Exam 3 Substance Abuse Flashcards
1
Q
HEROIN AND OTHER OPIOIDS
What are the subjective/behavioral effects?
A
- Initially patients get a “kick” or “rush” that lasts about 45 seconds that consists of pleasure, relaxation, warmth, and thirst. The next experience is a prolonged sense of euphoria “that all is well with the world”. This second response is the main reason for abuse.
- Note: first-time users may feel nausea and vomiting and a profound sense of dysphoria; prolonged use due to peer pressure is the main reason people progress to the enjoyable feeling caused by opioid use.
2
Q
HEROIN
A
- Heroin – crosses the blood-brain barrier easily because it has high lipid solubility → effects are immediate and intense (this is what sets it apart from other opioids)
- Administered (from most used to least): Intravenous injection (7-8 second onset), smoking (slower, peaks 10-15 min later), and nasal inhalation/sniffing or “snorting”.
- Note: when given orally or subcutaneously instead of IV, it acts like morphine and other opioids
3
Q
MEPERIDINE
A
- Meperidine – aka Demerol. May see more in nurse and physician abusers. Like heroin, highly effective when taken PO and does not have the warning sign of multiple injection sites, also less pupillary constriction. Also does not affect smooth muscle function, making constipation and urinary retention less problematic than other opioids
4
Q
OXYCODONE
A
- Oxycodone – given in medical setting as a controlled-release tablet that is designed to slowly release steady levels of oxycodone. Abusers crush the pill and then
- Snort it or mix it with water to be injected, which gets absorbed immediately and raising blood levels dangerously high
- Risk of respiratory depression and death is greatest in people who have not developed tolerance to opioids
5
Q
HEROIN AND OTHER OPIOIDS
S&S
ACUTE TOXICITY
A
- Classic triad of symptoms: respiratory depression, coma, and pinpoint pupils. Treat with Naloxone (Narcan), an opioid antagonist: titrate carefully or else you can put them straight from overdose straight into withdrawal, noooOOOoo! Readministered every few hours because of short half-life
6
Q
HEROIN AND OTHER OPIOIDS
SEQUELAE OF COMPULSVIE USE
A
- Actually has few direct detrimental effects. Many indirect hazards. Largely revolve around lifestyle of the opioid user, esp the impurities that come from street drugs and the non-sterile needles being shared, suffer from high rates of death from secondary infections and emboli from impure drugs
7
Q
HEROIN AND OTHER OPIOIDS
Describe the use of methadone for substitution and for long-term management
A
- Methadone is a long-acting oral opioid most common for easing withdrawal
- Methadone substitutes for the drug the addict is on
- Opioids display cross-dependance with one another
- Patient is stabilized on Methadone
- The process takes about 10 days
- Methadone must be matched closely to the existing degree of physical dependence
- For long-term management, larger doses are given progressively until a high dose of (120 mg/day) is achieved. This allows a high tolerance, which than no subjective effects are experienced.
- Cross-tolerance among opioids exists — so once tolerance for Methadone is achieved, pa
8
Q
BARBITURATES
What are the effects?
A
CNS depression: ranges from mild sedation, to coma, to death (so get the dosage right!)
9
Q
BARBITURATES
What is the issue with tolerance?
Why is it dangerous with this particular drug?
A
- Tolerance develops for some effects, not all. Progressively larger doses are needed to produce the desired effect, but little tolerance develops for respiratory depression. Basically, if you want to therapeutic effect, you’ll have to increase the dose as tolerance builds, but the amount it takes for you to not die from respiratory arrest stays the same since tolerance doesn’t develop for that. This is unlike something like opioids, where both increase as you take more.
10
Q
BARBITURATES
other drugs that have cross-tolerance with barbiturates?
A
Other CNS depressants: alcohol, benzos, general anesthetics. But NOT opioids
11
Q
S and S
BARBITURATES
A
Respiratory depression, coma, pinpoint pupils: the triad of symptoms
12
Q
BENZODIAZEPINES
How do they differ from barbiturates?
A
- Benzos are usually more antianxiety and some sleeping pills but they can also control seizures and work to relax muscles as in diazepam or valium.
- Barbiturates are hypnotics/sedatives but are also used for sleeping pills and anticonvulsants.
- Barbiturates can be used to treat seizures but benzos also raise the seizure threshold which means they make it harder to have a seizure
13
Q
COCAINE
How is it administered?
A
- Usually, intranasally. “snorted” where it is absorbed by the nasal mucosa into the bloodstream. Very few (5%) administer IV. It CANNOT be smoked because it is unstable at high temperatures. The base form of cocaine can be administered through smoking, called “freebasing”, which delivers large amounts of cocaine to the lungs where it is rapidly absorbed.
14
Q
COCAINE
What are the subjective effects?
A
- Euphoric high, dopamine feedback loop stimulation. IV and freebasing have the strongest effects, snorting less intense. The good effects quickly fade within minutes and get replaced with dysphoria. In order to regain the euphoria, users may repeat doses in short intervals, called “binging”. This can lead to quick addiction.
15
Q
COCAINE
What are the symptoms and treatment for acute toxicity?
A
- Mild overdose produces agitation, dizziness, tremor, and blurred vision. Severe overdose can produce hyperpyrexia (super high body temperatures), convulsions, ventricular dysrhythmias, and hemorrhagic stroke. Users may get a coronary artery spasm, which can result in secondary angina pectoris and MI ):
- Psychologically, users may experience severe anxiety, paranoid ideation, and hallucinations. Symptoms last about 1-2 hours because of cocaine’s short half-life.
- Treat symptoms since cocaine has not specific antidote. IV diazepam or lorazepam can reduce anxiety and seizures. Diazepam can also help with HTN and dysrhythmias. IV nitroprusside can help severe HTN. Dysrhythmias with prolonged QT intervals may respond to hypertonic sodium bicarbonate. Can prevent thrombus and MI with aspirin, beta blockers might help or make the dysrhythmia worse.
