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PSYCHIATRY > Management of Opiate Misuse > Flashcards

Management of Opiate Misuse Flashcards

1
Q

What is heroine chemically known as?

A

Diamorphine

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2
Q

What makes heroine addictive?

A
  • rapid ONSET of action
  • SHORT half life
  • AVAILABILITY
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3
Q

How is heroine/diamorphine produced?

A

Heroine is produced from MORPHINE- a naturally occurring substance found in the seed pod of certain POPPY seeds

  • addition of 2 acetyle rings, produces diacetylmorphine
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4
Q

What is OPIUM?

A
  • mixture of ALKALOIDS

esp CODEINE and Morphine

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5
Q

Which route of admission has a faster affect on the brain?

A

IV is said to be more potent than IN

- IV has a faster affect on the brain

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6
Q

What is the breakdown pathway of heroine?

A

Diacetylmorphine> 6-mono-acetylmorphine> morphine

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7
Q

How does the route of administration change the metabolism of heroine?

A

Oral: 1st pass metabolism in LIVER (morphine forms before BBB)

IV: acetyl groups of morphine help diamorphine to CROSS BBB; once in the brain it is metabolised to 6-MAM and morphine

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8
Q

What are the psychological effects of heroine on you?

A
  • Euphoria
  • analgesia
  • reduced conscious level
  • tolerance with repeated use
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9
Q

What are some systemic effects of heroine on you?

A
  • HYPOTENSION and BRADYCARDIA
  • pupillary constriction
  • CONSTIPATION
  • respirat. Distress
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10
Q

When do withdrawal symptoms usually set it?

A
  • within 6-8hrs
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11
Q

What are the psychological withdrawal symptoms ?

A
  • dysphoria
  • cravings
  • agitation
  • yawning
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12
Q

What are systemic withdrawal symptoms?

A
  • Hypertension and Tachycardia
  • piloerection
  • N.V.D
  • dilated pupils
  • JOINT pains
  • rhinorrhea and lacrimation
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13
Q

What are complications of IV use?

A
  1. INFECTIONS
    - LOCAL: cellulitis, abscess, thrombophlebitis, necrotizing fascitis
    - DISTANT: infective ENDOCARDITIS
    - SYSTEMIC: Hep B, Hep C and HIV
  2. THROMBOTIC/ EMBOLIC
    - DVT, PTE, Ishcaemic limb
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14
Q

Drug users sometimes ALSO take GABAPENTIN and PREGABALIN.

WHY?

A
  • they enhance the effects of OPIODS
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15
Q

Name 2 Novel Psychoactive Substance.

A

Diclazepam

Etizolam

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16
Q

What are NPS?

A

Drugs that produce the SAME affect as cannabis, ecstasy but are structurally diff. enough to not be considered under the MISUSE of DRUGS act

17
Q

WHat are the social consequences of Heroine use?

A
  • unemployment
  • neglect of FAMILY/CHILDREN
  • alternative interests
  • criminality
  • risk of violence
  • prostitute
18
Q

what are the psychiatric consequences of Heroine use?

A
  • depression

- Anxiety

19
Q

What are the psychiatric s/es of Heroine use?

A
  • DEPRESSION

- ANXIETY

20
Q

HEROINE does NOT cause these 2 conditions ________ ________

A

-psychosis and delirium

21
Q

What is the said treatment for Opiate addiction?

A

0piate Substitution therapy (OST) - the replacement of SHORT acting opiate with a long acting one

  • once a day
  • taken under supervision
22
Q

What drugs are usually given for OST?

A
  • Methadone

- Buprenorphine

23
Q

What is the concept behind OST that reduces the addictive craving?

A

-the SLOW diffusion of OST avoids PEAK effects; which contributes to addiction

24
Q

What are the PROs of OST?

A
  • reduces the mortality by less than 1/3; COMPARED TO THOSE OUT OF ost
  • reduces HIV risk by 50%
  • also prevents HCV infections
  • combin. of OST and NSP (reduces the odds of new HCV by 80%)
25
Q

Cons of OST?

A
  • compliance to visits (initially DAILY visits)
  • side effects
  • STIGMA (methadone> buprenorphine)
  • $$$
26
Q

How are the OST drugs administered?

A
  • Methadone: tablet or liq. (FULL agonist)

- Buprenorphine by tablet (partial agonist )

27
Q

Why detoxification from opiate still a challenge?

A
  • those who completed the detox, are 4x as likely to DIE from overdose as those who failed to complete it
  • —10% in a study who did the detox, died in 4 months
  • —70-80% of detox completers, RELAPSE within a year
28
Q

What are some pschosocial interventions?

A
  • CONTINGENCY MANAGEMENT (rewarding +ve behaviours to reduce drug use)
  • Behavioural COUPLES THERAPY
  • CBT and Psychodynamic therapy : for co-morbid anxiety and depression (not drug misuse)
29
Q

What is meant by opiate detoxification?

A
  • to achieve COMPLETE abstinence from ALL opiates —using the OST method
30
Q

WHat are opiates?

A
  • naturally occuring substances found in the OPIATE plant

- —ex: MORPHINE and CODEINE

31
Q

What are some SEMI-synthetic opioids?

A
  • man-made opiods derived from a NATURALLY occuring opiate

- –ex: diacetylmorphine (HEROINE), OXYCODONE, hydrocodone

32
Q

Name synthetic opioids.

A

Fentanyl
Methadone
Meperidine

PSYCHIATRY (32 decks)

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