1				2		3												4
									5						6
			7
8
									9								10
											11			12				13
																				14
15				16												17
																		18						19
				20
21		22
								23
						24
										25												26
																27			28
				29
							30				31

Across 5. _______ stimulant ADRs are CV instability due to weakening of smooth muscle from chronic stimulation - increase risk of stroke and MI; alterations in CNS neuronal pathways - potential for sustained depression or psychosis long after stopping drugs; increased tolerance to drug - requires larger and larger doses of drugs, do NOT develop tolerance to adverse/toxic effects; respiratory probs from smoking drugs - COPD, emphysema, lung cancer; sinus problems in those who snort drugs; weight loss, malnutrition, vit deficiencies; abusers at higher risk for infectious diseases - HIV, hepatitis, bacteremia; legal, financial, and other social consequences 8. this NT plays a role in reward-reinforcement center; induces euphoria in this pathway; induces psychoses in other pathways 9. this CNS stimulant increases release from pre-synaptic vesicles; prevents reuptake of NTs epi, NE, DA; PREVENTS METABOLISM OF EPI, NE, DA IN THE SYNAPSE; have many different illicit forms that can be oral, IV, or smoked 16. use of this CNS stimulant is done by undiagnosed ADHD pts attempting to self-medicate; MORE PRONOUNCED EFFECTS ON DA than other NTs --> euphoria, less energy; kinetics depend on form used; tox and w/drawal not highly pronounced; effects similar to other CNS stimulants - CV and CNS complications; tx the same for other CNS stimulants 18. this CNS stimulant increases release from pre-synaptic vesicles; prevents the reuptake of neurochemicals Epi, NE, and DA --> energy and euphoria; local anesthetic due to vasoconstriction properties of cocaine and epi effects 21. cocaine _________ has been treated w/methylphenidate/amphetamine, topirimate, modafinil, naltrexone, SSRIs and baclofen, disulfiram and selegine 27. MDMA _______ toxicity can lead to serotonergic cell death which leads to depression, sleeping disturbances, flashbacks - due to long-lasting changes made to brain structure & fxn; decreased sexual capacity and drive; tooth and jaw damage; hepatic failure 29. MDMA __________ is due to its effects quickly wearing off and user psychologically seeks more drug to continue the high - not so much pharmacokinetic as dynamic as serotonin neurons are depleted and post-synaptic neurons begin to down-regulate; users ingest more drug w/little gained effect; may lead to unintentional overdose, as users get physical, not psychic, effects w/higher doses 30. _______ use of CNS stimulants are to induce euphoria or a "rush", increase engergy, stamina, alertness, wakefulness, alter perception of reality, prevent "crash" from previous stimulant use, common use at parties or "raves"

Down 1. cocaine and _______ are commonly used together to help attenuate the crash of cocaine and to help control overstimulation of cocaine; complex together to form cocaethylene 2. tx of amphetamine ________ is similar to cocaine toxicity since s/sx can be very similar; IV antipsychotics may help reverse some toxic effects - DA blockade offsets dopaminergic surge; acidification of urine may help increase CL of drug; D-methamphetamine can potentially cause even more psychosis than other forms 3. these NTs play a role in "fight or flight", energy and arousal; induces "rush" of drug and increases energy/excitation 4. ______ administration of stimulants has the lowest peak but a quick onset b/c it gets into lungs quickly 5. this complex of cocaine and alcohol increases the T1/2 of cocaine to approx. 2 hrs, still retains basic cocaine pcol, increases euphoria due to extended duration of effect; may be up to 6 times more toxic than cocaine alone - increased cardiotoxicity, may increase agitation and propensity to violence 6. common __ __ effects of stimulants include increased BP due to vasoconstriction (NE,epi); increased HR due to direct eip/NE stimulation; end result = weakened blood vessels and heart muscle 7. _____ administration of stimulants has the second highest peak since there are lots of capillary vessels in sinus passages 10. __ __ administration of stimulants has the highest and fastest peak 11. cocaine __________ typically begins 7-10 days after last use; common s/sx are: anhedonia, decreased motivation, unusual dreams, increased appetite, anergia, depression, insomnia, psychomotor agitation, CRAVINGS for re-use of cocaine; NO accepted tx for 12. __________ use of CNS stimulants include ADHD, narcolepsy, depression, weight loss, anesthetic (cocaine) 13. _________ NTs increase NT release from presynaptic cells, prevent breakdown of NTs, prevent reabsorbtion/reuptake of NTs, agonize/antagonize NT receptors, and enhance action of NTs at receptor 14. _____ cocaine is the freebase form of cocaine; allows for greater lipophilicity --> greater absorption and CNS penetration; even quicker onset of action; different chemical properties - lower melting point allows for easier smoking 15. cocaine toxicity tx involves BBs (propanolol prob best) for HTNsive crisis and tachycardia, benzodiazepines for anxiety and agitation, antipsychotics (haloperidol, olanzapine, etc.) for psychosis, and other supportive tx measures as needed 17. amphetamine __________ is generally psychological and not physical in nature; some of same therapies for cocaine might also work here 19. MDMA, also known as _______, has LESS epinephrine effects and more DA and 5HT effects - greatly increases 5HT release from pre-synaptic vesicles, produces more psychic effects (perceptual disturbances) than physical effects; commonly co-ingested w/other substances like opiates or GHB, NO, LSD, SSRIs; MORE CALMING, peacefullness, happiness, sensory disturbance; causes muscle spasm/tightness, esp. in jaw, shoulders, and upper body 20. amphetamine __________ is not as pronounced, may have some depressive sxs, no known txs, return to normal after week or so off drug 22. this NT plays a role in sleep regulation and mood; plays small role in euphoria of drugs 23. this term is a mixture of cocaine (or other stimulants) with a CNS depressant - heroin/opiates, benzodiazepine, alcohol, others; helps attenuate over-stimulation of cocaine - controls the high and keeps edge off, also helps to sleep when desired; can have toxicity of BOTH drugs combined - depressant AND stimulant toxicities simutaneously, resp. depression w/increased BP, HR, arrythmias, etc. 24. _____ stimulant toxicity may be due to overdose or "regular" use of more potent form, esp. in naiive person; dosen't lead to any real medical emergency but pt feels as if they are dying; toxicity from overstimulation of CNS and CV systems - seizures, HTNsive crisis, tachycardia, stroke, cariac and/or respiratory arrest; concurrent CNS depressant use can complicate even further; time to onset of toxicity depends on several factors: agent used, how used, co-ingestants, personal factors, etc. 25. ____ administration of stimulants takes the longest to feel the effect; has about same peak as nasal 26. MDMA _____ toxicity leads to dehydration or water intoxication - depends on if fluids available or not, can lead to serious electrolyte disturbances; malignant hyperthermia due to constant muscle tightness/spasm, unchecked can cause rhabdomyolysis and renal failure; CV disturbances - arrythmias, CV failure; seizures, strokes, coma - acute anxiety rxns; supportive tx for these various probs: fluid replacement, ice/alcohol bath, decrease BP & HR 28. _____ common stimulant effects are weight loss due to appetite suppression, intial incrase in sexual potency and drive, long-term use leads to decrease, physical and psychological dependence w/continued use 31. common __ __ __ stimulant effects are increased energy, concentration (NE,epi); euphoria, "high", "rush" (DA); restlessness, talkativeness, irritability, insomnia (5HT); paranoia, agitation, aggression, psychosis (excess DA)