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toxicology > opiates > Flashcards

opiates Flashcards

1
Q

define opium

A

fluid obtained from the poppy plant

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2
Q

define opiate

A

a substance derived from opium

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3
Q

define opioid

A

substance with morphine-like actions, but not derived directly from the poppy plant

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4
Q

which plant does opium come from

A

papaver somniferum

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5
Q

where does this plant grow

A

SEA
Middle East
LATIN
SOUTH AMERICA

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6
Q

process of deriving opiuim from poppies

A

After flowering, the petals drop in a few days leaving bulbous green capsules atop the stalks.
• These are the seed pods.
Incisions are made in the pods and the milky fluid that oozes out is air dried.
• This must be done while the
pods are still green.

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7
Q

what opiates are derived from the poppy plant

A

MORPHINE 4-21

CODEINE 1-25

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8
Q

the main receptor that opiates work on

A

mu receptor

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9
Q

name the different opiate receptors and activation effect

A

mu1 - analgesia, euphoria
mu2 - constipation, respiratory depression
kappa - spinal analgesia
delta - analgesia through the endorphin, enkephalins, dynorphin system

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10
Q

define agonist

A

fully binds

morphine like effect ie heroin, weak binding except for fentanyl

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11
Q

define partial agonist

A

weak morphine-like effects with strong receptor affinity ie buprenorphine

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12
Q

define anatagonist

A

no effect in absence of an opiate or opiate dependence ie naltrexone

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13
Q

what’s the name of active metabolite of morphine

A

morphine-6-glucuronide
gets into the brain quicker than morphine
10X more potent than morphine

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14
Q

chemical name of codeine

A

3-O-methyl morphine

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15
Q

chemical name of heroin

A

diacetylmorphine

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16
Q

when heroin is hydrolysed what is the name of the byproduct

A

6-MAM

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17
Q

Which metabolite is only found when heroin is used

A

6-MAM

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18
Q

what can be seen in the urine when poopy seeds are eaten

A

morphine

codeine

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19
Q

what morphine level is indicative of abuse

A

above 5000ng/ml

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20
Q

which medications do not metabolise to morphine and codeine

A

hydrocodone
hydromorphone
methadone
oxycodone

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21
Q

what are opiate user’s desired effects

A

sedation
euphoria
analgesia

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22
Q

opiate effects after IV injection

A

warm skin rush
pruritus, morphine use which releases histamines
pleasure, relaxation and satisfaction in 45 seconds

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23
Q

effects of opiate intoxication

A 
miosis
nodding
hypotension
depressed respiration
bradycardia
euphoria
floated feeling
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24
Q

classic triad seen in opiate overdose

A

miosis
coma
respiratory depression

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25
Q

other symptoms of opiate overdose

A

pulmonary oedema

seizures

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26
Q

opiate overdose treatment

A

Naloxone
0.4mg/ml IV push

no response
then 2mg/ml IV push every 2-3 minutes until a total dose of 10mg is given or a response

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27
Q

what do heroin users die of

A

overdose
murder
suicide
street crime

28
Q

name the different phases of withdrawal

A

early
middle
late

29
Q

first phase of withdrawal symptoms

A

Lacrimation
• Yawning
• Rhinorrhoea
• Sweating

sense of anxiety and doom, though not life threatening

30
Q

second phase of withdrawal symptoms

A 
Restless sleep
• Dilated pupils (mydriasis)
• Anorexia
• Goose-flesh
• Irritability
• Tremor
31
Q

third phase of withdrawal symptoms

A 
Increase in all previous signs and symptoms
• Increase in heart rate
• Increase in blood pressure
• Nausea and vomiting
• Diarrhoea
• Abdominal cramps
• Labile mood
• Depression
• Muscle spasm
• Weakness
• Bone pain
32
Q

what is the 1/2 life of heroin

A

2-3 hours

33
Q

onset of last dose for withdrawal

A

8-12 hours

34
Q

peak of heroin withdrawal

A

48 hours

35
Q

duration of heroin withdrawal

A

5-10 days

36
Q

protracted opiate withdrawal symptoms

A
  • Weight gain
  • Increased basal metabolic rate
  • Decreased temperature
  • Increased respiratory rate
  • Increased blood pressure
  • Menstrual irregularities (secondary to increased prolactin hormone levels)
37
Q

what type of withdrawal treatment used

A

inpatient or ambulatory detox

  • clonidine
  • buprenorphine - parietal agonist, few deaths associated
  • methadone
38
Q

what other symptoms and medications you give in opiate withdrawal treatment

A

Examples include:
• Hydroxyzine,Vistaril®,formildtomoderateanxiety
• Oxazepam(15-30mgq6hours)orotherbenzodiazepineifsevere anxiety
• Ibuprofen,Motrin®,formuscleandjointaches
• Trimethobenzamide,Tigan®,fornausea
• Bismuth subsalicylate, Kaopectate®, Pepto-Bismol® ,for diarrhoea
• Dicycloverine, dicyclomine, Bentyl® for abdominal cramps

39
Q

what are the neurologic complications of opiates

A
  • Toxic amblyopia (optic nerve pathology)
  • Mononeuropathy (dysfunction of a single nerve)
  • Polyneuropathy (dysfunction of several nerves)
  • Meningitis
  • Brain abscess
40
Q

what are the dermatological complications. of opiates

A

abscess
• Tracks
• Lymphangitis (swelling and dysfunction of the lymph system)

41
Q

what are the pulmonary complications of opiates

A
  • Aspiration
    • Pneumonia
    • Lung abscess
    • Pulmonary emboli (clots going to the lung)
    • Pulmonary fibrosis (scarring of the lung)
    • Noncardiogenic pulmonary oedema (lung fills with fluid not as a result of heart dysfunction)
42
Q

what are the hepatic complications of opiates

A

hep B C D G

43
Q

What infections can you get from using opiates

A

endocarditis due to the needle use

tetanus in immigrants in california

44
Q

what are the different formulations for hydromorphone

A

dilaudid

palladone

45
Q

what are the different oxycodone formulations

A

oxycontin
oxyir
percodan
Percocet

46
Q

how can oxycontin be taken

A

oral
crushed
sniffed or dissolved in water and injected

47
Q

different hydrocodone formulations

A 
hycodan 
lorcet
lortab
tussionex
Vicodin

used as schedule 2 analgesic and antitussive
potency equals morphine

48
Q

what is dextropropoxyphene

A

IV

49
Q

what are the different formulations of fentanyl

A

sublimaze- IV
Duragesic - transdermal patch
Actiq - lollipop

iv smoked snorted oral transdermal

50
Q

name a fentanyl analog

A

carfentanil used to immobilise large animals

51
Q

what does phase 1 of methadone maintenance consist of

A

methadone stabilisation
- stabilise the patient for 3-9 months
- Programs closely monitor and frequently counsel patients to help reach an effective methadone dose level and cease opioid use.
• During inform patients about methadone and available services. Programs focus on medical issues and stable living arrangements.

methadone induction
dose depends on patient

52
Q

at what dose of methadone do we start of with

A

30mg typical with known tolerance

53
Q

what is phase 2 of methadone maintenance

A

social integration
9-24 months
Programshelppatientsalterpre-treatmentbehaviourandadopt positive habits and lifestyles, while stabilized on methadone.
• Duringthisphase,programscontinuetodeliverfrequent counseling, if needed.
• Programsfocusonvocationaltraining,educationalassistance,or other productive activities that help patients become self-sufficient.

54
Q

what is phase 3 of methadone maintenance

A

MAINTENANCE/ONGOING SUPPORT
• 24to48monthsorlonger
• Patientsmayreceivecounselingserviceslessfrequently,if appropriate, while stabilized on methadone, as needed.
• Duringthisphase,programsfocusonlate-stagetreatmentneeds, including continued maintenance, or tapering, or other personal issues presented by the patient.

55
Q

what symptoms does one have when they are addicted

A
  • Loss of control over the use of a substance
  • Time spent in trying to obtain the substance
  • Bio-psycho-social dysfunction
  • Continued use despite problems
  • Associated denial and dishonesty
  • Progressive and potentially fatal
56
Q

what is the theory on methadone mechanism

A

prevents the ‘off and on’ so its always bound allowing patient to function normally

57
Q

what are the advantages of using the opiod agonist

A 
Decreases in illicit opioid use
• Decreases in other drug use
• Decreases in criminal activity
• Decreases in needle sharing
• Improvements in prosocial activities 
• Improvements in mental health
58
Q

what medications can decrease the level of methadone in the blood

A 
Carbamazepine
• Alcohol
• Pentazocine
• Phenobarbital 
• Phenytoin
• Rifampicin
• Rifabutin
59
Q

what medications can increase the level of methadone in the blood

A

Cimetidine
• Ketoconazole
• Erythromycin

60
Q

what is LAAM

A

1 alpha acetylmethadol acetate

oral active analog

61
Q

how is LAAM better than methadone

A

slower onset

longer duration of action

62
Q

what’s the disadvantage of LAAM

A

cardiac arryhthmias like TORSADES DE POINTES

63
Q

what are the desirable properties of buprenorphine

A

low abuse potential
lower level of physical dependence
weak opioid effect compared to methadone

64
Q

bioavilability of buprenorphine

A

poor oral

sublingual absorption through the oral mucosa

65
Q

pharmacological uses of buprenorphine

A

potent analgesic

treatment of addictions

toxicology (4 decks)

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