Iatrogenic analgesia addiction Flashcards
Define iatrogenic
Disease or symptoms induced in a patient by treatment or comments of a physician.
Define addiction
a complex state that involves both psychological & physiological dependence.
Describe the drug dependence cycle
- Drug taking
- rewarding experience
- frequent drug taking
Dependence
- Withdrawal
- dependence
- acute- physical withdrawal
- prolonged- lowered, blunted mood, anxiety)
Abstinence
- Craving
- cue- induced
- stress- induced
Relapse
NOTE: view notes for diagram
What are the stages of opioid addiction? How do endorphins block pain messages?
- Normal physiological effects upon taking the drug: release of endorphins, which contributes to pain relief.
- Tolerance - if taken repeatedly over time, body slows production of endorphins so stronger doses needed to stimulate pain relief (or euphoria).
- Dose increase- people who develop tolerance may feel the need to increase the dose as they could now get WITHDRAWAL SYMPTOMS.
Endorphins block pain messages:
- Substance P is a neurotransmitter involved in pain response
- Endorphins released by pituitary gland to block pain perception
- endorphins bind to opiate receptors located on pre-synaptic membrane & block release of substance P
What are the risk factors of opioid addiction?
- poverty
- unemployment
- family history of substance abuse
- personal history of substance abuse
- stressful conditions
- history of severe depression or anxiety
- history of criminal activity
What are the features of drug dependence?
- Drug taking becomes compulsive, taken over other needs.
- Loss of control of the amount of drug taken.
- Physical and psychological changes when drug is not taken i.e. withdrawal symptoms
What are the two types of dependence?
- Physical dependence: associated w/ withdrawal syndrome, lasts for a few days.
- Psychological dependence: associated w/ craving & lasting for months or years.
What is abstinence syndrome? What are the symptoms?
Side effects experienced when opioids are withdrawn
Symptoms of withdrawal:
- Sweating
- chills
- irritability
- anxiety
- diarrhoea
- nausea & vomitng
What is abstinence syndrome? What are the symptoms?
Side effects experienced when opioids are withdrawn
Symptoms of withdrawal:
- Sweating
- chills
- irritability
- anxiety
- diarrhoea
- nausea & vomiting
What drugs can relive withdrawal symptoms?
- Methadone
- Buprenorphine
- Long-acting µ receptor agonists
Which opioids are less likely to cause physical or psychological dependence?
- Codeine
- Buprenorphine
- Tramadol
How can you prevent opioid/drug addiction?
- Short duration: < 3 days; to manage acute pain, such as pain that follows surgery or a bone fracture.
- Combination of opioids & NSAIDs - effects are additive, therefore less of each drug is given.
- DO NOT USE LONG TERM - opioids are not a safe & effective long-term treatment option for chronic pain.
- Always use WHO analgesic ladder
How can you prevent opioid/drug addiction?
- Short duration: < 3 days; to manage acute pain, such as pain that follows surgery or a bone fracture.
- Combination of opioids & NSAIDs - effects are additive, therefore less of each drug is given.
- DO NOT USE LONG TERM - opioids are not a safe & effective long-term treatment option for chronic pain.
- Always use WHO analgesic ladder
What is the name of the opioid antagonist?
Naloxone (short acting)
Naltrexone - very similar, but longer half life (10hrs).
Work by reversing the respiratory depression caused by an over-dose.
They are opiod inhibitors.
What drug is used to alleviate abstinence syndrome?
Lofexidine
- An adrenoceptor agonist
