Table 6: Marijuana-derived Pharmaceutical Products Generic Name Brand Name FDA Status
FDA-Approved or Under Review Indications Treatment and prevention of chemotherapy- induced nausea/ vomiting
Pharmacology
Nabilone
Cesamet (capsules)
FDA-approved controlled substance Schedule II
Derivative of cannabinol, a nonpsychoactive constituent of marijuana
Cannabidiol (CBD)
Epidolex (oral solution)
Descheduled by the DEA; no longer subject to the CSA
Treatment of Lennox- Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex cancer patients who experience inadequate analgesia during optimized chronic opioid therapy Clinical trials for pain treatment in
Plant-derived cannabidiol (CBD), accounting for 40% of cannabis extracts Combination of delta- 9-THC, the primary active compound, and cannabidiol, a nonpsychoactive component of marijuana
Cannabidiol (CBD) and delta-9- Tetrahydrocannabinol
Sativex (oro- mucosal spray)
Under investigation in the United States, Phase II/III trials
Case study 4 Mr. and Mrs. Jones bring in their teenage son for evaluation. His school performance has declined recently, and Mrs. Jones is concerned that he “vapes” and reports that he admitted occasionally using marijuana in the vape device. He states that he uses it to “relax” sometimes and that he would be doing worse without it. He states that it is legal, so that it must not be that bad. Questions 1. What information could you share with the Joneses and their son regarding the potential risks of marijuana in all its forms? _______________________________________________________________________________________________ 2. The Joneses have questions regarding the legality of the use of marijuana and ask whether a prescription for medical marijuana would be appropriate. Would it? _______________________________________________________________________________________________ OPIOIDS Both “opiate” and “opioid” have commonly been
negative impacts on society. OUD is a chronic, relapsing disease influenced by genetics, stress response, and prior experimentation or exposure. 63 Mu opioid receptors (MORs) modulate nociception, stress, temperature, respiration, endocrine activity, memory, mood, and motivation. MORs bind opioids and delta opioids, kappa opioids, and nociception receptors to increase drug tolerance. Physical dependence can develop between 2 and 10 days of continuous use with withdrawal symptoms occurring when stopped abruptly. 64 natural endorphins that are released within the body and therefore produce a physiological effect of decreased pain perception. Endogenous stimulation of opiate receptors occurs naturally within the body via release of endorphins in response to multiple stimuli including pain, stress, exercise, eating, and sex. 74 The physiology of opioid pathways is well, but
used interchangeably in the past, but current accepted practice is to specifically use the term “opioids” to refer to all natural, semisynthetic, and synthetic forms of this centuries-old agent of pain control. Fentanyl, the most prevalent synthetic opioid today, is included in this category along with naturally occurring opioid formulations such as heroin, morphine, and codeine. The popularity of this drug class stems from its powerful ability to control pain and induce euphoria. Opioid use disorder (OUD) has reached epidemic proportions with substantial Physiology Opioid receptor stimulation can be achieved from both exogenous and endogenous sources. Exogenous opioids like morphine, heroin, and fentanyl are substances that are introduced into the body and will bind to the same receptors as the endogenous opioids, commonly referred to as endorphins. These opioid medications closely mimic the structure of
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Book Code: MDCO1025
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