Management of Opiate Misuse Flashcards
what is opium?
mixture of alkaloids (esp codeine and morphine)
what is morphine?
morphine extracted though often codeine contaminants remain
what is diamorphine?
addition of 2 acetyl rings to produce diacetylmophine (diamorphine)
what is the different ways you can take heroin?
IV smoking suppository insufflation ingestion
what is the basic early metabolic pathway of heroin?
diacetylmorphine -> 6-mono-acetylmorphine -> morphine
what effects does heroin have on body?
euphoria analgesia respiratory depression constipation reduced conscious level hypotension and badycardia pupillary constriction tolerance develops with repeated use
how long after taking heroin does withdrawal usually occur?
6-8 hours
what are the symptoms of heroin withdrawal?
dysphoria and cravings agitation tachycardia and hypertension piloerection diarrhoea, nausea and vomiting dilated pupils joint pains yawning rhinorrhea and lacrimation
what are the complications of IV use heroin?
local infection - cellulitis, abscess, thrombophlebitis, necrotising fasciitis
distant - infective endocarditis
systemic - hep B, HIV, hep C
thrombotic / embolic - DVT, PTE, ischaemic limb
what effect do gabapentin and pregabalin have on opioids?
enhance effects
what is etizolam?
benzo type novel psychoactive substance - twice as likely as diazepam to be implicated in deaths where it was found present
what are the social and psychiatric consequences of heroin use?
social - unemployment, neglect of family / children, alternative interests, criminality, risk of violence, prostitution
psychiatric - depression, anxiety
does heroin cause psychosis or delirium?
no
what is opiate substitution therapy (OST)?
replacement of short acting opiate with long acting opiate eg buprenorphine or methadone
once daily dosing, taken under supervision (initially)
what are the pros of OST?
reduced mortality rate
reduce HIV risk
prevents new HCV infection
