Opiates Flashcards

Question

Signs of Opiate Overdose

Answer 1

Loss of Conciousness Unresponsive Unable to talk Breathing very slow, erratic

Answer 2

Synthetic opioid with potency 80-100 times that of morphine Highly lipid soluble, immediate rise in plasma levels followed by an immediate fall Rapid offset of action is due to redistribution

Answer 3

Use needle to remove fetanyl gel from transdermal patch Drug/gel is put in a syringe, and injected High doses absorbed in short period Results in thrombophelebitis, deep venous and abscesses Revised formulation eliminates gel, reduced incidence of abuse Mylan Fentanyl Transdermal System- Comes in a variety of doses to make it easier for patients

Answer 4

``` Generally non-toxic, as tolerance develops Overdoses from combination or pure batch Coma, respiratory depression, pinpoint pupils ER treatment with naloxone Related to IV use AIDS unsterile technique Adulterants Infections, abscesses in skin poppers ```

Answer 5

Developed in 1964 Dose was higher than used on street Prevents withdrawal, but produces significant amount of cross tolerance, so prevents heroin or other opiates from binding to receptors, preventing acute effects-- leads to extinction Converts to less risky route- oral vs IV Use of pure medication with known potency Slower onset of action avoids the rush Improved general heath status Reduced use of healthcare services Stabilization may take days or weeks Patients must be educated to expect this delay Withdrawal and craving suppressed slowly Cross tolerance at 5-20 mg After a few weeks- pool of methadone is established Patient can miss a daily dose and not feel withdrawal Does not assist analgesia, no need for additional analgesics for pain medication

Answer 6

Death rate is 10 times lower than in untreated individuals Needle sharing is 14% vs 47 % Slower progression to AIDS in HIV infected individuals Decreased incidence of ER visits Fewer upper respiratory infections Improved immune function Improved nutritional status Reduced incidence of criminal convictions Reduced incidence of selling drugs Long-acting (24-36 hours)

Answer 7

``` Constipation Sweating Nonmalignant edema Loss of libido Relatively safe, true methadone related deaths in maintenance are rare ```

Answer 8

1/3 get better, 1/3 vacillate, 1/3 get worse Methadone does not treat antisocial behavior Methadone decreases needle sharing, decreases HIV/AIDS

Answer 9

Switch to use methadone as primary medication for treating chronic pain Developed after OxyContin crisis But methadone pharmacokinetics are more complicated so OD is more common

Answer 10

Partial agonist at mu receptor Similar effects to morphine at receptor but at a lower dose range .3 mg buprenorphine = 10 mg morphine

Answer 11

Sublingual buprenorphine formulation that does not contain naloxone Management of pain in low risk patients

Answer 12

Slow release off receptor will delay appearance of withdrawal, even after abrupt termination

Answer 13

Sublingual formulation that contains naloxone HCl Naloxone not absorbed orally or sublingually, so has no effect on buprenorphine If preparation is injected, naloxone blocks buprenorphine access to opiate receptor

Answer 14

Office-based prescribing of buprenorphine, allows private physicians to manage Physician training is available from a variety of source Strategy opens opiate dependence treatment options to many more individuals

Answer 15

Orally absorbed Use only after detoxification- with patients who are highly motivated Prevents heroin or morphine from getting into receptor Injectable formulation vivitrol has been approved for use as a treatment

Answer 16

``` Opiate receptor antagonist Not orally absorbed- IV Sometimes used to asses dependence Not useful in maintenance-- too short acting Reverses opiate overdose in emergency Must put on slow drip after bolus ```

Answer 17

Giving naloxone injectors to the public | Given to ambulance drivers, police officers, first responders

Answer 18

``` use short acting opiates to engage Gradually shift to longer acting drugs Increase drug-taking interval Survey urine for illicit opiates Switch to antagonists after they have been detoxified ``` ALTERNATE Some period may need maintenance for an extended period of time Very low dose methadone may be all that is needed

Answer 19

Troops had very little dependence once they returned to the US

Answer 20

IV combination of heroine and cocaine sometimes norted often co-administered, but can also give one after the other in a short time period Heroine allows a parachute from the intense high of cocaine

Answer 21

Black tar mexican heroin mixed with crushed OTC that contain antihistamine diphenhydramine Sedative effects of the heroin and sleep aids make it very dangerous Targeted to middle school children

Answer 22

Desomorphine- 8-10 X more potent Homemade from codeine, iodine, red phosphorous, gasoline, lighter fluid, and industrial clearners Sensationalized as flesh eating heroin- causes skin necrosis and gangrene Popular in Russia and Ukraine

Answer 23

Made from the leaves of Mitragyna speciosa, southeast asian tree related to coffee, and has been consumed in Asia for Millenia, typically as tea or powder Herb contains alkaloids that activate opioid receptors in the brain and reduce pain Although most opioids have sedative qualities, low to moderate doses of kratom serve as a mild stimulant Led advocated to claim kratom can be used as a maintenance drug to help recovering opiate dependents DEA planning to place it on schedule 1 Mitragynine and 7hydroxymitragynine active ingredients in kratom, bind to opiate receptors in the brain