Chapter 35: Substance Use Disorders IV Flashcards
major drugs of abuse
Opioids
Psychostimulants
Depressants
Psychedelics
Dissociative drugs
Anabolic steroids
Miscellaneous drugs of abuse
Marijuana
d-Lysergic acid diethylamide (LSD)
Heroin, Oxycodone, and
Other Opioids
Major drugs of abuse: Heroin, oxycodone, meperidine
Most opioids are Schedule II need DEA to scribe
In Ohio need OAARS
heroin pattern of abuse
Greatest use among 18- to 25-year-olds
All segments of society
First exposure usually social or for pain management
subjective and behavioral effects of heroin
Moments after IV injection: Sensations of pleasure, relaxation, warmth, and thirst
Followed by euphoria
Initial use causes nausea and vomiting
Initially may also cause an overall sense of dysphoria
heroin preferred drugs and routes of admin
Opioid of choice for street use
High lipid solubility
IV route preferred, but also smoking, nasal inhalation
oxy
Opioid similar to morphine
Intended as controlled-release drug [OxyContin]
Abusers crush tablet
Snort powder or dissolve in water for IV
Entire dose absorbed immediately with high risk of death
Meperidine
Nurses and health care providers who abuse opioids often select meperidine
Highly effective in oral route (unlike injections, leaves no sign)
Minimal effect on smooth muscle: Fewer problems with constipation and urinary retention
opioid tolerance
develops for resp depression, euphoria, nausea
does not develop for meiosis and constipation
cross tolerance to other opioids -not to CNS depressants
opioid physical dependence
Long-term use
Abstinence syndrome
Acute phase (10 days) and second phase (months)
opioid acute toxicity
Triad of symptoms
Respiratory depression
Coma
Pinpoint pupils
Treatment
Naloxone [Narcan]: Careful titration
Opioid Detoxification: Clonidine-assisted withdrawal
Centrally acting alpha2-adrenergic agonist
Most effective against symptoms related to autonomic hyperactivity (nausea, vomiting, diarrhea)
Provides modest relief from muscle aches, restlessness, anxiety, and insomnia
Does not diminish opioid craving
opioid detox withdrawa;
Rapid withdrawal
Ultrarapid withdrawal
Administration of naloxone or naltrexone: Immediate withdrawal
Withdrawal process accelerated
Ultrarapid procedure: General anesthesia or heavy sedation with IV midazolam [Versed]
In both procedures, clonidine may be added to ease symptoms
No more effective than standard withdrawal techniques
Considerably more expensive
opioid detox sub
Methadone substitution
Long-acting oral opioid
Most commonly used agent
Approximately 10 days
Buprenorphine -suboxone
Substituted for opioid the addict is physically dependent on
Prevents symptoms of withdrawal
Drugs for Long-Term Opioid Addiction Management
Three groups of medications
Opioid agonists, opioid agonist-antagonists, and opioid antagonists
Methadone
Maintenance and suppressive therapy
Buprenorphine
Maintenance therapy and detox facilitation
Naltrexone
Discourages renewed opioid abuse
Sequelae of Compulsive
Opioid Use
Few direct detrimental effects
Individuals on methadone maintenance can be successful socially and at work
Indirect hazards: Septicemia, cellulitis, abscesses, endocarditis, tuberculosis, hepatitis C, HIV, and foreign body emboli
Accidental overdose
general CNS depressants
Barbiturates, benzodiazepines, alcohol, and other agents
Benzodiazepines have unique properties
Barbiturates
Depressant effects are dose dependent
Mild sedation to sleep to coma and death
Subjective effects similar to those of alcohol
Agents with short to intermediate duration of action have highest abuse incidence and are Schedule II
Amobarbital, pentobarbital, and secobarbital
Tolerance
Physical dependence
Withdrawal
Acute toxicity
Maintain respiration and remove drug
Naloxone: Reverses opioid poisoning but is not effective against barbiturate poisoning
Benzodiazepines
Benzodiazepines (Schedule IV)
Much safer than barbiturates
Overdose rare when taken alone and orally
Risk increased with IV or with other depressants
Tolerance
Physical dependence and withdrawal techniques
Acute toxicity
Flumazenil [Romazicon] -reversal
Psychostimulants
CNS stimulants (Schedule II) with a high potential for abuse
Methamphetamines
Cocaine
Can stimulate the heart, blood vessels, and other structures under sympathetic control
Cocaine
Extracted from leaves of coca plant
CNS effect similar to that of amphetamines
Two forms used by abusers:
Cocaine
“Crack”
Can produce local anesthesia, vasoconstriction, and cardiac stimulation
Tolerance, dependency, and withdrawal
Treatment of cocaine addition
Anticocaine vaccine
Disulfiram [Antabuse]
coke acute tox
Mild overdose: Agitation, dizziness, tremor, blurred vision
Severe overdose: Hyperpyrexia, convulsions, ventricular dysrhythmias, hemorrhagic stroke, angina pectoris, myocardial infarction
Treatment: Intravenous diazepam or lorazepam, nitroprusside, hypertonic sodium bicarbonate, aspirin, external cooling
coke chronic tox
Intranasally: Atrophy of the nasal mucosa and loss of sense of smell
Extreme cases: Necrosis and perforation of the nasal septum
Injury to the lungs can occur from smoking cocaine base
Use during pregnancy
coke admin
Cocaine hydrochloride
White powder
Diluted for sale
Taken intranasally
Cocaine base: Commonly called “crack”
Heated for use
Taken by IV injection
Methamphetamines
In abuse, usually taken orally, snorted, smoked, or IV
Also called “ice” or “crystal meth”
Form of dextroamphetamine
Smoked, snorted, or inserted into rectum
Effects
Arousal, euphoria, sense of increased physical strength and mental capacity
Hallucinations, psychotic state, sympathomimetic actions
meth adverse CV effects
Hypertension
Angina pectoris
Dysrhythmias
Cerebral and systemic vasculitis and renal failure, stroke
Vasoconstriction can be relieved with an alpha-adrenergic blocker (e.g., phentolamine)
Cardiac stimulation can be reduced with a mixed alpha and beta blocker (e.g., labetalol)
other meth effects
Significant weight loss
Fetal effects
“Meth mouth”
meth Tolerance, dependency, and withdrawal
Treatment: Cognitive behavioral therapy, matrix model, bupropion [Wellbutrin, Zyban], modafinil [Provigil, Alertec], and Ibudilast
Marijuana
Cannabis sativa (hemp)
Marijuana and hashish are derivatives
Common names: “Grass,” “weed,” “pot”
Most commonly used illicit drug in the United States, although it is now legal in some states
Marijuana
Psychoactive substance
Delta-9-tetrahydrocannabinol (THC)
Routes
Smoking -60% of THC content is absorbed; effects begin in minutes and peak within 20 to 30 minutes
Oral -Most of THC is inactivated by first-pass effect
Effects
Low to moderate dose
High dose
Long-term use
Schizophrenia
Cardiovascular
Dose-related increase in heart rate
Respiratory
Acute: Bronchodilation
Chronic: Airway constriction
Reproduction
Males and females affected
Altered brain structure
Hippocampal volume left hemisphere
Tolerance and dependence
Therapeutic Use of Marijuana
Approved uses for cannabinoids
Unapproved uses for cannabinoids
Medical research on marijuana
Legal status of medical marijuana
Synthetic marijuana
Comparison of marijuana with alcohol
Aggressive behavior is rare with marijuana use
Less loss of judgment with marijuana
Increased appetite with marijuana: Fewer problems with nutritional deficiencies
Marijuana produces increased toxic psychosis, dissociative phenomena, and paranoia, more so than alcohol does
Psychedelics lsd
d-Lysergic acid diethylamide (LSD)
Acts on the brain’s serotonin receptors
Routes: Oral, IV, smoked
Alters the following (as otherwise occurs only in dreams):
Thinking
Feelings
Perception
Relationship to environment
other psychedelics
Salvia: Causes dream-like state of unreality
Mescaline
From peyote cactus
Psilocybin
Psilocin
Dimethyltryptamine
Dissociative Drugs pcp
Original use: Surgical anesthetics
Recreational use: Distort sight and sound and produce dissociation
Act in the cerebral cortex and limbic system
PCP easily synthesized/manufactured by amateurs
Routes: Oral, intranasal, IV, smoking
Effects
Low to moderate doses, high doses
Toxicity
ketamine
Similar to PCP in structure, mechanism, and effects
Shorter duration of effects
Dextromethorphan
Over-the-counter (OTC) cough suppressant
Low dose for antitussive: No psychologic effects
Doses 5 to 10 times higher: Produces euphoria, disorientation, paranoia, altered sense of time, and hallucinations
Also used in combination cold products
Highly abused by adolescents and teenagers
3,4-Methylenedioxymethamphetamine
Common names: MDMA, ecstasy
Complex drug with stimulant and psychedelic properties
Structurally related to methamphetamine (stimulant) and mescaline (hallucinogen)
Low doses: Mild LSD-like psychologic effects
Higher doses: Amphetamine-like effects
Promotes release of neurotransmitters
Usually taken orally; also snorted, injected, or taken by rectal suppository
Adverse effects
Can injure serotonergic neurons, stimulate the heart, and dangerously raise body temperature
Neurologic effects
Seizures, spasmodic jerking, jaw clenching, teeth grinding
Confusion, anxiety, paranoia, panic
Inhalants
Term can refer to many drugs; common characteristic is administration by inhalation
Anesthetics
Volatile nitrites
Organic solvents
Anabolic Steroids
Androgens
Taken to enhance athletic performance
Increase muscle mass and strength
Massive doses often used have high risk for adverse effects
Most are classified as Schedule III drugs
