Opiates - Ley Flashcards
(blank) is a morphine derived alkaloid and is 2-3x more potent, a schedule I drug with a purity from 40-60%
diacetylmorphine
what is the street value of a kilo of heroin?
130-150k
What fraction of the world’s supply of heroin comes to the US?
half
what percent of high schoolers have tried vicodin? oxycodone?
vicodin: %
oxycodone: 5%
What percent of 12th graders develop lifetime use?
1.5%
what percent of high schoolers have used IV drugs?
0.7%
how many heroin addicts are there in the US?
800k
What percent of the world’s supply of vicodin is in the US?
99%
what percent of the world’s supply of oxycodone is in the US?
82%
T/F: more people die of overdoses each than car crashes, crack in the 80s and heroin in the 70s
true
T/F: male to female drug abuse is roughly similar
true
What racial group is most likely to abuse heroin
whites
What is the average age of the heroin useer? is this true in reno?
35; younger in reno
what percent of people that try heroin will become addicted?
25%
What are the risk factors for heroin addiction?
trying heroin
first degree relatives with SUD
the social learning of use (context, age of first use)
environmental stimuli
What percent of heroin users OD?
75%
the (blank) axis and opioid systems are linked via stress-induced analgesia
stress axis
What are the three opioid peptides/
enkephalins
endorphins
dynorphins
the opioid peptides are derived from….
POMC (pro-opiomelanocortin)
What receptors do opiates act on?
mu
kappa
delta
Opioids with abuse potential are selective for which receptor?
mu
You are more likely to get sick from opiates if….
pain isn’t present (N/V, itching, apathy)
T/F: there is a linear relationship between risk of respiratory depression and dose
true
What neuro pathway is implemented in opioid reinforcement?
dopamine
t/f: opioid reinforcement is separate from dependence and analgesia
true
What are the negative physiological effects of opiates?
- CV: suppression of vasoconstriction (important in shock)
- depress cough reflex
- CONSTRICT pupils
- diminished response to CO2 in the brainstem
- emesis, gastric motility, constipation
- reduce testosterone and cortisol
- hypogonadism via decreased GRF
- dyslipidemia
- concentration and attention imapired
- robbed of will
Heroin is a (full/partial) agonist
full agonist
how well does heroin cross the BBB?
readily
How long does heroin onset after:
snorting
subq
IV
snort: 30 minutes
subq: 15 minutes
IV: instant
what are the desired effects of heroin?
tranquility
euphoria
clouding of the sensorium
use of heroin increases your overall mortality by how many fold?
7x
What is codeine?
10% methylated to morphine
Codeine has (low/high) affinity for opioid receptors
low affinity
what are the alkaloid derivatives found in poppy sap?
morphine
codeine
thebaine
papaverine
What is tramadol?
a synthetic opioid analog
(blank) can cause spasms of the sphincter of Oddi and has a risk of seizures
Demerol (meperidine)
What is 100x more potent that morphine
Fentanyl
vicodin use jumped what percent from 97-06?
270%
oxy use jumped what fold from 97-06?
7 fold
methadone use jumped what fold from 97-06?
15 fold
Nevada is the number one state for (oxy/vicodin)
vicodin
What is hyperalgesia?
actually makes one more sensitive to pain
what drug is the dragon?
methadone
How quickly do doses escalate in methadone?
really fucking fast
Is methadone long or short acting?
long actign
How is methodone cleared from the body?
CYP 3A4
what are the negative side effects of methadone?
loss of teeth no libido wt. gain insomnia irregular menstruation
Which is a prodrug, oxy or hydrocodone?
hydrocodone
Oxycodone is cleared via what system?
CYP 2D6
Oxycodone has (low/high) bioavailability
high
What are the three stages of dependence?
- initiation
- continuation
- detox/withdrawal
initiation is reinforced via which receptors?
mu;
conditioned responses and craving are which stage of dependence/
initiation
Which stage of dependence is characterized by multiple nuerotransmitter involvement and dopamine in the nucleus accumbens/
continuation
What two neurotransmitters are involved in detox and withdrawal?
glutamate and NE
opioid receptors are (blank) style receptors
GPCRs
(blank) of the opioid GPCR becomes sensitized as use progresses
adenlyl cyclase
What are the molecular changes with opiate use?
- adenyl cyclase sensitization
- transcription factor upregulation
- alterations in transmembrane signaling and transduction
- reinforcement via inhibition of GABA (inhibition of DA in the VTA)
what percent of HIV pts have injected opiates?
30%
What percent of IV uses have hep C?
60-90%
what drug is used to reverse coma in OD pts?
naloxone
What are the methods of harm reduction in opiate tx?
reduce needle sharing
injection rooms
heroin maintanence
substitution therapy
what percent of opiate abusers relapse?
80%
When do detox symptoms peak?
48-72 hours (methadone is longer)
What drug isused for active optiate withdrawal?
suboxone (buprenorphine/naloxone)
What are the Sx of protracted abstinence syndrome?
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
During detox, clonidine has effects on the rewards system and may inhibit hyperactivation of (blank) pathways
NE
What drugs do you give on a Sx basis during detox?
valium
immodium
Ibu
trazodone
What part of the brain mediates the sx of withdrawal?
locus ceruleus
Suboxone can be used as an alternative for which two drugs?
methadone
heroin
Abstinence based therapies have (good/poor) outcomes
poor
What do you need to do to prevent relapse?
have contigency management and psychosocial therapy
12 step also works well
Patients in pain management often which psych co-morbidities?
anxiety and depression
Lifetime substance use in context of pain management is up to (blank)%
56
chronic pain patients have increased risk of….
addiction
abuse and dependenc> 30%
What should you use to measure pain?
validated pain scales
assess via PQRST
assess physiological and psychological effects of pain
What are the physiological effects of chronic pain?
heightened sensitivity to pain
increased catabolic demand
autonomic hyperactivity
what are the psychological effects of chronic pain?
negativity
sleep disturbance
low energy
struggle with personal meaning
T/F: exercise, therapy, and mindfulness are effective pain management strategies
true
T/F: medication is often the answer to chronic pain
false
