Drugs Classification

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Drugs Classification
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Drugs Administration and Absorption

• Ingestion
• Dissolve in the stomach absorbed by intestine
• Absorbed thought stomach walls (e.g., alcohol)
• Absorption will depend on various factors
• amount and type of food
• Injection
• Strong, fast, predictable
• Subcutaneous, intramuscular, intravenous
• Inhalation
• Difficult to regulate doses
• Insufflation (snore)
• Absorption through mucous membrane of
• nose, mouth, rectum, vagina

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Psychoactive/Psychotropic DrugsAction on
Central Nervous System (CNS)

• Analgesics
• Anesthetics
• Anxiolytics (anti-anxiety agents)
• Antidepressants
• Antipsychotics
• Anticonvulsants
• Mood stabilizers
• Stimulants
• Depressants
• Hallucinogens

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Psychoactive Substances Usage

• Analgesics (painkillers)
• used to relive pain without producing anesthesia
  or loss of consciousness
• Psychiatric medications
• use in the treatment of psychiatric conditions
• anxiolytics, antidepressants, antipsychotics,
  anticonvulsants, and mood stabilizers
• Recreational drugs
• used/abused for their mood and perception
  altering effects, including those with accepted
  uses in medicine and psychiatry
• frequently used include narcotics, stimulants,
  depressants, hallucinogens
• Entheogens
• used for ritual and spiritual practice, such as
  the mescaline-containing peyote cactus or
  psilocybin-containing mushrooms

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Psychoactive DrugsClassification

• Depressants
• Stimulants
• Narcotics
• Hallucinogens

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CNS Depressants

• Slows down the central nervous system
• Provide feeling of relaxation
• Reduced inhibitions
• Impair reflexes
• Impair coordination
• Reduce reaction time
• Slurring speech, stumbling walk, and loss of
  balance
• Hand-eye coordination is reduced
• Thought and judgment impaired

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CNS Depressants

• Sedative
• Barbiturates
• Benzodiazepines
• Solvents-sedatives
• Herbal sedatives
• Nonbenzodiazepine
• Uncategorized sedative-hypnotics
• Narcotics (opiate derivatives)
• Antihistamines (diphenhydramine)

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CNS DepresantsSedatives

• Also known as sedative-hypnotic
• Produces feelings of calmness, relaxation,
  sleepiness, slowed breathing, reduction of
  anxiety, and at higher doses slurred speech,
  staggering gait, poor judgment, and slowcertain
  reflexes.
• Whenused to induce sleep tend to be higher doses
  than those used to relieve anxiety.
• May be referred to as tranquilizers, depressants,
  anxiolytics, soporifics, and sleeping pills.
• Can be abused to produce an overly-calming effect
  (alcohol being the most common sedating drug).
• At high doses many of these drugs can cause
  unconsciousness and even death.

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CNS DepressantsBarbiturates

• Effect range mild sedation to anesthesia.
• Effective as anxiolytics, hypnotics and as
  anticonvulsants.
• Widely used in surgical anesthesia.
• Have addiction potential, both physical and
  psychological.
• Dangerous in overdose.
• Used for physician-assisted suicide (PAS), and in
  combination with a muscle relaxant for capital
  punishment by lethal injection.
• Thiopental is an ultra-short acting barbiturate
  that is marketed under the name Sodium Pentothal
  is sometimes used as a "truth serum". When
  dissolved in water, it can be swallowed or
  administered by intravenous injection. The drug
  does not itself force people to tell the truth,
  but is thought to decrease inhibitions, making
  subjects more likely to be caught off guard when
  questioned.

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CNS DepressantsBarbiturates

• amobarbital (Amytal)
• pentobarbital (Nembutal)
• secobarbital (Seconal)
• Phenobarbitol (Luminal)

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CNS Depressants Benzodiazepines

• Minor tranquilizers with varying properties.
• Slow down the CNS.
• Useful in treating anxiety, insomnia, agitation,
  seizures, muscle spasms, and alcohol withdrawal.
• Also used before medical procedures such as
  endoscopies and dental work.
• Recreational stimulant users often use
  benzodiazepines as a means of "coming down"
• All have an addictive potential.

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CNS Depressants Benzodiazepines (minor
tranquilizers)

• alprazolam (Xanax)
• bromazepam (Lexotan)
• clonazepam (Klonopin)
• diazepam (Valium)
• estazolam (Prosom)
• flunitrazepam (Rohypnol)
• lorazepam (Ativan)
• midazolam (Versed)
• nitrazepam (Mogadon)
• oxazepam (Serax)
• triazolam (Halcion)
• temazepam (Restoril, Normison, Planum, Tenox, and
  Temaze)
• chlordiazepoxide (Librium)

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CNS DepressantsSolvents-Sedatives

• chloral hydrate (Noctec)
• diethyl ether (Ether)
• ethyl alcohol (alcoholic beverage)
• methyl trichloride (Chloroform)

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CNS DepressantsAlcohol

• Among the most abused drugs in our society.
• Can be as potent as many other illegal drugs.
• Can cause severe damage to a developing fetus.
• Reduces sensitivity to pain.
• Long-term effect can produce damage to liver,
  heart and pancreas.
• Linked to gastro intestinal problems,
  malnutrition, high blood pressure, and lower
  resistance to disease.
• Also linked to several types of cancer including
  esophagus, stomach, liver, pancreas and colon.
• People often do not realize that they are
  becoming dependent on alcohol.

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Other CNS Depressants

• Herbal sedatives
• kava
• valerian
• Nonbenzodiazepine sedatives
• eszopiclone (Lunesta)
• zaleplon (Sonata)
• zolpidem (Ambien)
• zopiclone (Imovane, Zimovane)
• Uncategorized sedative-hypnotics
• ethchlorvynol (Placidyl)
• glutethimide (Doriden)
• ketamine (Ketalar, Ketaset)
• methaqualone (Sopor, Quaalude)
• methyprylon (Noludar)
• ramelteon (Rozerem)

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Narcotics

• Refers to opium, opium derivatives, and their
  semi-synthetic or fully synthetic substitutes.
• Most medical professionals prefer the more
  precise term opioid, which refers to natural,
  semi-synthetic and synthetic substances that
  behave pharmacologically like morphine, the
  primary active constituent of opium.
• Main use pain relief and cough suppressant.

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Four broad classes of Narcotics(opioids)

• Endogenous Opioids
• produced naturally in the body (endorphins)
• Opium Alkaloids
• morphine (the first alkaloid isolated from opium)
• codeine
• Semi-synthetic Opioids
• heroin and oxycodone
• Fully Synthetic Opioids
• methadone and pethidine

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Clinical use of Narcotics(opioids)

• Opioids have been used to treat acute pain
• such as post-operative pain
• Used in palliative care to alleviate
• severe, chronic, disabling pain of terminal
  conditions such as cancer
• In recent years there has been an increased use
  of opioids in
• management chronic pain (transdermal patches)

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Clinical use of Narcotics(opioids)

• Cough
• (codeine and hydrocodone)
• Diarrhea
• (opium)
• Anxiety due to shortness of breath (oxymorphone)
  
• Detoxification
• (methadone and buprenorphine )

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Narcotics Classification

• Opium alkaloids
• Phenanthrenes naturally occurring in opium
• Codeine
• Morphine
• Thebaine
• Oripavine
• Preparations of mixed opium alkaloids, including
  papaveretum, are still occasionally used.
• Semisynthetic derivatives
• Diacetylmorphine (heroin)
• Dihydrocodeine
• Hydrocodone
• Hydromorphone
• Nicomorphine
• Oxycodone
• Oxymorphone

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Examples of Narcotics

• Opium
• Codeine
• Morphine
• Heroin
• Methadone
• Oxycodone
• Demerol
• Dilaudid
• Percodan
• Lomotil

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CNS Stimulants

• Stimulate central nervous system (CNS)
• Increase alertness and wakefulness
• Some produce a sense of euphoria
• Can be used therapeutically
• Narcolepsy - to counteract abnormal states that
  diminish alertness or consciousness
• Used to boost endurance and productivity as well
  as to suppress appetite
• Significant mood-altering effects
• Controlled substances in many jurisdictions

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Common Stimulants

• Amphetamines
• Methylphenidate
• Methamphetamine
• Methcathinone
• Cocaine
• Ecstasy

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StimulantsAmphetamine

• Also known as amfetamine, and benzedrine
• brand name Adderall
• Prescription (Rx) stimulant used to treat
• ADHD
• Traumatic brain injury
• Narcolepsy
• Chronic fatigue syndrome
• Initially used to control appetite
• Also used illegally as
• a recreational club drug
• as a performance enhancer

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StimulantsMethylphenidate (MPH)

• Amphetamine-like Rx stimulant
• Used to treat
• ADHD
• Traumatic brain injury
• Narcolepsy
• Chronic fatigue syndrome
• Brand names include
• Ritalin (Ritalina, Rilatine)
• Attenta, Concerta
• Metadate, Methylin, Rubifen
• Focalin (dextro-methylphenidate)
• Daytrana (transdermal patch)

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StimulantsMethamphetamine

• Also known as Methyl amphetamine or
  desoxyephedrine
• Rx for ADHD or narcolepsy under the brand name
  Desoxyn
• Used illegally for recreational purposes
• crystal meth" refers to the crystalline
  (smokeable form)
• It is prone to abuse and addiction
• Rapidly enters the brain and triggers a cascading
  release of norepinephrine, dopamine and serotonin
• Users may become obsessed or perform repetitive
  tasks such as cleaning, hand-washing, or
  assembling and disassembling objects
• Withdrawal is characterized by excessive
  sleeping, eating and depression-like symptoms,
  often accompanied by anxiety
• Users often take benzodiazepines as a means of
  "coming down"

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StimulantsMethcathinone

• Potent CNS stimulant
• Controlled substance
• No clinical use at present
• Used as antidepressant during 1930-40
• Snorted, smoked, injected, or ingested
• Chronic abuse may result in acute mental
  confusion ranging from mild paranoia to psychosis

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StimulantsCocaine

• Stimulant of CNS
• Appetite suppressant
• Produce euphoric feelings
• Increased energy
• Most often used recreationally
• Used in medicine as a topical anesthetic
• eye, nose and throat surgeries

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History of Cocaine

• In 1879 cocaine was used to treat morphine
  addiction
• In 1884 cocaine is introduced as a local
  anesthetic
• In 1885 Parke-Davis sold cocaine in various
  forms, including cigarettes, powder, and as a
  mixture that could be injected
• Park-Davis promised that cocaine products would
• supply the place of food, make the coward
  brave, the silent eloquent and render the
  sufferer insensitive to pain
• In 1886 Coca-Cola included cocaine in its formula
  
• In 1903 cocaine is eliminated from Coca-Cola
• In 1914 the Harrison Narcotics Tax Act outlawed
  use of cocaine
• This law incorrectly referred to cocaine as a
  narcotic
• Cocaine is a stimulant, not a narcotic

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Forms of cocaine

• Cocaine Sulfate
• Produced by macerating coca leaves with water
  that has been acidulated with sulfuric acid, or a
  solvent, like kerosene or benzene.
• Often accomplished by putting the ingredients
  into a vat and stamping on it, similar to the
  method for crushing grapes in wine production.
• When water is evaporated will yield a pasty mass
  
• Cocaine Sulfate is intermediate step to producing
  cocaine hydrochloride (salt form)
• It is commonly sold in South America as a pasty
  mass
• Also known as pasta, basuco, basa, pitillo, paco
• Smoked along with tobacco

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Freebase Cocaine

• Base form of cocaine
• Cocaine base is insoluble in water and is
  therefore not suitable for drinking, snorting or
  injecting
• Smoking freebase is preferred by many because
  cocaine is absorbed immediately into blood via
  the lungs, reaching the brain in about five
  seconds
• Rush is more intense than sniffing the same
  amount of cocaine nasally
• Peak of rush is over almost as soon as the user
  exhales
• High typically lasts 510 minutes afterward

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Crack Cocaine

• Another form, of freebase
• Often called "crack" or "rocks
• Created during early 1980s
• Popular because it is cheap
• Sodium bicarbonate (baking soda) is preferred in
  preparing the freebase
• Commonly "cooked" the ratio of 50/50 to 40/60
  cocaine/bicarbonate
• When the rock is heated, the water boils, making
  a crackling sound

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Chewed/eaten

• Coca leaves typically are mixed with an alkaline
  substance (such as lime) and chewed in the same
  way as chewing tobacco
• It is absorbed by the mucous membrane of the
  mouth and GI tract
• Coca leaves can be infused in liquid and consumed
  like tea
• Not readily absorbed when ingested alone
• Need to be mixed with a highly alkaline substance
  (such as lime) to be absorbed through the stomach

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Coca Leaf InfusionsCoca Tea

• Coca tea is used in coca-leaf producing countries
  much as any herbal medicinal tea.
• The free and legal commercialization of dried
  coca leaves to be used as "coca tea" has been
  actively promoted by the governments of Peru and
  Bolivia for many years as a drink having
  medicinal powers.
• Visitors to the city of Cuzco in Peru, and La Paz
  in Bolivia are greeted with the offering of coca
  leaf infusions (prepared in tea pots with whole
  coca leaves) purportedly to help the
  newly-arrived
• The effects of drinking coca tea are a mild
  stimulation and mood lift
• It does not produce any significant numbing of
  the mouth nor does it give a rush like snorting
  cocaine

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Insufflation snorting," sniffing," or
"blowing"

• Powder cocaine
• The most common method of ingestion
• Drug is absorbed through mucous membrane of
  sinuses
• Absorption is approximately 30-60
• Chronic use results in rhinitis and necrosis of
  the nasal membranes
• Damage the inside of the nose since cocaine
  constricts blood vessel
• Users report a burning sensation in the nostrils
  after cocaine's anesthetic effects wear off
• Rolled up banknotes, hollowed-out pens, cut
  straws, and specialized spoons are often used to
  insufflate cocaine

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Injected Cocaine

• The highest blood levels of drug in the shortest
  amount of time
• Upon injection, cocaine reaches the brain in a
  matter of seconds
• rush can be so intense that can induces
  uncontrollable vomit
• Euphoria passes quickly
• Aside from the toxic effects of cocaine, there is
  danger of
• circulatory emboli from the substances used to
  cut the drug
• risk of infection associated with use of
  contaminated needles
• Speedball
• Injected mixture of cocaine and heroin
• Dangerous combination, as drugs complement each
  other

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StimulantsEcstasy/MDMA

• Methylenedioxymethamphetamine
• Often known as E, X, or XTC
• Primary effect is inducing a general sense of
  openness, energy, euphoria, and well-being
• Tactile sensations are enhanced, making physical
  contact with others more pleasurable
• May produce aphrodisiac effects
• A patent for MDMA was granted in 1914 to the
  German pharmaceutical company Merck
• It was patented as an intermediate chemical used
  in the synthesis of a hydrastinine (a drug
  intended to control bleeding from wounds)

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Hallucinogens

• Can cause subjective changes in perception,
  thought, emotion and consciousness
• Induce experiences that are qualitatively
  different from those of ordinary consciousness
• Three broad categories
• Psychedelics
• Dissociatives
• Deliriants

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Hallucinogenous

• Cannabis sativa
• Herbal form of the drug consists of dried mature
  leaves of pistillate ("female") plants
• Hashish (resinous form)
• Carefully produced and screened hashish is up to
  three times as potent as the highest quality
  herbal varieties
• Active chemical compound in cannabis is
  ?9-tetrahydrocannabinol (THC)

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Psychedelic

• Any drug with perception-altering effects such as
  
• Lysergic acid diethylamide (LSD), semisynthetic
  drug
• synthesized from lysergic acid derived from
  ergot, a grain fungus that grows on rye
• Psilocybin (psilocybine)
• found in psilocybin mushroom
• Mescaline occurs naturally in the
• Peyote cactus, San Pedro cactus, Peruvian Torch
  cactus
• Ayahuasca preparations (use for religious
  purposes)
• Seeds of Morning Glory Hawaiian Baby Woodrose

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Dissociatives Drugs

• Reduce (or block) signals to the conscious mind
  from other parts of the brain, typically the
  physical senses
• Such a state of sensory deprivation can produce
  hallucinations, and dreamlike states of mind
• Some are
• PCP (angel dust)
• Ketamine (an anaesthetic)
• DXM (dextromethorphan) active ingredient in many
  cough syrups
• nitrous oxide (inhalant)
• salvia divinorum (plant)

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Deliriants

• Deliriants - effects similar to experience of
  delirious fevers
• Considered to be true hallucinogens as users will
  
• have conversations with people who aren't there
• become angry with a 'person' mimicking their
  actions, not realizing it is their own reflection
  in a mirror
• Included in this group are
• Plants such a
• deadly nightshade, mandrake, henbane and datura
• Pharmaceutical drugs when taken in very high
  doses
• antihistamine diphenhydramine (Benadryl)
• antiemetic dimenhydrinate (Dramamine or Gravol)
• Native Americans can consumed large amounts of
  tobacco during religious ceremonies to experience
  deliriant effects.
• Can be toxic, can cause death due to overdose.

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Metabolisms and Elimination

• Elimination of most drugs by
• enzymes synthesized by liver
• Some are deactivates by being passed in
• urine, sweat, feces, mother's milk

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Drug Tolerance

• Decreased sensitivity to a drug
• Same doses has less effect
• Need more drug to have same effect
• Cross tolerance
• Tolerance to the effect of one drug that develops
  as the result of exposure to another drug that
  act by same mechanism

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Drug ToleranceTwo type of changes

• Metabolic Tolerance
• results from a reduction in the amount of a drug
  getting to its sites of action
• Functional Tolerance
• results from a reduction in the reactivity of the
  nervous system (or other sites of action) to a
  drug
• Tolerance to psychoactive drugs mainly fuctional