Drugs of Abuse - Heroin B

Question 1

PRESENTATION

Answer 1

• Usually occurs after dependence, no longer euphoric but now to avoid dependence symptoms
• Withdrawal symptoms
  
  • Sweating
  • Dilated pupils
  • Tachycardia
  • Hypertension
  • Piloerection
  • Watering eyes and nose
  • Abdominal cramps
  • Nausea and vomiting
  • Tremor
  • Joint pains and muscle cramps

Question 2

MANAGEMENT

General

Answer 2

• Harm reduction advice
• Specifying safe injecting advice
• Cnsider managed detox or transfer to maintenance prescribing in establish dependence

Question 3

INVESTIGATIONS

Answer 3

• Urine screening
• Blood testing
  
  • FBC, LFTs, HIV and hepatitis screening

Question 4

MANAGEMENT

Symptomatic medication

Answer 4

• Lofexidine
• Laperamide - diarrhoea
• Metaclopramide - nausea and vomiting
• Ibuprofen - headaches and muscle pains

Question 5

MANAGEMENT

Substitute prescribing

Answer 5

• Methadone
• Buprenorphine
• Dihydrocodeine