Drug Misuse Flashcards
Drug categs
Opiates eg heroin, codeine, morphine, methadone, buprenorphine, pethidine.
Depressants eg BDZ, barbit, alc, GHB (gamma hydroxybuturate).
Stims eg amphet, cocaine, MDMA (ecstasy).
Hallucinogens eg LSD (lysergic acid diethylamide), PCP (phenylcyclidine), mushrooms, ketamine.
Other eg cannabis, volatiles, steroids.
Mx
Emergency psychosis or dep tx of req.
return to dep use if px in uncomplic withdrawal and no prev tx.
Counselling and supp grps.
Detox- supported w/o prescrip. supported with sym meds eg lofexidine, loperamide, metaclopramine, ibuprofen for opiate withdrawal.
Convert to substit drug with aim of detox.
-substit for opiate-
Methadone long acting synthetic. Sats opiate Rs minims reward.
Buprenorphine partial agon. Less euphoria.
Dihydrocodeine short acting. Unlicensed.
-opiate maint-
Dose reduc, symp mx, opiate rel preven eg naltrexone antag. Aid
abstin.
-buprenorphine only once already in opiate withdrawal.
-substit for BDZ-
Use logn acting diazepam.
Common dangers
Cocaine- incr HR and SV but incr periph resis so haemorr stroke and MI.
Heroin- resp dep. give naloxone. Esp if alc or BDZ already reducing RR.
Withdrawal
-opiate-
Grade 0- craving, anx, drug seeking.
Grade 1- yawn, sweat, runny nose and eyes, restless sleep.
Grade 2- dilat pupil, gooseflesh, musc twitch, hot and cold flush, shivers, aching, loss appet, irrit.
Grade 3- insom, low fever, incr HR/RR/BP, restless, cramps, NV, diarr, weak, wl.
Investig
Hx- what drug, how long, how much, money, how often, withdrawal. Prev tx, complics, OD, blood tests, vaccs.
Mx
-prescribe/substit-
Make sure are dependant by hx, 2 urine tests, physic exam.
For opiates- methadone synthetic opiate long t1/2 IV, buprenorphine part agon for low lev heroin use only.
For alc- BDZ, chlordiazepoxide, diazepam, detox only.
For BDZ- diazepam long t1/2, less dependancy.
-relapse preven-
For opiates- naltrexone opiate blocker for 6 mnth.
For alc- disulfiram, acamprosate.
