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PMCOL 305 > opioid 1 > Flashcards

opioid 1 Flashcards

1
Q

what is happening to fentanyl related accidental opioid poisoning deaths over time

A

they are increasing (compared to non-fentanyl opioids)

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2
Q

what are almost all opioid poisoning deaths caused by

A

fentanyl

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3
Q

which drugs often are laced with fentanyl

A

meth
cocaine
heroin

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4
Q

has the % of heroin that contains fentanyl increased or decreased in recent years

A

increased to 60% in 2017

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5
Q

what does opioid mean

A

term to describe both natural and synthetic compounds that have properties similar to opium or morphine

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6
Q

what is opiate

A

only referred to naturally occurring compounds

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7
Q

what makes opioids so good clinically

A

powerful analgesics, dramatic effect on the affective part of pain (anxiety, worry)

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8
Q

what is a narcotic

A

causes sleep

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9
Q

is opioid narcotic

A

yes seep

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10
Q

what are natural opiates

A

opium from poppies contains natural opiates

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11
Q

what are 2 examples of natural opiates

A

morphine

codeine

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12
Q

what are semisynthetic opiates

A

modified versions of naturally occurring chemicals found in poppies

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13
Q

what are 2 examples of semisynthetic opiates

A

heroin

oxycodone

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14
Q

what are synthetic opiates

A

entirely artificial but bind to opioid receptors

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15
Q

what is 1 examples of synthetic opiates

A

fentanyl

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16
Q

how long does opioid cause analgesia

A

3-5 hours

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17
Q

what are some feelings when you take opioids IV

A

euphoric rush followed by sedation, drowsy, mental cloudiness

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18
Q

what do opioids do to pupils and how

A

constrict because of agonistic effects on mu and kappa receptors (in oculomotor nucleus)

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19
Q

which opioid drugs dont cause constriction of pupils

A

meperidine

demerol

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20
Q

what do opioids do to nausea and how

A

induce nausea and vomiting via chemoreceptor trigger zone in area postrema in medulla

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21
Q

what do opioids do to BP and how

A

lowers by medulla + histamine effect

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22
Q

what do opioids do to sweating and how

A

increase due to vasodilation

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23
Q

what do opioids do to histamine and what does this cause

A

increase histamine release, causing hypotension, bronchoconstriction, itching

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24
Q

what do opioids do to respiration and how

A

depress respiration via mu activation - inhibition of respiratory rhythm generator in medulla

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25
Q

what is respiratory depression associated with

A

decrease in sensitivity to arterial pH, CO2 and O2

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26
Q

what do opioids do to digestion and how

A

constipation -increased muscular tone and less motility, mu opioid receptors in GI and CNS

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27
Q

what do opioids do to cough and how

A

suppression of cough by codeine maybe, unknown how

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28
Q

what part of the poppy is opium

A

the sap

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29
Q

how many days of opium poppys life cycle does it make drug and when is that

A

10 days between petals dropping and seed pod maturing

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30
Q

how do the laborers extract opium

A

scratch seeds in evening, white sap oozes overnight, oxidizes into brown gummy substance

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31
Q

is there narcotic or non-narcotic alkaloids in opium

A

both

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32
Q

what are the 2 major narcotic components in opium, and how much (%)

A

morphine 10%

codeine 0.5%

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33
Q

how much is morphine more potent than opium

A

10 fold

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34
Q

how is codeine converted into morphine and where

A

in liver and brain by CYP2D6

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35
Q

what % of what race is deficient in CYP2D6

A

10% caucasians

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36
Q

what happens in the 10% caucasians that are deficient in CYP2D6

A

codeine produces no effect

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37
Q

what % of population is overactive in CYP2D6

A

2%

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38
Q

what happens in the 2% of population that are overactive in CYP2D6 who use codeine

A

can get morphine intoication from codeine use

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39
Q

what kind of opiod is heroin

A

semisynthetic

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40
Q

how is heroin diff from morphine (structure)

A

2 more acetal groups

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41
Q

why is heroin more potent than morphine

A

its 10X more lipid soluble than morphine so more potent

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42
Q

how does heroin enter the brain vs morphine (2 things)

A

faster and in higher concentrations

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43
Q

what happens once heroin enters the brain

A

acetyl groups metabolically removed then converted into morphine (which can then bind to receptors)

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44
Q

do both acetal groups from heroin get removed at the same time

A

no, one at a time (still quick)

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45
Q

what are the 2 incomplete acetylation products of heroin

A

6-MAM and 3-MAM

46
Q

which receptors does 6-MAM bind to

A

mu receptors

47
Q

is 6-MAM psychoactive

A

yes

48
Q

which receptors does 3-MAM bind to

A

none I think (not psychoactive)

49
Q

is 3-MAM psychoactive

A

no

50
Q

which MAM product is psychoactive

A

6-MAM

51
Q

which MAM product binds to mu receptors

A

6-MAM

52
Q

what happens to 3 and 6 MAM

A

converts into morphine

53
Q

what is a way to tell if someone was on heroin (legal cases)

A

6-MAM (only produced from heroin)

54
Q

is 6-MAM or 3-MAM only produced when you take heroin

A

6-MAM

55
Q

how does black tar heroin get its color from

A

heroin mixed with 3-MAM and 6-MAM formed from incomplete acetylation reaction

56
Q

where does krokodil come from

A

Russia

57
Q

what is desomorphine

A

krokodil

58
Q

what makes krokodil/desomorphine

A

codeine, red phosphorus, gasoline, iodine, HCl

59
Q

is krokodil/desomorphine or morphine more potent and why

A

krokodil/desomorphine because it is more lipophilic

60
Q

how is krokodil/desomorphine administered

A

IV

61
Q

why does krokodil/desomorphine cause so much damage

A

because the final product is unfiltered

62
Q

what happens to the skin when you take krokodil/desomorphine

A

abseccess, gangrene, large-scale necrosis

63
Q

what opioid class is krokodil/desomorphine

A

semi-synthetic

64
Q

what opioid class is oxycodone

A

semi-synthetic

65
Q

what is one of the most abused prescription analgesics

A

oxycodone

66
Q

what is percocet

A

oxycodone +acetaminophen

67
Q

what is percodan

A

oxycodone and aspirin

68
Q

what is the difference with oxycodone and oxycontin

A

oxycontin contained much more oxycodone, time release, could be crushed

69
Q

what is the difference with oxycodone and oxyneo

A

a new version (from oxycontin) slow release with polyethylene oxide (polymer)

70
Q

which drug replaced oxycontin and why

A

oxyneo

people abused oxycontin, this had a polymer in it

71
Q

what was added to oxyneo to make it different

A

polyethylene oxide

72
Q

what is polyethylene oxide (1 word)

A

polymer

73
Q

what happens when polyethylene oxide is exposed to water

A

turns into a gummy gel

74
Q

why couldnt people abuse oxyneo as easily as oxycontin

A

it forms a gummy gel when exposed to fluid

75
Q

what happened to demand when oxyneo went to the market (+ explanation)

A

demand went down, abusers switched to heroin and other opioids (fentanyl)

76
Q

where does most fentanyl in canada come from

A

china

77
Q

where do bad guys sneak fentanyl into

A

“oxycontin” pills, heroin, cocaine, MDMA

78
Q

how does resp depression from fentanyl compare to from other opioids

A

much higher depression

79
Q

how is fentanyl used clinically

A

surgical anesthetic and analgesic, but also lollipops and patches to control pain

80
Q

how much more potent is fentanyl than morphine

A

100X

81
Q

how much more potent is fentanyl than heroin

A

40-50X

82
Q

why is fentanyl sooooo potent

A

very highly lipophilic

83
Q

how much more potent is carfentanyl than morphine in managing pain

A

10000X times

84
Q

how many mg of morphine is lethal

A

150-200mg

85
Q

how many mg of heroin is lethal

A

12-180mg

86
Q

how many mg of fentanyl is lethal

A

2mg

87
Q

how many mg of carfentanyl is lethal

A

0.02

88
Q

how much more potent is carfentanyl than fentanyl

A

100X

89
Q

how much more potent is 3-methylfentanyl than fentanyl

A

10-15

90
Q

what happens to heroin and morphine in stomach pH wise and why

A

they become ionized because they are weak bases

91
Q

are heroin and morphine well absorbed in stomach

A

no

92
Q

why is heroin and morphine so bad orally

A

not well absorbed in GI and major first pass metabolism (liver)

93
Q

which opioids have been designed to be taken orally and absorbed from GI

A

oxyneo

methadone

94
Q

what is a specific medical issue that comes with chasing the dragon

A

destruction of white matter in cerebellum (leukoencephalopathy)

95
Q

what is leukoencephalopathy

A

destruction of white matter

96
Q

what kind of destruction happens with chasing the dragon / leukoencephalopathy

A

spongiform destruction

97
Q

what is spongiform destruction

A

sponge like appearance of brain due to loss of tissue

98
Q

what causes spongiform destruction

A

leukoencephalopathy from chasing the dragon

99
Q

what are the symptoms of leukoencephalopathy/ spongiform destruction

A

ataxia, apathy, akathisia, complete inability to speak or more

100
Q

what is akathisia

A

compulsive need to more

101
Q

why does chasing the dragon cause leukoencephalopathy/ spongiform destruction

A

maybe the tin from the tinfoil, or contaminant - unsure

102
Q

how do you chase the dragon

A

heat on tin foil, inhale the fumes

you can also use a pipe

103
Q

how do you prep heroin for injection (3)

A

mix with water in spoon then add something acidic to help dissolve (like lemon juice)
then heat to help dissolve and warm to body temp

104
Q

what is a stupid thing heroin users do to filter out impurities bacteria and viruses

A

draw it up through a cotton ball

105
Q

can heroin be snorted

A

yes

106
Q

can morphine be snorted

A

no

107
Q

why can heroin be snorted

A

it crosses mucosal membranes

108
Q

what causes track marks

A

scars left by frequent injections, especially with dull reused needles

109
Q

what does multiple injections do to the vein and why

A

collapsed vein due to scarring

110
Q

why are crushed pills especially dangerous to vein health

A

due to the fillers in them

111
Q

what happens when veins collapse to blood flow

A

blood is rerouted through deeper smaller veins

PMCOL 305 (26 decks)

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