Opiate abuse Flashcards
• Analyze a clinical scenario and choose the correct diagnosis and/or treatment for Opioid intoxication • Analyze a clinical scenario and choose the correct diagnosis and/or treatment for Opioid withdrawal • Identify the rationale, appropriate patient population, and medication choices for Opioid maintenance treatment
location of dopamine neurons
VTA
DSM criteria for abuse
1 of the following in the last12 months
1) failure to fufill role
2) use in hazadrous situations
3) legal problems
4) use despite problems
sx of dependance
Need 3: tolerance, withdrawal, larger/longer use, can’t quit, much time with habit, loss of activites, continued use despite problems
sx of opioid tox
recent use, maladapted behavior, drowiness/coma, slurred speech, impairment in treatment or memeory
“triad” opioid overdose
miotic pupils, altered mental status resp depression (< 12 .min)
treatment of opioid tox
ABC +naloxone
problem with naloxone treatment for opioid tox
t 1/2 of opioid is much longer that t 1/2 of naloxone
long half life opioid receptor antagonist
naltrexone
effect of naltrexone
decreases cravings for Opioids and EtOH
effects of opioids that lessen with tolerance
euphoria, sedation, miosis, resp depression, vomiting, analgesia
DSM sx of opioid withdrawal
significant impairment AND 3 or more:
dysphoric mood n/v muscle aches lacrimation/rhinorrhea pupillary dialation, piloerection, sweating diarrhea yawning fever insonmmia
symptomatic tx of opioite wd (pharm)
clonadine, NSAIDS, loperamide, muscle relaxer
methadone/buprenorphine
pharm for rapid withdrawal of opioids
clonidine and naltrexone
effects of clonidine in opioid WD
reduces lacrimation, rhinorrhea, restlessness, muscle pain, joint pain, GI sx
MOA of clonadine in opioid WD
blocks locus ceruleus activity
