Drugs Classification

Drugs Classification

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

Psychoactive/Psychotropic DrugsAction on Central Nervous System (CNS)

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

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

Psychoactive DrugsClassification

Depressants Stimulants Narcotics Hallucinogens

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

CNS Depressants Sedative

Barbiturates Benzodiazepines Solvents-sedatives Herbal sedatives Nonbenzodiazepine Uncategorized sedative-hypnotics

Narcotics (opiate derivatives) Antihistamines (diphenhydramine)

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.

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.

CNS DepressantsBarbiturates

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

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.

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)

CNS DepressantsSolvents-Sedatives

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

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.

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)

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.

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

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)

Clinical use of Narcotics(opioids)

Cough (codeine and hydrocodone)

Diarrhea (opium)

Anxiety due to shortness of breath (oxymorphone)

Detoxification (methadone and buprenorphine )

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

Examples of NarcoticsOpiumCodeineMorphineHeroinMethadoneOxycodoneDemerolDilaudidPercodanLomotil

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

Common Stimulants Amphetamines Methylphenidate Methamphetamine Methcathinone Cocaine Ecstasy

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

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)

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"

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

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

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

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

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 5–10 minutes afterward

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

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

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

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

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

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)

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

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: Δ9-tetrahydrocannabinol (THC)

PsychedelicAny 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

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)

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.

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

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

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