead to pathologic reinforcement o behavior may become
compulsive and no longer under control— common features of addiction • most addictive drugs
have actions that include facilitation of the effects of dopamine in the CNS SUPPLEMENT: OTHER
RELATED COMPOUNDS METHYLPHENIDATE Chemically related to Amphetamine, A CNC stimulant
used for ADHD. Do not use together with antidepressants ATOMOXETINE A NE reuptake inhibitor;
used for ADHD AMPHETAMINES Methamphetamine (“speed”, “ice”) Dextroamphetamine • Feeling
of euphoria and self-confidence that contributes to the rapid development of addiction • Effects of
chronic high-dose abuse Fx • Psychotic state (w/ delusions and paranoia) development of necrotizing
arteritis, → cerebral hemorrhage, renal failure CM OVERDOSE WITHDRAWAL agitation, hypertension,
tachycardia, delusions, hallucinations, hyperthermia, seizures, death apathy, irritability, increased
sleep time, disorientation, depression • no specific antidote MGT • control of body temperature •
protection against cardiac arrhythmias and seizures • antidepressants (amineptine, mirtazapine) are
of limited benefit • acidify urine to increase elimination Dimethoxymethylamphetamine (DOM)
Methylenedioxyamphetamine (MDA) Methylene dioxymethamphetamine (MDMA/ Ecstasy) • More
selective action on the serotonin transporters in CNS Fx • Facilitate interpersonal communication •
Act as sexual enhancers • Causes depletion of neurons in serotonergic tracts CM OVERDOSE
agitation, hypertension, tachycardia, delusions, hallucinations, hyperthermia, seizures, death • No
specific antidote MGT • control of body temperature • Protection against cardiac arrhythmias and
seizures COCAINE STREET NAMES: “coke”, “super-speed”, “crack” • Inhibition of CNS transporters of
dopamine, norepinephrine, and serotonin Fx • Marked amphetamine-like effects • Short-lasting
euphoria, self-confidence and mental alertness positively reinforce its continued use OVERDOSE CM
WITHDRAWAL hypertension, vasoconstriction, thrombus formation, psychomotor agitation, severe
hyperthermia, dyspnea, bowel ischemia, mydriasis, crack lung (hemorrhagic alveolitis), fatalities from
arrhythmias, seizures or respiratory depression apathy, irritability, increased sleep time,
disorientation, severe depression strongly reinforces compulsions • no specific antidote is available •
supportive care MGT • cocaine abuse during pregnancy is associated with increased fetal morbidity
and mortality • antidepressant drugs may be indicated • infants born to mothers who abuse have
possible teratogenic abnormalities (cystic cortical lesions), increased morbidity and mortality and
may be cocaine dependent PHENCYCLIDINE Phencyclidine (PCP; "angel dust") Ketamine ("special K")
• antagonists at the glutamate NMDA receptor • no actions on dopaminergic neurons in the CNS
unlike most drugs of abuse Fx • PCP: most dangerous hallucinogenic agent • Psychotic reactions,
impaired judgment leading to reckless behavior (psychotomimetic effect) CM OVERDOSE horizontal
and vertical nystagmus, marked hypertension, and fatal seizures WITHDRAWAL fever, seizures,
muscle breakdown, depression and memory loss in long-term • Supportive care (seizures
hypertension) MGT • Supportive care • Benzodiazepines and/ antipsychotics • Parenteral
benzodiazepines (diazepam, lorazepam) are used to curb excitation and protect against seizures
HALLUCINOGENS Lysergic acid diethylamide (LSD) Mescaline Psilocybin • Psychedelic and mind
raveling effects Fx • Perceptual and psychological effects accompanied by marked somatic effects
(nausea, weakness, paresthesia) • Panic reactions ("bad trips") may also occur TOPNOTCH MEDICAL
BOARD PREP PHARMACOLOGY MAIN DIGITAL HANDOUT BY MARIA YNA PEREYRYA-BORLONGAN,
MD-MBA Page 49 of 95 For inquiries visit www.topnotchboardprep.com.ph or
https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the October
2022 PLE batch. This will be rendered obsolete for the next batch since we update our handouts
regularly. TOPNOTCH MEDICAL BOARD PREP PHARMACOLOGY MAIN HANDOUT BY DR. YNS
PEREYRA-BORLONGAN, MD-MBA For inquiries visit www.topnotchboardprep.com.ph or
https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for October 2022
PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.
MARIJUANA Lysergic acid diethylamide (LSD) Mescaline Psilocybin Psychoactive constituents in crude
extracts of the plant Cannabis sativa (hemp) Active ingredients: tetrahydrocannabinol (THC),
cannabidiol (CBD), cannabinol (CBN) Hashish is a partially purified, more potent form Street names:
"weed", "pot", "grass", "damo", "dope", "Mary Jane", "hash" • Fx • Feeling of being "high," with
euphoria, disinhibition, uncontrollable laughter, changes in perception, and achievement of a dream-
like state • impaired mental concentration • vasodilation, tachycardia reddened conjunctiva • dry
mouth • impairment of judgment and reflexes • effects potentiated by concomitant use of sedative
hypnotics including ethanol DRUGS USED TO TREAT DISEASES OF THE BLOOD AGENTS USED IN
ANEMIAS AND HEMATOPOIETIC GROWTH FACTORS Katzung and Trevor’s Pharmacology Examination
and Board Review. 12th ed. 2018 For this topic, kindly read through the whole section then after, go
through the quizlet we prepared for you. Aside from understanding, active recall and repetition is the
key for pharma. Dr. Rodriguez IRON IRON • essential metallic component of heme • distribution of
iron in the body o mostly contained in hemoglobin o bound to Transferrin, a transport protein o
bound to Ferritin, a storage protein o children and pregnant women have increased iron
requirements Types of Vitamin deficient Anemias • microcytic hypochromic anemia caused by iron
deficiency is the most common type of anemia o Laboratory picture: ↓ Iron, ↓ Ferritin, ↑ TIBC •
megaloblastic anemias are caused by a deficiency of vitamin B12 or folic acid o pernicious anemia is
the most common type § caused by a defect in the synthesis of intrinsic factor or by surgical removal
of that part of the stomach that secretes intrinsic factor HEMATOPOIETIC GROWTH FACTORS (IRON)
oral: FERROUS SULFATE, Ferrous gluconate, Ferrous fumarate, Ferrous carbonate parenteral: IRON
DEXTRAN, Iron sucrose, Sodium ferric gluconate complex All are Preg Cat A MOA Uses Required for
the biosynthesis of heme and heme-containing proteins, including hemoglobin and myoglobin Iron
deficiency anemia, Iron supplementation The best way to give iron is through oral preparation added
with ascorbic acid for better absorption. SE Black stools (may obscure acute GI loss) Acute overdose:
necrotizing gastroenteritis, abdominal pain, bloody diarrhea, shock, lethargy, dyspnea Chronic iron
overload: hemochromatosis, organ failure (heart, liver, pancreas etc.), death Iron content of some
oral Iron preparations (% w/w) Fe carbonate / Carbonyl Iron Fe fumarate 100% 33% Fe sulfate, dried
30% Fe sulfate, hydrated 20% Ferric ammonium sulfate 18% Fe gluconate 12% IRON CHELATORS
IRON INTOXICATION Acute Iron Intoxication • usually occurs as a result of accidental ingestion of iron
supplementation tablets, commonly in children • CLINICAL MANIFESTATIONS o necrotizing
gastroenteritis, shock, metabolic acidosis, coma, death • TREATMENT o removal of unabsorbed
tablets from the gut o correction of acid-base and electrolyte abnormalities o parenteral
administration of DEFEROXAMINE, which chelates circulating iron Chronic Iron Intoxication:
Hemochromatosis • state of chronic iron overload that damages the organs that store excess iron
(heart, liver, pancreas) • Triad: CIRRHOSIS, DIABETES MELLITUS, SKIN PIGMENTATION • OCCURRENCE
o persons with an inherited abnormality of iron absorption o persons who receive frequent
transfusions for treatment of hemolytic disorders (e.g. thalassemia major) • TREATMENT o
Phlebotomy o chronic administration of DEFEROXAMINE or DEFERASIROX HEAVY METAL CHELATORS
DEFEROXAMINE, DEFERASIROX, DEFERIPRONE MOA Chelates excess iron Uses Acute iron poisoning,
Hemochromatosis not adequately treated by phlebotomy SE Hypotension, ARDS, Neurotoxicity,
Increased susceptibility to infections Notes Deferoxamine is used for acute intoxication (IV form),
while Deferasirox and Deferiprone are for chronic (Oral) VITAMINS (FOLATE AND B12) FOLATE •
required for normal DNA synthesis Pharmacokinetics • readily absorbed by the proximal jejunum •
only modest amounts are stored in the body • decrease in dietary intake within 1-6 months is
followed by megaloblastic anemia Folic acid deficiency • deficiency usually presents as megaloblastic
anemia • deficiency of folic acid during pregnancy increases the risk of neural tube defects in the
fetus VITAMIN B12 • deficiency of either vitamin B12 or folic acid usually manifests as megaloblastic
anemia • vitamin B12 deficiency (NOT folic acid deficiency) causes neurologic defects o Ataxic gait,
impaired position and vibratory sense, spasticity • absorbed in the distal ileum in the presence of
intrinsic factor • stored in the liver in large amounts (5-year supply) • 2 available forms:
cyanocobalamin and hydroxocobalamin • linked to folic acid metabolism and synthesis of
deoxythymidylate (dTMP), a precursor required for DNA synthesis Vitamin B12 Deficiency •
administration of folic acid to patients with vitamin B12 deficiency helps refill the tetrahydrofolate
pool and partially or fully corrects the anemia TOPNOTCH MEDICAL BOARD PREP PHARMACOLOGY
MAIN DIGITAL HANDOUT BY MARIA YNA PEREYRYA-BORLONGAN, MD-MBA Page 50 of 95 For
inquiries visit www.topnotchboardprep.com.ph or
https://www.facebook.com/topnotchmedicalboardprep/