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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
what is respiratory depression associated with
decrease in sensitivity to arterial pH, CO2 and O2
26
what do opioids do to digestion and how
constipation -increased muscular tone and less motility, mu opioid receptors in GI and CNS
27
what do opioids do to cough and how
suppression of cough by codeine maybe, unknown how
28
what part of the poppy is opium
the sap
29
how many days of opium poppys life cycle does it make drug and when is that
10 days between petals dropping and seed pod maturing
30
how do the laborers extract opium
scratch seeds in evening, white sap oozes overnight, oxidizes into brown gummy substance
31
is there narcotic or non-narcotic alkaloids in opium
both
32
what are the 2 major narcotic components in opium, and how much (%)
morphine 10% | codeine 0.5%
33
how much is morphine more potent than opium
10 fold
34
how is codeine converted into morphine and where
in liver and brain by CYP2D6
35
what % of what race is deficient in CYP2D6
10% caucasians
36
what happens in the 10% caucasians that are deficient in CYP2D6
codeine produces no effect
37
what % of population is overactive in CYP2D6
2%
38
what happens in the 2% of population that are overactive in CYP2D6 who use codeine
can get morphine intoication from codeine use
39
what kind of opiod is heroin
semisynthetic
40
how is heroin diff from morphine (structure)
2 more acetal groups
41
why is heroin more potent than morphine
its 10X more lipid soluble than morphine so more potent
42
how does heroin enter the brain vs morphine (2 things)
faster and in higher concentrations
43
what happens once heroin enters the brain
acetyl groups metabolically removed then converted into morphine (which can then bind to receptors)
44
do both acetal groups from heroin get removed at the same time
no, one at a time (still quick)
45
what are the 2 incomplete acetylation products of heroin
6-MAM and 3-MAM
46
which receptors does 6-MAM bind to
mu receptors
47
is 6-MAM psychoactive
yes
48
which receptors does 3-MAM bind to
none I think (not psychoactive)
49
is 3-MAM psychoactive
no
50
which MAM product is psychoactive
6-MAM
51
which MAM product binds to mu receptors
6-MAM
52
what happens to 3 and 6 MAM
converts into morphine
53
what is a way to tell if someone was on heroin (legal cases)
6-MAM (only produced from heroin)
54
is 6-MAM or 3-MAM only produced when you take heroin
6-MAM
55
how does black tar heroin get its color from
heroin mixed with 3-MAM and 6-MAM formed from incomplete acetylation reaction
56
where does krokodil come from
Russia
57
what is desomorphine
krokodil
58
what makes krokodil/desomorphine
codeine, red phosphorus, gasoline, iodine, HCl
59
is krokodil/desomorphine or morphine more potent and why
krokodil/desomorphine because it is more lipophilic
60
how is krokodil/desomorphine administered
IV
61
why does krokodil/desomorphine cause so much damage
because the final product is unfiltered
62
what happens to the skin when you take krokodil/desomorphine
abseccess, gangrene, large-scale necrosis
63
what opioid class is krokodil/desomorphine
semi-synthetic
64
what opioid class is oxycodone
semi-synthetic
65
what is one of the most abused prescription analgesics
oxycodone
66
what is percocet
oxycodone +acetaminophen
67
what is percodan
oxycodone and aspirin
68
what is the difference with oxycodone and oxycontin
oxycontin contained much more oxycodone, time release, could be crushed
69
what is the difference with oxycodone and oxyneo
a new version (from oxycontin) slow release with polyethylene oxide (polymer)
70
which drug replaced oxycontin and why
oxyneo | people abused oxycontin, this had a polymer in it
71
what was added to oxyneo to make it different
polyethylene oxide
72
what is polyethylene oxide (1 word)
polymer
73
what happens when polyethylene oxide is exposed to water
turns into a gummy gel
74
why couldnt people abuse oxyneo as easily as oxycontin
it forms a gummy gel when exposed to fluid
75
what happened to demand when oxyneo went to the market (+ explanation)
demand went down, abusers switched to heroin and other opioids (fentanyl)
76
where does most fentanyl in canada come from
china
77
where do bad guys sneak fentanyl into
"oxycontin" pills, heroin, cocaine, MDMA
78
how does resp depression from fentanyl compare to from other opioids
much higher depression
79
how is fentanyl used clinically
surgical anesthetic and analgesic, but also lollipops and patches to control pain
80
how much more potent is fentanyl than morphine
100X
81
how much more potent is fentanyl than heroin
40-50X
82
why is fentanyl sooooo potent
very highly lipophilic
83
how much more potent is carfentanyl than morphine in managing pain
10000X times
84
how many mg of morphine is lethal
150-200mg
85
how many mg of heroin is lethal
12-180mg
86
how many mg of fentanyl is lethal
2mg
87
how many mg of carfentanyl is lethal
0.02
88
how much more potent is carfentanyl than fentanyl
100X
89
how much more potent is 3-methylfentanyl than fentanyl
10-15
90
what happens to heroin and morphine in stomach pH wise and why
they become ionized because they are weak bases
91
are heroin and morphine well absorbed in stomach
no
92
why is heroin and morphine so bad orally
not well absorbed in GI and major first pass metabolism (liver)
93
which opioids have been designed to be taken orally and absorbed from GI
oxyneo | methadone
94
what is a specific medical issue that comes with chasing the dragon
destruction of white matter in cerebellum (leukoencephalopathy)
95
what is leukoencephalopathy
destruction of white matter
96
what kind of destruction happens with chasing the dragon / leukoencephalopathy
spongiform destruction
97
what is spongiform destruction
sponge like appearance of brain due to loss of tissue
98
what causes spongiform destruction
leukoencephalopathy from chasing the dragon
99
what are the symptoms of leukoencephalopathy/ spongiform destruction
ataxia, apathy, akathisia, complete inability to speak or more
100
what is akathisia
compulsive need to more
101
why does chasing the dragon cause leukoencephalopathy/ spongiform destruction
maybe the tin from the tinfoil, or contaminant - unsure
102
how do you chase the dragon
heat on tin foil, inhale the fumes | you can also use a pipe
103
how do you prep heroin for injection (3)
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
what is a stupid thing heroin users do to filter out impurities bacteria and viruses
draw it up through a cotton ball
105
can heroin be snorted
yes
106
can morphine be snorted
no
107
why can heroin be snorted
it crosses mucosal membranes
108
what causes track marks
scars left by frequent injections, especially with dull reused needles
109
what does multiple injections do to the vein and why
collapsed vein due to scarring
110
why are crushed pills especially dangerous to vein health
due to the fillers in them
111
what happens when veins collapse to blood flow
blood is rerouted through deeper smaller veins

PMCOL 305 (26 decks)

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