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Psych Exam II AP > LECT Drugs of abuse/opiates - MacIntyre > Flashcards

LECT Drugs of abuse/opiates - MacIntyre Flashcards

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1
Q

methamphetamine effects

A

this is an amphetamine

Highly addictive & toxic to dopamine nerve terminals → brain damage, esp in frontal cortex (teens > adults)

Can cause ↑BP/HR/temperature,

dilated pupils,
irregular heartbeat, muscle twitching (“tweaking”),

mood disturbances, wt loss, psychosis, dental problems, teeth grinding, insomnia, violence and extreme agitation

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2
Q

Prescription stimulants

A

type of amphetamine

Abuse or overuse can cause anxiety, ↑ BP/HR, irritability, psychosis (esp paranoia), weight loss, insomnia, cardiovascular effects, teeth grinding

abuse is on the rise, especially college age

don’t give benzo’s for patients who are agitated and having side effects. lower the dose

Women are using AD/HD medication at notably higher rates than girls, with those in the 26-to-34 age range posting a staggering 85 percent jump in the use of such drugs in just five years

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3
Q

bath salts effects

A

Surge in serotonin, norepinephrine, and dopamine (10x more dopamine than cocaine?)**

(↑risk Serotonin Syndrome)

Can cause: chest pains, ↑BP/pulse, agitation, hallucinations, suicidality, extreme paranoia, delusions, and extreme violence***

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4
Q

effects of marijuana

A

Causes euphoria, ↑appetite, sense of relaxation;

can also cause tachycardia, injected conjunctivae, dry mouth, paranoia, distorted perceptions, and difficulty with memory or complex tasks

May accelerate psychosis in those predisposed

Gateway drug?

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5
Q

substance in bath salts

A

Contain amphetamine-like chemicals:
methylenedioxypyrovalerone (MDPV),

mephedrone

pyrovalerone

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6
Q

Spice , K2

A

fake weed
synthetic cannabinoids

Causes effects similar to marijuana;

in some cases, can be more potent and cause anxiety &/or psychosis.

Can also cause ↑ heart rate & BP, vomiting, pulmonary irritation

May contain heavy metal elements…and…really whatever else you could think of

schedule 1 drug

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7
Q

effects of cocaine

A

“Blow, snow, coke”

Causes psychomotor agitation (“crack dance”),
dilated pupils,

↑BP/HR/energy/speech,

euphoria,
sinus problems;
chest pain,
risk of HIV or hepatitis transmission;

can also cause MI thru vasoconstriction (24-fold increased risk!)

Surge of dopamine release (150x more powerful than orgasm…?) ** uses a lot of available dopamine –> depletion –> depression, usu temporary but can be profound (“crash”) & accompanied by hypersomnia

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8
Q

Name 3 hallucinogens

A

Psilocybin (shrooms)
LSD
Ecstasy (MDMA, X, XTC, love drug, molly, adam, rave drug)

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9
Q

Psilocybin

A

Shrooms

cholinergic rush…
Causes distorted perceptions, dilated pupils, hallucinations, cholinergic excess, ↑BP/HR/temperature, anxiety, nausea

LSD frequently in play

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10
Q

effects of LSD

A

Produces vivid hallucinations and distorts reality;

can also cause ↑BP/HR/temp and insomnia

Can produce “bad trips-” and “flashbacks”

lasts 8-12 hrs

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11
Q

ecstasy (3,4-methylenedioxymethamphetamine)

A

aka MDMA, X, XTC, love drug, Molly, Adam, rave drug

↑serotonin release (↑ risk Serotonin Syndrome)

Causes intense feelings of mental stimulation, emotional warmth, connection to others, energy;

can also disrupt temperature homeostasis (↓thirst signal), cause nausea, chills, muscle cramps, teeth clenching, ↑HR/BP, pupillary dilation.

Death can occur thru dehydration

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12
Q

what can happen with long term use of ecstasy

A

Use can lead to destruction of serotonergic neurons. Long-term use theorized to –> depression

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13
Q

inhalants?

high effects

A

Causes rapid high; can resemble EtOH intoxication. Inhaling greater quantities can result in feelings of sensation loss and/or unconsciousness

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14
Q

what are the adverse outcomes of inhalants

A

Extremely dangerous and/or deadly:

many contain heavy metals; can cause kidney failure, suffocation (inhalants displace O2), hearing loss, limb spasms, bone marrow damage, organ damage, or death

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15
Q

PCP

A

aka angel dust, wet, embalming fluid, sherms, ozone, wack. Original name/use: Sernyl

Mimics schizophrenia-like ***(psychosis (NMDA antagonist)

Dissociation
detachment
increased BP/HR
nystagmus
sensation of heat
unusual strength 
anesthetic effects
volatility and unpredictability 
pt's can be highly agitated

making “ssssss’ noise

“Everything must go”

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16
Q

Ketamine effects

A

aka Special K, vitamin K, jet, cat tranquilizer

Sx incl dreaminess, ataxia, ↓sensations, emotional warmth, epiphanies**, hallucinations, near-death experiences, blackouts, etc.

“arms are 40 feet long”

could eventually be used for depression !! under intense study

30-60 min duration of effects

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17
Q

chronic benzodiazepine use

A

much like alcohol use, leads to ↑regulation of NMDA receptors, and ↓regulation of GABA receptors –> CNS hyperactivity in withdrawal.

Risk of seizure from benzo withdrawal just like EtOH withdrawal. Withdrawal can present as a delirium. These pts need detox

Careful w/Flumazenil: can precipitate acute, severe withdrawal

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18
Q

benzo’s and alcohol? benzo’s and other sedatives?

A

Wide therapeutic window; however, be very careful if/when prescribing benzos to someone on other sedatives or opiates (risk of respiratory depression, delirium). Should not be given to those abusing alcohol. Period.

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19
Q

abuse of benzos looks like what in a pt?

A

Abuse can cause sedation, lethargy, memory problems, ataxia, slurred speech & sent 123,000 people to the ED in 2011

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20
Q

barbituates

A

low therapeutic window

Abuse  tolerance. If drug is stopped abruptly, withdrawals and seizure can occur.

Intoxication similar to benzo picture and carries same risk of seizures

These pts also need detox

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21
Q

dextromethorphan

A

Dextromethorphan (aka “Robotripping” and “DXM”)

Popular among younger set
Dissociative
Dangerous w/serotonin agents, other anticholinergics, risk of Olney’s Lesions?

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22
Q

why don’t you give a benzo to someone with acute agitation from alcohol (substance abuse)

A

b/c its making them more drunk/toxic

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23
Q

which pt’s (substance abuse) require detox

A

benzo’s
barbs
etoh
opiates

24
Q

what is speedball

A

cocaine mixed with heroin

energy and relaxed combo
heart pounding
sympathomimetic response

heroin is an opiate and causes the relaxing part

25
Q

methamphetamine route of admin

A

Can be swallowed, snorted, injected or smoked

26
Q

Rx stimulants route of admin

A

Can be swallowed, snorted, or injected

27
Q

bath salts route of admin

A

po, inhale, IV, vape

28
Q

synthetic cannabinoids route of admin

A

Smoked or used as herbal infusion in drink

29
Q

route of admin of cocaine

A

Can be smoked (“crack”), snorted or injected; Can be mixed w/heroin (“speedball”)

30
Q

route of admin of psilocybin

A

Swallowed or used in tea

31
Q

route of admin of LSD

A

Tablets, capsules, liquid, or absorbent paper. Lasts 8-12 hrs

32
Q

route of admin of ecstasy

A

Taken orally

33
Q

PCP route of admin

A

Usually smoked; can be swallowed or snorted

34
Q

ketamine route of admint

A

snorted, ingested or IM

35
Q

how many people die per day from opioid OD

A

44

that’s b/c these are so addictive

Physiologic dependence is pure misery for most people. It robs them of life and livelihood and can lead to incarceration due to criminal acts pursued to obtain the drug (prostitution, theft, etc)

36
Q

people who die of drug OD often have combo of what in their bodies

A

benzos and opioids

37
Q

what percent of pt’s prescribed opiates for 30 days are taking them 3 years later

A

1/2 !

38
Q

MC opiates and routes of admin

A

Oxycontin

Vicodin (acetominophen/hydrocodone)

Percocet (Oxycodone/Acetaminophen)

Swallowed or crushed and snorted, sometimes injected as well

39
Q

effects of opiate “high”

A

Leads to feelings of euphoria and sedation.

Causes constricted pupils, slurred speech, impaired coordination.

Can cause ↓BP/HR and respiratory depression***

Consider drug-drug interactions and CYP-450 system (most of these are metabolized thru liver)  possible ↑ risk of respiratory depression

if you are taking a 3A4 inhibitor then the level of opiates will go up

40
Q

aka H, horse, dope, junk, smack

A

Heroin

full opiate agonist

IV, IM, snorted (sometimes smoked but not efficient, $$), “skin popping”

41
Q

effects of heroin “high”

A

Euphoria, sedation, constricted pupils, impaired coordination, can cause ↓BP/HR, respiratory depression (dangerous when combined w/other substances)

IV use  shared/dirty needles  risk of HIV, HCV, HBV, cellulitis, sepsis, bacterial endocarditis, etc

Street heroin can be “cut” w/adulterants; some can be harmful/deadly (Fentanyl, barbiturates, household powders, etc)

42
Q

Intoxication symptoms of opiates **

A 
Intoxication symptoms
Pupillary constriction
Flushing
Sedation
Slurred speech
Bradycardia
Hypotension
Respiratory depression
Hypothermia
Constipation (nausea/vomiting are rarer)

Intoxication rapid if IV, delayed if po. Duration of effect depends on the drug (wide variety available)

Typically, users always yearn for that first high that can never be recreated (“chasing the dragon”)

43
Q

Withdrawal symptoms of opiates

A 
Withdrawal symptoms
Pupillary dilation
Piloerection
Nausea
Vomiting
Diarrhea
Lacrimation
Rhinorrhea
Joint/muscle pain
Abdominal cramps
Yawning

Withdrawal peaks in 3-4 days (for short-acting opiates, longer for others), but symptoms can continue for weeks, even months

Won’t kill you…but it’s very unpleasant

44
Q

how do you prevent opioid-related death

A

Watch for co-morbid respiratory conditions (asthma, PNA, flu, OSA). Reduce opiate dose 20-30% in the presence of these

Do not use extended-release opioids for acute pain. Period.

Avoid benzos! If they must be used, consider reduction of opioid dose. Benzos enhance opioid toxicity and runs risk of resp depression

Rx Naloxone when/where appropriate

45
Q

Naloxone (Narcan)

A

Now available for patients, friends, family (check your State law).

In CO, anyone who is an interested party in someone’s care can obtain a Rx for it

If a patient is using ≥100mg morphine equivalents/day, this is recommended

The same drug that the ED uses to reverse opiate OD (opiate antagonist)

Available as shown, in “Epi-Pen”-like format, or intranasal as well

46
Q

what are detox treatment options (detox is the first step in opiate treatment)

A

“Cold turkey”

Methadone: start w/approx 20-25mg/day and decrease by 5mg/day

Buprenorphine: start w/4mg upon 1st signs of withdrawal and, if sx persist in 1 hr, give another 2-4mg dose. For the next couple of days, give 8-12mg daily and then begin to taper

Supportive medications: Trimethobenzamide (for nausea/vomiting), Dicyclomine (stomach cramps), Loperamide (diarrhea), Ibuprofen (muscle/joint pain) all used during withdrawal period

Clonidine is very useful both as monotherapy for mild withdrawal or as adjunct tx for “supportive medication” option above. Good at treating tremor, diaphoresis, and agitation

47
Q

why is maintenance required after detox

A

Detox does absolutely nothing to address cravings (physiological and psychological)

Other agents are usually required after the detox period to assist the patient in remaining sober.

Many patients are simultaneously both detoxed and transitioned to new treatment (methadone, etc.)

Patients who do not transition to maintenance treatment have an extremely high likelihood of returning to drug use

48
Q

pros of using methadone

A

long ½ life –> once daily dosing
Safety
Safe in pregnancy (fetal withdrawal can be fatal)
Intoxicating effects are less euphoric and less sedating than heroin
Pts may eventually be allowed to utilize daily tablets from home

49
Q

cons of using methadone

A

Usu have to go to clinic daily
Can’t leave clinic vicinity > 1 day (“the methadone chain”)

Prolongs QT

Multiple drug-drug interactions

Use is restricted only to certain facilities

Patient is still opioid-dependent

50
Q

LAAM Levo-α-acetylmethadol

A

Very similar to Methadone treatment except that the dosing is less (2-3x/week vs. daily)

Many of the same problems with Methadone exist

51
Q

buprenorphine

A

High affinity for opioid receptors mu (as partial agonist) and kappa (as antagonist)

prevents binding of other opiates

Can cause nausea/vomiting

Lower potential for abuse because partial activation produces much less effect (↓euphoria) and ↓risk of resp depression as partial agonist

don’t need to go to the clinic every day to get the drug, you can take it at home

52
Q

route of admin of buprenorphine

A

Sublingual d/t poor oral bioavailability

Still can be abused, esp if taken IV. Can still be fatal

53
Q

Suboxone

A

Combo of Buprenorphine/Naloxone

Buprenorphine: partial agonist, quick onset, prevents binding of other opiates–> sublingual so works very quick

Naloxone: opiate antagonist w/poor sublingual bioavailability

Can still be abused

In combination:
Poor oral bioavailability, needs sublingual release
When taken sublingually, only the buprenorphine is absorbed (not naloxone)
If crushed and injected, pt goes into withdrawal

Office-based, portable

allows outpatient treatment of opioid dependence

54
Q

Naltrexone
MOA
uses

A

Synthetic opiate antagonist
Begin 7-10 days after last opiate use to avoid precipitation of withdrawal

Comes in IM depot form

Also effective for EtOH and possibly cocaine

55
Q

Naltrexone ADR’s

A

Hepatotoxic: baseline liver fxn tests & monitor LFTs

Requires that the patient carry an alert card notifying medical personnel that they are on an opiate antagonist and add’l higher doses of opiates may be needed in an emergency to overcome blockade

Psych Exam II AP (6 decks)

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