Management of Opiate Misuse Flashcards
heroin has a ___ half life
short
2 main constituents of opium
morphine
codeine
what do you add to morphine to get heroin?
add 2 acetyl rings to the morphine molecule
medical term for snorting?
insufflation
why does heroin cross the BBB easily?
due to its 2 acetyl groups
heroin is metabolised to ___ in the body
morphine
if you do a drug screen and you detect 6-mono-acetylmorphine what does this mean?
indicative of recent definite heroin use
if you do a drug screen and detect morphine, what does this mean?
the patient could have had either codeine or heroin as both metabolise to morphine
effect of heroin?
initial euphoria analgesia respiratory depression bradycardia and hypotension pupillary constriction constipation
what is gouching?
nodding off due to drowsiness
why can teeth look in bad condition in heroin addicts?
depressed salivary production
increased analgesia so cant feel toothache
withdrawal symptoms typically occur between _ to _ hours
6-8 hours
how often do heroin addicts use the drug per day?
3
withdrawal symptoms from heroin?
dysphoria cravings agitation tachycardia and hypertension diarrhoea/N+V piloerection join pains dilated pupils yawning runny nose/watery eyes
local complications of IV drug use?
cellulitis
abscess
thrombophlebitis
NF
distant complications of IV drug use?
infective endocarditis
systemic complications of IV drug use?
hep b/c
HIV
thrombotic/embolic complications of IV drug use
DVT
PE
ischaemic limb
main reason for death of heroin?
respiratory depression
what combination of drugs are commonly causative of multi-drug related deaths in heroin addicts?
opiates
benzodiazepines
gabapentin/pregabalin
heroin causes psychosis T or F
F
heroin causes delirium T or F
F
what does opiate substitution therapy do?
replaces a short acting opiate with a long acting opiate eg methadone
why is OST good?
reduces HIV risk
reduces mortality
no longer having to seek drugs
what long acting opiates are used in OST
methadone
buprenorphine
methadone is given in what preparation?
liquid
how does heroin assisted treatment
give methadone 1x per day
prescribe heroin 3x a day under supervision
clozapine side effects?
constipation agranulocytosis myocarditis weight gain sialorrhoea (Excessive salivation)
what antipsychotic medication is most antisuicidal?
clozapine
