AGENDA For 09/23/19 Current News in the drug world Discussion questions from Chapter 3 Chapter Five 1st Quiz this Wednesday, review chapters 1-3 11 questions, bring small scan tron

Current News http://pe.ca.newsmemory.com/?publink=09012daad https://www.cnn.com/2019/09/25/europe/austrian-couple-ecstasy-pills-scli-intl/index.html

What causes a person to stop breathing? What causes a person to stop breathing or become unresponsive when using opioids Receptors in the brain slow, stopping the body’s ability to breathe Treatment for opioids is NARCAN

Walgreens carry this product When buying naloxone, the price can vary greatly depending on your insurance plan and the type you want to buy. Generic naloxone can cost between $20 and $40 per dose, while Narcan can cost around $130 to $140 for a kit that includes two doses.

Discussion Questions Describe the FDA approval process for assessing the safety and efficacy of a newly described drug Advantages? Disadvantages? What are the principal advantages and disadvantages of switching products from prescription to OTC Status

Chapter 5 How and Why Drugs Work Instructor Ed Ramirez

Introduction A common belief is that drugs can solve most of life’s serious physical, emotional, and medical problems. Although medications are essential to treatment for many diseases, excessive reliance on drugs causes unrealistic expectation that may lead to dangerous– even fatal consequences. We’ve covered this so far in the semester, relaxing, escaping, etc.

Celebrities Just because they're legal doesn't mean that prescribed drugs are any less dangerous than illicit drugs. They are potentially deadly when taken in large doses or when combined with alcohol or other drugs. Sometimes it takes high-profile cases to remind us of the dangers. Methaqualone, AKA Quaaludes (sedative) Secobarbital, AKA Seconal (sleeping pill) Pentobarbital and chloral hydrate (sleeping pills) As many as 14 different drugs, including codeine (painkiller) and methaqualone, AKA Quaaludes (sedative) Propofol And now fentanyl

Some of the drugs used Elvis, On August 16, 1977, he suffered a heart attack in his Graceland estate, and died as a result. His death came in the wake of many years of prescription drug abuse. #42 Jimi Hendrix-the cause of death as: "Inhalation of vomit due to barbiturate intoxication ( he took nine sleeping pills) #27 Heath Ledger- (CNN) -- Heath Ledger died from an accidental overdose of prescription medications including painkillers, anti-anxiety drugs and sleeping pills, the New York City medical examiner's office said Wednesday. Actor Heath Ledger, 28, died January 22 at an apartment in Lower Manhattan. (Cardiac arrest) caused by drug use

Elvis’s death Though Elvis's actual cause of death appears to have been heart failure, the cardiac incident is now considered to be a result of the rock star's longstanding and serious drug abuse.

What Killed Michael Jackson? Propofol Propofol is a potentially deadly drug in the wrong hands, and there is no room for error. "It's only designed for people trained to do advanced cardiac life support," Dombrowski says. "It induces a deep level of sleep and sedation, and it can cause your blood pressure to go down and your breathing to stop. You can die https://www.google.com/search?q=propofol Propofol is the generic name for Diprivan, which is a prescription, injectable drug. It's an anesthetic used to put people to sleep before surgery. It's also given for sedationin hospital intensive care units

Now Used In Missouri Executions https://deathpenaltyinfo.org/lethal-injection-missouri-intends-use-propofol-one-drug-lethal-injection http://www.foxnews.com/health/2012/05/24/missouri-to-use-same-drug-involved-in-michael-jackson-death-for-executions.html

Intended and Unintended Effects of Drugs When physicians prescribe drugs, their objective is usually to cure or relieve symptoms of a disease. However, drugs cause unintended effects that neither the physician nor the patient expected: THESE ARE CALLED SIDE EFFECTS

Side effects- Unintended drug responses

Side effects

Common Side Effects of Drugs Nausea or vomiting Changes in mental alertness Dependence Withdrawal Allergic reactions Changes in cardiovascular activity

Opiate withdrawal Withdrawal “Side Effects” Unpleasant effects that occur when use of a drug is stopped Withdrawal “Side Effects”

Withdrawal

Common Side Effects of Drug Figure 5-1: Common side effects with drugs of abuse. Almost every organ or system in the body can be negatively affected by the substances of abuse.

Dose-Response Dose Tolerance Potency Many factors can affect the way an individual responds to a drug, including the following: Dose Tolerance Potency

Dose-Response (continued) Additional factors Pharmacokinetic properties: Defined below Rate of absorption Manner distributed throughout the body Rate metabolized and eliminated Form of the drug Manner in which the drug is administered -the branch of pharmacology concerned with the movement of drugs within the body

Dose-Response Curve Figure 5-2: Dose-response curve for relieving a headache with aspirin in three users. User A is the most sensitive and has 100% headache relief at a dose of 600 mg. User B is the next most sensitive and experiences 50% headache relief with a 600-mg dose. The least sensitive is user C: with a 600-mg dose, user C has no relief from a headache.

Margin of Safety The range in dose between the amount of drug necessary to cause a therapeutic effect and a toxic effect.

Potency vs. Toxicity Potency: The amount of drug necessary to cause an effect Toxicity: The capacity of a drug to do damage or cause adverse effects in the body

Drug Interaction A drug’s effect can be dramatically altered when other drugs are also present in the body This effect is known as DRUG INTERACTION

Drug Interaction

Grapefruit and certain medications

Drug Interaction Cont’d Additive effects Effects created when drugs are similar and actions are added together Antagonistic (inhibitory) effects One drug cancels or blocks effects of another Potentiative (synergistic) effects Effect of a drug is enhanced by another drug or substance

OTC and Herbal drugs ae as likely to cause interactions problems. Public must be educated about the interactions most likely to occur with drugs that are prescribed, self-administered legitimately. OTC and Herbal drugs ae as likely to cause interactions problems. Example- Decongestant contains mild CNS stimulants. If taken with Illegal drugs such as cocaine or amphetamines, can cause fatally affect in the heart and brain. Page 155

Figure 05.B01A © Monkey Business/Fotolia.com

Pharmacokinetic Factors How does the drug enter the body? (Administration) How does the drug move from the site of administration into body’s system (Absorption) How does the drug move to various areas (Distribution) How and where does the drug produce its effects (Activation) How is the drug inactivated, metabolized excreted from the body (Biotransformation and Elimination)

Pharmacokinetics Absorption Distribution Metabolism Excretion Pharmacokinetics-The study of factors that influence the distribution and concentration of drugs in the body Pathways Absorption Distribution Metabolism Excretion

Onset vary Figure 05.03: Relationship between the method of drug administration and drug effects.

Forms and Methods cont’d Oral Ingestion-one of the most common and convenient ways of taking a drug is orally The drug must enter the bloodstream after passing through the wall of the stomach or intestines without being destroyed or changed to an inactive form Materials in the stomach or intestines (food) may interfere The liver might metabolize orally ingested drugs to rapidly

Forms and Methods cont’d Inhalation-into the lungs through the mouth or nose Injection- into the Intravenous Intramuscular Subcutaneous, pronounced sub·cu·ta·ne·ous Topical Application

Adam Goldstein Better known as DJ AM Overdosed, August, 2009 CNS Depressants Six pills where found in his stomach. An OxyContin capsule was lodged in his throat.

Forms and Methods of Taking Drugs Half way Forms and Methods of Taking Drugs oral ingestion inhalation injection topical application Topical Application -made to be put on the skin topical lotions/creams a topical drug/treatment Half way Drugs can be introduced into the body using various methods, such as pills, capsules, oral liquids, topicals, or injections. © Oscar Knott/FogStock/Alamy Images

Topical application Drugs that readily pass though surface tissues such as the skin

Factors affecting Distribution Most drugs are distributed throughout the body in the blood. It takes approximately 1 minute for a drug to circulate throughout the body after it enters the bloodstream. Drugs have different patterns of distribution depending on their chemical properties. We have approximately 5 to 6 liters of blood

Factors affecting distribution Their ability to pass across membranes and through tissues Their molecular size (large versus small molecules) Their solubility properties Their tendency to attach to proteins and tissues throughout the body

Factors affecting distribution Cont’d Blood is carried to the nerve cells of the brain in a vast network of thin-walled capillaries. Drugs are soluble in fatty oily solutions are most likely to pass across these capillary membranes known as “the blood-brain barrier” THE BBB is defined as selective filtering between the cerebral blood vessels and the brain

The BBB

Opioid Epidemic 130 https://www.youtube.com/watch?v=s4LV0tBZncI https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis Every day, more than 115 Americans die after overdosing on opioids 130 Source: https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

Required Doses for Effects Threshold dose—the minimum amount of a drug necessary to have an effect Plateau effect—the maximum effect a drug can have regardless of the dose Example, aspirin, can effectively relieve your mild to moderate pain, but aspirin will not effectively treat your severe pains, regardless of the dose taken.

Time-Response Factors The closer a drug is placed to the target area, the faster the onset of action. Acute drug response: Immediate or short-term effects after a single drug dose Chronic drug response: Long-term effects after a single dose

Time-Response Factors Cont’d Important time factor that influences drug response is the interval between multiple administrations. If sufficient time for drug metabolism and elimination does not separate doses, a drug can accumulate within the body Cumulative effect—the buildup of drug concentration in the body due to multiple doses taken within short intervals

Inactivation and elimination of drugs from the body Half-life- Time required for the body to eliminate and/or metabolize half of a drug dose Metabolism- Chemical alteration of drugs by body processes Metabolites- Chemical products of metabolism Usually makes it possible for the body to inactivate, detoxify and excrete drugs and other chemicals. Exception: HEROIN becomes more active when it metabolizes.

Biotransformation Biotransformation—the process of changing the chemical or pharmacological properties of a drug by metabolism. The liver is the major organ that metabolizes drugs in the body. The kidney is the next most important organ for drug elimination.

Inactivation and elimination of drugs from the body Cont’d The body may eliminate small portions of drugs through perspiration and exhalation. Approximately 1% of consumed alcohol is eliminated in the breath and thus may be measured with a

Figure 05.B03: Family Matters: Genetics of Metabolic Enzymes and Alcoholism

Inactivation and elimination of drugs from the body Cont’d

Physiological Variables That Modify Drug Effects AGE Gender Pregnancy Changes in body size and makeup occur throughout the aging process Variations in drug responses due to gender usually relate to differences in body size, composition or hormones During pregnancy, unique factors must be considered when administering drugs.

Physiological Variables That Modify Drug Effects Cont’d The increase demand can make the woman more susceptible to the toxicity of some drugs As the fetus develops, it can be very vulnerable to drugs with Teratogenic- Something that causes physical defects in a fetus

Teratogenic Remember from chapter 3??

AGENDA FOR 09/25/19 Current News in America regarding drugs Question, why is there an opioid crisis in America. Why are more Americans using opioid type drugs? Quiz Finish up with Chapter 5

Adaptive Processes Figure 05.04: The relationship and consequences of adaptive processes to drug abuse. The processes discussed in the text are highlighted in the figure.

Adaptive Processes Your body systems are constantly changing Drugs sometimes interfere with the activity of the body’s systems and compromise their normal workings Stimulants can dangerously increase the heart rate, blood pressure and can cause heart attacks Depressants can diminish the brain activity, resulting in unconsciousness and loss of breathing reflexes

Figure 05.HN01A: Here and Now: Drug Test Results Can be Flawed THE POPPY SEEDS Figure 05.HN01A: Here and Now: Drug Test Results Can be Flawed Data from Fiore, K. “APA: Drug Test Results Often Flawed.” MedPage Today. 23 May 2010. Available http://www.medpagetoday.com/MeetingCoverage?APA/20253. Accessed March 2, 2011.

Figure 05.HN01B: Here and Now: Drug Test Results Can be Flawed

DRUG TESTING ? poppy seeds Research shows that morphine and codeine can sometimes be detected in the urine up to 48 hours after ingestion of poppy seeds from some pastries, such as bagels, muffins, and cakes (see reference one for a free article on this top While poppy seeds don’t actually contain morphine, the seeds can become coated by, or absorb, opium extract during harvesting. Opium is the milky substance that is extracted along with the poppy seeds from the seed pod of the opium poppy after all the petals have fallen off poppy seeds

Tolerance to drugs Reverse tolerance (sensitization): Enhanced response to a given drug dose; opposite of tolerance Cross-tolerance: Development of tolerance to one drug causes tolerance to related drugs

Drug Dependence Drug dependence can be associates with either physiological or psychological adaptations. Physical dependence reflects changes in the way organs and systems in the body respond to a drug, whereas psychological dependence is caused by changes in attitudes and expectations.

(e.g.,withdrawal and rebound) Drug Dependence Physical Dependence (e.g.,withdrawal and rebound) Psychological Dependence (e.g., craving)

Physical Dependence In general, the drugs that cause physical dependence also cause a drug withdrawal phenomenon called, “rebound effect” “This is a form of withdrawal; paradoxical effects that occur when a drug has been eliminated from the body” Physical dependence , drug withdrawal- two opposite things and that seems impossible but is actually true or possible

What does paradoxical effect mean? A paradoxical reaction or paradoxical effect is an effect of a chemical substance, mostly a medical drug, opposite to the effect which would normally be expected. An example of a paradoxical reaction is pain caused by a pain relief medication. Paradoxical reactions to benzodiazepines, characterized by increased talkativeness, emotional release, excitement, and excessive movement, are relatively uncommon and occur in less than 1% of patients. The exact mechanism of paradoxical reactions remains unclear. Benzodiazepines are a depressant drug, chapter 6

Physical Dependence Cont’d Cross Dependence- dependence on a drug can be relieved by other similar drugs Examples- Benzodiazepines and other CNS depressants can be used to treat the abstinence syndrome experienced by the chronic alcoholic Methadone, long acting narcotic, to treat heroin withdrawal

Psychological Factors Affecting Drug Effect Individual’s mental set The collection of psychological and environmental factors that influence an individual’s response to a drug Placebo effects A placebo is anything that seems to be a "real" medical treatment -- but isn't. It could be a pill, a shot, or some other type of "fake" treatment. What all placebos have in common is that they do not contain an active substance meant to affect health. SOURCE: https://www.webmd.com/pain-management/what-is-the-placebo-effect#1 Placebo- From the Latin word meaning, “I shall please.”

Addiction and Abuse The use of the term addiction is sometimes confusing. It is often used interchangeably with dependence, either physiological or psychological in nature; other times, it is used synonymously with the term drug abuse. A more accurate definition is the compulsive drug use despite negative consequences.

Addiction and Abuse (continued) Other factors contributing to drug use patterns Positive versus negative effects of drug (dysphoric is the opposite of euphoric) Peer pressure Home, school, work environment Mental state

Dysphoric Dysphoric is the opposite of euphoric Characterized by unpleasant mental effects Dysphoric is the opposite of euphoric Figure 5.4 again Slide 59 DYSPHORIA- dys·pho·ri·a a state of dissatisfaction, anxiety, restlessness, or fidgeting.

Questions