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CME / CE

The Basis of Cannabinoid Therapeutics: What You Need to Know

  • Authors: Ethan Russo, MD; Barry Gidal, PharmD
  • CME / CE Released: 10/31/2017; Reviewed and Renewed: 10/31/2018
  • THIS ACTIVITY HAS EXPIRED FOR CREDIT
  • Valid for credit through: 10/31/2019, 11:59 PM EST
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Target Audience and Goal Statement

This activity is intended for neurologists, pharmacists, pediatricians, and primary care physicians.

The goal of this activity is to provide background on the endocannabinoid system and its potential role in investigational therapies.

Upon completion of this activity, participants will have increased knowledge regarding the:

  • Physiologic functions of endogenous cannabinoids
  • Function of exogenous cannabinoid compounds
  • Potential receptor targets of cannabinoid ligands
  • Outcomes of cannabinoids in experimental models of epilepsy


Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Authors

  • Ethan B. Russo, MD

    Medical Director, PHYTECS, Los Angeles, California

    Disclosures

    Disclosure: Ethan B. Russo, MD, has disclosed the following relevant financial relationships:
    Employed by a commercial interest: PHYTECS

    Dr Russo does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

    Dr Russo does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

  • Barry E. Gidal, PharmD

    Professor of Pharmacy & Neurology, University of Wisconsin School of Pharmacy, Madison, Wisconsin

    Disclosures

    Disclosure: Barry E. Gidal, PharmD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Eisai Inc.; Greenwich Biosciences, Inc.; Sunovion Pharmaceuticals Inc.; UCB Pharma, Inc.; Upsher-Smith Laboratories, Inc.
    Served as a speaker or a member of a speakers bureau for: Eisai Inc.; Lundbeck, Inc.; Sunovion Pharmaceuticals Inc.; UCB Pharma, Inc.; Upsher-Smith Laboratories, Inc.

    Dr Gidal does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

    Dr Gidal does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editors

  • Catherine Friederich Murray, BS

    Associate Scientific Director, Medscape, LLC

    Disclosures

    Disclosure: Catherine Friederich Murray, BS, has disclosed no relevant financial relationships.

  • Hilary North Scheler, PhD

    Freelance writer

    Disclosures

    Disclosure: Hilary North Scheler, PhD, has disclosed no relevant financial relationships.

CME Reviewer

  • Nafeez Zawahir, MD

    CME Clinical Director, Medscape, LLC

    Disclosures

    Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.


Accreditation Statements

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Interprofessional Continuing Education

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    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Medscape, LLC staff have disclosed that they have no relevant financial relationships.

    Contact This Provider

    For Pharmacists

  • Medscape, LLC designates this continuing education activity for 1.0 contact hour(s) (0.10 CEUs) (Universal Activity Number JA0007105-0000-18-296-H01-P).

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

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CME / CE

The Basis of Cannabinoid Therapeutics: What You Need to Know

Authors: Ethan Russo, MD; Barry Gidal, PharmDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / CE Released: 10/31/2017; Reviewed and Renewed: 10/31/2018

Valid for credit through: 10/31/2019, 11:59 PM EST

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Editor's Note: In June 2018, the United States Food and Drug Administration approved Epidiolex(R) (cannabidiol [CBD]) oral solution for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, in patients two years of age and older. The Department of Justice and Drug Enforcement Administration subsequently placed Epidiolex in schedule V of the Controlled Substances Act, the least restrictive schedule of the Controlled Substances Act.

Introduction

Discovered after centuries of cannabis plant use by humans for spiritual, medicinal, and recreational purposes, the ECS has in recent decades been revealed to be an integral component of normal physiology. A major contributor to the maintenance of homeostatic balance, the ECS influences nearly every organ and function in the body. This review will include the function of the ECS, its main endogenous components, the exogenous compounds that interact with it, and the current state of research into therapeutic potential of this system, particularly for the treatment of epilepsy.

The ECS

History of the ECS

Though phytocannabinoids (plant-based cannabinoids) have been in use for millennia, identification of the molecules and signaling pathways underlying their efficacy did not progress until the discovery of the main psychoactive compound in Cannabis sativa, ?9-tetrahydrocannabinol (THC).[1] Thereafter, dozens of additional plant-based cannabinoid compounds were identified, their unique chemical structures defined, and their myriad pharmacological profiles described. Later, evidence that ?9-THC was interacting with a particular mammalian target was uncovered in murine neuroblastoma cells, which expressed upregulated adenylate cyclase in response to exposure to the compound or its synthetic analogues. This finding led the way for the isolation and cloning of a G protein-coupled receptor (GPCR) that was subsequently named the cannabinoid receptor type 1 (CB1).[2] A few years after this, the counterpart to CB1, cannabinoid receptor type 2 (CB2), was isolated from human leukemia cells.[3]

The identification of these receptors led to the hypothesis that endogenous ligands may also exist. Indeed, the first such endogenous cannabinoid receptor ligand, or endocannabinoid, was isolated from pig brain and named N-arachidonoylethanolamine (AEA), or anandamide.[4] A second ligand, 2-arachidonoylglycerol (2-AG), was next isolated from canine gut tissue.[5] Of note, these GPCR ligands are lipids, as opposed to the large number of GPCR ligands that are instead protein.[6] In the years since these compounds were identified, the molecules comprising the ECS have expanded to include additional receptors that bind cannabinoids, as well as a number of enzymes that facilitate their synthesis and degradation. Furthermore, the body of research into the system's function has uncovered numerous roles for the ECS in normal mammalian physiology, as well as therapeutic possibilities for multiple diseases and disorders (Figure 1).[1]

Figure 1. The Endocannabinoid System Is Involved in a Variety of Functions[7]

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