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Psychiatry Week 1 2018/19 > 9: Management of opiate misuse > Flashcards

9: Management of opiate misuse Flashcards

1
Q

What is diamorphine also known as?

A

Heroin

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2
Q

How does heroin affect your mood initially?

A

Euphoria

Sedation

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3
Q

What properties of heroin make it highly addictive?

A

Short onset of action

Short half life (provokes cravings)

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4
Q

Which plant does opium come from?

A

Poppy

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5
Q

What are the two main constituents of opium?

A

Morphine

Codeine

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6
Q

How is morphine, from opium, changed into diamorphine?

A

Addition of 2 acetyl groups

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7
Q

What are the two most common routes of administration of heroin?

Why?

A

IV

INH

fastest absorption into bloodstream

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8
Q

IV and INH heroin bypass ___ ___ ___.

A

first pass metabolism

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9
Q

What is diamorphine metabolised into?

A

Morphine

which is the active metabolite

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10
Q

What is the most common opioid receptor?

A

Mu receptor

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11
Q

Heroin and codeine are both broken down into morphine.

How do you tell what a patient has used in a drug screen?

A

Heroin has a unique intermediate which sticks around for 6h

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12
Q

What are the

a) desired
b) side effects

of heroin?

A

a) Euphoria, analgesia

b) Constipation, N&V, sedation, respiratory depression, hypotension and bradycardia

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13
Q

What is a sign, seen in the eyes, that someone has used an opioid?

A

Pupillary constriction

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14
Q

What process occurs with repeated use of opioids?

A

Tolerance

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15
Q

Patients using opioids may report that their teeth are rotting.

What causes this?

A

Analgesia - patient unaware of dental problems e.g abscess

Vomiting - breakdown by stomach acid

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16
Q

What are some symptoms of opioid withdrawal?

A

Opioid cravings

GI symptoms - N&V, diarrhoea

Cardio symptoms - tachycardia, hypertension

Joint pain

Rhinorrhoea

Watery eyes

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17
Q

In patients tolerant to opioids, how long without the drug does it take for withdrawal to start?

A

6 - 8 hours

18
Q

Opioid withdrawal effects overlap with ___ symptoms.

Why?

A

sympathetic

locus caeruleus releases loads of NA

19
Q

___ is a common complication of IV heroin use.

A

Infection

local, distant (e.g infective endocarditis) or systemic

20
Q

As IV heroin use requires vascular access and damage to the endothelium, what vascular complication can occur?

A

Thrombosis

Embolism

21
Q

What is naloxone?

A

Opioid receptor antagonist

used to reverse opioid overdose

22
Q

What state does opioid overdose mimic?

23
Q

Which atypical analgesics have a street value and are often used at the same time as opioids?

A

Gabapentin

Pregabalin

24
Q

Which commonly prescribed sedative drugs can be abused alongside opioids?

A

Benzodiazepines e.g lorazepam

25
Q

Which psychiatric disorders are you more at risk of when using heroin?

A

Anxiety

Depression

26
Q

Does opioid withdrawal cause psychosis or delirium?

A

NO

trainspotting isn’t accurate

27
Q

What is opiate substitution therapy?

A

Substitution of a SHORT-ACTING opioid with a LONG-ACTING one

28
Q

What are long-acting opioids used in substitution therapy?

A

Buprenorphine

Methadone

29
Q

How is opiate substitution therapy carried out?

A

Administration of ORAL buprenorphine or methadone

Once daily

Under direct supervision

30
Q

Opiate substitution therapy removes the risks of ___ administration.

A

IV administration

infection, embolism

31
Q

Opiate substitution therapy allows users to live a more ___ life.

A

normal

family, employment, criminal activity

32
Q

Initially, patients on opiate substitution therapy have to visit the chemist how often?

A

Every day

Eventually relaxed if they’re complying with treatment

33
Q

Why is methadone only prescribed as a liquid?

A

Tablets can be hidden and sold on

34
Q

What are the two opioids prescribed as part of opiate substitution therapy?

A

Methadone

Buprenorphine

35
Q

What is the more ambitious therapy for opioid addiction?

36
Q

What does opioid detox involve?

A

Gradually tapering opioid dose until patient is drug free

37
Q

Opioid detox therapy hugely increases a patient’s risk of ___ in the next year.

38
Q

Patients who successfully complete opioid detox are only ___ detoxified.

A

physically

they are still psychologically dependent and therefore at huge risk of relapse > overdose

39
Q

Patients who complete opioid detox are most likely to die due to overdose.

Why?

A

Physical dependence gone but psychological dependence remains

Patient then takes the huge dose they took before

And dies from overdose

40
Q

What management allows patient who would otherwise abuse heroin to be monitored safely?

A

Prescription of heroin and supervised use of it

Psychiatry Week 1 2018/19 (9 decks)

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