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Psychiatry > Opiate addiction > Flashcards

Opiate addiction Flashcards

1
Q

What is the chemical name for heroin?

A

Diacetylmorphine (Diamorphine)

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2
Q

Describe the production of heroin

A

Opium is extracted from opium poppies
This contains a mix of alkaloids, mainly codeine and morphine
Morphine is extracted and 2 acetyl rings are added to produce diacetylmorphine (Heroin)

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3
Q

What are some of the ways that heroin is taken?

A
  • IV
  • Smoking (Most common)
  • Suppository
  • Snorting
  • Ingestion
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4
Q

What happens to heroin in the body?

A

It is broken down into 6-mono-acetylmorphine and then into morphine to produce effects

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5
Q

What are some of the effects of heroin on the body?

A
  • Euphoria
  • Analgesia
  • Respiratory depression
  • Constipation
  • Reduced conscious levels
  • Hypotension and bradycardia
  • Pupillary constriction
  • Tolerance with repeated use
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6
Q

How quickly do withdrawal symptoms occur after heroin use?

A

6-8 hours

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7
Q

What are some of the withdrawal symptoms of heroin?

A
  • Insomnia
  • Dysphoria and cravings
  • Agitation
  • Tachycardia and hypertension
  • Piloerection and shivering
  • Diarrhoea, nausea and vomiting
  • Dilated pupils
  • Joint pains
  • Yawning
  • Rhinorrhoea and lacrimation
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8
Q

What are some possible complications of IV heroin use?

A

Infections (Local, Distant, systemic)
Thromboses

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9
Q

What are some local infections that can occur in IV heroin use?

A

Cellulitis
Abscess
Thrombophlebitis
Necrotising fasciitis

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10
Q

What is a distant infection that can occur in IV heroin use?

A

Infective endocarditis

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11
Q

What are some systemic infections that can occur with IV heroin use?

A

Hep B
Hep C
HIV

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12
Q

How does Scotland’s drug death compare with the rest of the UK and Europe

A

It was 3.5x that of the UK was the highest in Europe

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13
Q

What are some social consequences of heroin use?

A
  • Unemployment
  • Neglect of family or children
  • Criminality
  • Risk from violence and prostitution
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14
Q

What are some psychiatric consequences of heroin use?

A
  • Depression
  • Anxiety
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15
Q

What are some of the clinical treatment options for heroin use?

A

Opiate substitution therapy (OST)
Heroin assisted treatment
Psychological therapy

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16
Q

What is opiate substitution therapy?

A

This is the replacement of a short acting opiate with a long acting opiate

17
Q

What are some examples of long-acting opiates used in OST?

A

Buprenorphine (Partial agonist)
Methadone (Full agonist)

18
Q

What are some positives of OST?

A
  • Reduced mortality rate
  • Reduced HIV risk by approx. 50%
  • Reduces criminality
  • Promotes pro-social activities
  • Promotes family life
  • Promotes employment
19
Q

What are some negatives of OST?

A
  • Daily visits to the chemist
  • Stigma (Esp. methadone)
  • Side effects
20
Q

What is heroin assisted treatment?

A

Treatment that involves the use of prescribed, carefully monitored heroin

21
Q

What are the advantages of heroin assisted treatment?

A

Heroin based treatment results in greater improvements in most other outcomes such as criminality and psychosocial function

22
Q

What are some psychosocial interventions that can be used in opiate addiction?

A

Contingency management (Reward positive behaviour - Vouchers, etc)
Behavioural couples therapy
CBT and psychodynamic therapy

23
Q

What is opiate detoxification?

A

This is the achievement of complete abstinence from ALL opiates

24
Q

What are some of the advantages of opiate detoxification?

A

There is the potential to realise a lot of social, physical and psychiatric benefits

25
Q

What are some negatives of opiate detoxification?

A

increases the risk of OD in the case of relapse, as their tolerance is greatly decreased

10% of people in a study of 137 patients who underwent opiate detoxification were dead within 4 months

70-80% of detoxification completers will relapse within 1 year

26
Q
A

Psychiatry (29 decks)

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