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Block 8 Week 5 Colt > Opiates - Ley > Flashcards

Opiates - Ley Flashcards

1
Q

(blank) is a morphine derived alkaloid and is 2-3x more potent, a schedule I drug with a purity from 40-60%

A

diacetylmorphine

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2
Q

what is the street value of a kilo of heroin?

A

130-150k

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3
Q

What fraction of the world’s supply of heroin comes to the US?

A

half

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4
Q

what percent of high schoolers have tried vicodin? oxycodone?

A

vicodin: %
oxycodone: 5%

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5
Q

What percent of 12th graders develop lifetime use?

A

1.5%

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6
Q

what percent of high schoolers have used IV drugs?

A

0.7%

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7
Q

how many heroin addicts are there in the US?

A

800k

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8
Q

What percent of the world’s supply of vicodin is in the US?

A

99%

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9
Q

what percent of the world’s supply of oxycodone is in the US?

A

82%

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10
Q

T/F: more people die of overdoses each than car crashes, crack in the 80s and heroin in the 70s

A

true

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11
Q

T/F: male to female drug abuse is roughly similar

A

true

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12
Q

What racial group is most likely to abuse heroin

A

whites

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13
Q

What is the average age of the heroin useer? is this true in reno?

A

35; younger in reno

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14
Q

what percent of people that try heroin will become addicted?

A

25%

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15
Q

What are the risk factors for heroin addiction?

A

trying heroin
first degree relatives with SUD
the social learning of use (context, age of first use)
environmental stimuli

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16
Q

What percent of heroin users OD?

A

75%

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17
Q

the (blank) axis and opioid systems are linked via stress-induced analgesia

A

stress axis

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18
Q

What are the three opioid peptides/

A

enkephalins
endorphins
dynorphins

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19
Q

the opioid peptides are derived from….

A

POMC (pro-opiomelanocortin)

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20
Q

What receptors do opiates act on?

A

mu
kappa
delta

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21
Q

Opioids with abuse potential are selective for which receptor?

A

mu

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22
Q

You are more likely to get sick from opiates if….

A

pain isn’t present (N/V, itching, apathy)

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23
Q

T/F: there is a linear relationship between risk of respiratory depression and dose

A

true

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24
Q

What neuro pathway is implemented in opioid reinforcement?

A

dopamine

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25
Q

t/f: opioid reinforcement is separate from dependence and analgesia

A

true

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26
Q

What are the negative physiological effects of opiates?

A
  1. CV: suppression of vasoconstriction (important in shock)
  2. depress cough reflex
  3. CONSTRICT pupils
  4. diminished response to CO2 in the brainstem
  5. emesis, gastric motility, constipation
  6. reduce testosterone and cortisol
  7. hypogonadism via decreased GRF
  8. dyslipidemia
  9. concentration and attention imapired
  10. robbed of will
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27
Q

Heroin is a (full/partial) agonist

A

full agonist

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28
Q

how well does heroin cross the BBB?

A

readily

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29
Q

How long does heroin onset after:
snorting
subq
IV

A

snort: 30 minutes
subq: 15 minutes
IV: instant

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30
Q

what are the desired effects of heroin?

A

tranquility
euphoria
clouding of the sensorium

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31
Q

use of heroin increases your overall mortality by how many fold?

A

7x

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32
Q

What is codeine?

A

10% methylated to morphine

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33
Q

Codeine has (low/high) affinity for opioid receptors

A

low affinity

34
Q

what are the alkaloid derivatives found in poppy sap?

A

morphine
codeine
thebaine
papaverine

35
Q

What is tramadol?

A

a synthetic opioid analog

36
Q

(blank) can cause spasms of the sphincter of Oddi and has a risk of seizures

A

Demerol (meperidine)

37
Q

What is 100x more potent that morphine

A

Fentanyl

38
Q

vicodin use jumped what percent from 97-06?

A

270%

39
Q

oxy use jumped what fold from 97-06?

A

7 fold

40
Q

methadone use jumped what fold from 97-06?

A

15 fold

41
Q

Nevada is the number one state for (oxy/vicodin)

A

vicodin

42
Q

What is hyperalgesia?

A

actually makes one more sensitive to pain

43
Q

what drug is the dragon?

A

methadone

44
Q

How quickly do doses escalate in methadone?

A

really fucking fast

45
Q

Is methadone long or short acting?

A

long actign

46
Q

How is methodone cleared from the body?

A

CYP 3A4

47
Q

what are the negative side effects of methadone?

A 
loss of teeth
no libido
wt. gain
insomnia
irregular menstruation
48
Q

Which is a prodrug, oxy or hydrocodone?

A

hydrocodone

49
Q

Oxycodone is cleared via what system?

A

CYP 2D6

50
Q

Oxycodone has (low/high) bioavailability

A

high

51
Q

What are the three stages of dependence?

A
  1. initiation
  2. continuation
  3. detox/withdrawal
52
Q

initiation is reinforced via which receptors?

A

mu;

53
Q

conditioned responses and craving are which stage of dependence/

A

initiation

54
Q

Which stage of dependence is characterized by multiple nuerotransmitter involvement and dopamine in the nucleus accumbens/

A

continuation

55
Q

What two neurotransmitters are involved in detox and withdrawal?

A

glutamate and NE

56
Q

opioid receptors are (blank) style receptors

A

GPCRs

57
Q

(blank) of the opioid GPCR becomes sensitized as use progresses

A

adenlyl cyclase

58
Q

What are the molecular changes with opiate use?

A
  1. adenyl cyclase sensitization
  2. transcription factor upregulation
  3. alterations in transmembrane signaling and transduction
  4. reinforcement via inhibition of GABA (inhibition of DA in the VTA)
59
Q

what percent of HIV pts have injected opiates?

A

30%

60
Q

What percent of IV uses have hep C?

A

60-90%

61
Q

what drug is used to reverse coma in OD pts?

A

naloxone

62
Q

What are the methods of harm reduction in opiate tx?

A

reduce needle sharing
injection rooms
heroin maintanence
substitution therapy

63
Q

what percent of opiate abusers relapse?

A

80%

64
Q

When do detox symptoms peak?

A

48-72 hours (methadone is longer)

65
Q

What drug isused for active optiate withdrawal?

A

suboxone (buprenorphine/naloxone)

66
Q

What are the Sx of protracted abstinence syndrome?

A

Can last up to 6-7 months after withdrawal
Vague sense of feeling abnormal
Depression (increased propensity to sleep)
Abnormal response to stress
Abnormal respiration and temperature
Decreased self-esteem
Anxiety
Craving
Confounded by high comorbidity with other psychiatric disorders

67
Q

During detox, clonidine has effects on the rewards system and may inhibit hyperactivation of (blank) pathways

A

NE

68
Q

What drugs do you give on a Sx basis during detox?

A

valium
immodium
Ibu
trazodone

69
Q

What part of the brain mediates the sx of withdrawal?

A

locus ceruleus

70
Q

Suboxone can be used as an alternative for which two drugs?

A

methadone

heroin

71
Q

Abstinence based therapies have (good/poor) outcomes

A

poor

72
Q

What do you need to do to prevent relapse?

A

have contigency management and psychosocial therapy

12 step also works well

73
Q

Patients in pain management often which psych co-morbidities?

A

anxiety and depression

74
Q

Lifetime substance use in context of pain management is up to (blank)%

A

56

75
Q

chronic pain patients have increased risk of….

A

addiction

abuse and dependenc> 30%

76
Q

What should you use to measure pain?

A

validated pain scales
assess via PQRST
assess physiological and psychological effects of pain

77
Q

What are the physiological effects of chronic pain?

A

heightened sensitivity to pain
increased catabolic demand
autonomic hyperactivity

78
Q

what are the psychological effects of chronic pain?

A

negativity
sleep disturbance
low energy
struggle with personal meaning

79
Q

T/F: exercise, therapy, and mindfulness are effective pain management strategies

A

true

80
Q

T/F: medication is often the answer to chronic pain

A

false

Block 8 Week 5 Colt (12 decks)

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