Exam 4 Opioids Flashcards
Acute Toxicity of Opioids
- it is overdose that leads to death
- death can happen through seizures or respiratory depression
- abuse deaths aren’t that simple…
- can happen b/c of purity/potency/drug interaction issues
- these addicts know exactly how much they need in order to overdose
- other drugs can be mixed in w/ narcotic causing ppl to go into anaphylactic shock
- & release of conditioned tolerance
- can happen b/c of purity/potency/drug interaction issues
Chronic toxicity of opioids
- no dramatic life-threatening toxicity
- increases in cancer and liver disease
- especially when combined w/ tobacco. higher probability of Hepatitis
- increases in cancer and liver disease
- suppression of immune system
- endorphins inhibit immune cells???
- link between stress & illness
behavioral toxicity of opioids
- can be chronic too
- happens from sores and infections from needles
- malnutrition
- problems w/ diet
- risky behavior
- like stealing
what are the types of toxicity that can occur from opioid use
acute toxicity
chronic toxicity
behavioral toxicity
tolerance development with opioids
- opioids typically show rapid tolerance
- tolerance to euphoria (pleasure) occurs quickly. person has to use more & more over time to get same amount of pleasure as before
- effective dose gets closer and closer to lethal dose…SO they take more of drug to get same effect, leading to death
- opioids increase drug administration in nucleus accumbens
- hallmark signature for dependence
addictive potential with opioids
addictiveness varies
heroin & fentanyl: very addictive
codeine & methadone: less addictive
how is addiction shown in opioids?
- physical dependence is marked by a withdrawal symptom (also called abstinence syndrome)
ex:
restlessness
* very painful, BUT rarely lethal
dysphoria
* sadness, unhappy
flu-like symptoms
* fevers, chills, diarrhea
muscle spasms
* cold turkey = develop goosebumps
it occurs within 6-12 hrs for short duration drugs like heroin
what are the types of treatment for opioid dependency?
weaning
methadone maintenance
treatment w/ opioid agonists
RAAD
what is weaning & how does it help with opioid dependency
- its the traditional approach
- done by giving smaller & smaller doses over time to allow body to adjust to absence of drug
what is methadone maintenance?
- methadone is substituted for heroin
- used as a replacement drug while Pt. goes through treatment
- said to prevent withdrawal symptoms
- most common approach used today for treatment of narcotic addiction AND **most effective!!!*
- only 25% of ppl will relapse after doing methadone maintenance
what does methadone do for opioid dependancy (explain the process behind it)
- it blocks withdrawal symptoms.
- produces less euphoria
- its a long active drug
- longer half life (24hrs)
- tolerizes slower
-
less disruptive to normal life
- goal is to taper dose down to practically nothing. it starts at a relatively high dose, then goes down
why is methadone therapy considered controversial?
ppl dont want these clinics in residential areas like neighborhoods with houses and schools bc they dont want to live near addicts
it lessens the impact on society BUT for the addict it…
- allows patients to not commit crimes b/c they arent on the streets
- allows them to stay heroine free as they continue to use methadone to replace it
- BUT if they stop using methadone they will suffer from withdrawals…will be less severe compared to heroin withdrawal, but still bad of course
how are opioid agonists used to treat opioid dependency
Re Via (naltrexone)
- agonist to endorphin system
- Naltrexone would be used for chronic treatment, but it isn’t effective. doesnt do anything for psychological treatment like eliminating the craving itself.
what are agonists?
- should only be used on someone who has ALREADY gone through withdrawals
- block the effects of opioids in the brain
- displace opioids from the opioid receptor
- fast induction of strong withdrawal
- short acting form (naloxone, Narcan) used to treat narcotic overdose
- BUT, not as effective as maintenance therapy
What is RAAD & how is it used to treat opioid dependency
RAAD = Rapid Anesthesia Aided Detoxification,
- also called Rapid Detox
- its a way to get through withdrawals so patient is no longer addicted
- patient goes into clinic, sedated, & Naloxone is given to them while they’re unconscious so patient doesn’t feel pain of withdrawals
- agonists are delivered during general anesthesia or sedation^
- considered controversial
- elective procedure, can be dangerous. pt. needs to sign a form b/c they can die during this due to anesthesia being used
- very expensive
- doesn’t treat the actual addiction
- they can still have psychological dependency afterwards b/c cravings can remain
- might need other forms of treatment b/c of high levels of relapse
- 90% of ppl eventually relapse within a year after doing rapid detox. WOW
