substance misuse: chapter 18 Flashcards
what are 8 drugs that fall under the class of opioids
heroin, codeine, hydrocodone, hydromorphone, meperidine, morphine, fentayl, oxycodone
mechanism of action of opioids
block receptors in the cns
effect of opioids (4)
analgesia, drowsiness, euphoria, reduced sensory response
indication for methadone. why
opioid dependence. long acting drug to reduce cravings, suppress euphoria, and prevent withdrawal
3 contraindications for opioids
high doses or prolonged use with pregnancy, respiratory depression, severe asthma
4 cns adverse effects of opioids
diuresis, miosis, convulsions, respiratory depression
4 non cns adverse effects of opioids
hypotension, decreased urinary retention, flushing, sweating
what is the peak period for opioid withdrawal
1-3 days
how long do opioid withdrawal symptoms last for
5-7 days
7 signs of opioid withdrawal
drug seeking, dilated pupils, goosebumps, sweating, rhinorrhea, lacrimation, elevated bp and pulse
4 symptoms of opioid withdrawl
desire for drugs, muscle cramps, arthralgia, anxiety
why is naltrexone used. why
to prevent euphoria that is produced by opioids because it blocks opioid receptors
what is methylnatrexone
the injectable form of naltrexone
what is naloxone used for. what two drugs is it commonly combined with
used for opioid overdose and respiratory depression. commonly combined with buprenorphine or hydromorphone
what are 3 classes of amphetamines
salts of racemic amphetamine, dextroamphetamine, methamphetamine
effects of cocaine
creates the temporary illusion of limitless power and energy but leaves the user feeling depressed, edgy, and craving more
what 4 things does dextroamphetamine effect
mood, behaviour, cognition, mental status
which amphetamine has the strongest effect on the body
methamphetamine
what is another name for methylenedioxymethamphetamine
ectasy
how do the effects of ecstasy differ from other amphetamines
it has a more calming effect but can also be energizing
mechanism of action of amphetamines
stimulate the release of norephinephrine which stimulates the cns and cardiovascular systems
what are the general effect of amphetamines (4)
elevate mood, reduce fatigue, increase alertness, increase aggression
7 cns adverse effects of amphetamines
fainting, hypoactive reflexes, fever, aggression, delirium, hallucinations, suicidal or homocidal tendencies
5 cardiovascular adverse effects of amphetamines
chilliness, pallor/flushing, tachycardia, hyper or hypotension, cardiac arrest
2 gi adverse effects of amphetamines
metallic taste, abdominal cramps
what is a potentially fatal adverse effect of amphetamines
hyperthermia
what is the peak period for withdrawal from amphetamines
1-3 days
how long do withdrawal symptoms last from amphetamines
5-7 days
3 signs of amphetamine withdrawal
social withdrawal, psychomotor retardation, hypersomnia
3 symptoms of amphetamine withdrawl
depression, suicidal thoughts/behaviours, delusions
treatment for amphetamine withdrawal/overdose
no pharmacological treatments or antidotes. treatment is supportive and the patient is usually sedated
how does death from amphetamine overdose usually occur (3)
convulsions, coma, cerebral hemorrhage
what are the two main classes of depressants
benzodiazepines, barbiturates
which drug is a benzodiazepam
flunitrazepam
mechanism of action of depressants (marihuana)
THC binds to cannabinoid receptors in the cns which stimulates the sympathetic system and inhibits the parasympathetic system
4 effects of marihuana
euphoria, memory lapses, enhanced appetite, distortion of time and space
4 cns adverse effects while on depressants
sedation, loss of coordination, dizziness, hallucinations
what can long term use of marihuana during childhood lead to
cognitive and psychomotor problems
what chronic syndrome has been seen in adolescents who regularly use marihuana
chronic, depressive “amotivational” syndrome
peak period of depressant withdrawal (short acting and long acting)
2-4 days for short acting, 4-7 days for long acting
duration of depressant withdrawal symptoms
4-7 days for short acting, 7-12 days for long acting
5 signs of depressant withdrawal
increased psychomotor activity, hyperthermia, delirium, increased bp and pulse, muscle weakness
treatment for benzodiazepine withdrawl
7-10 day taper or 10-14 day taper for long acting
which drug is used for the tapering of benzodiazepines
diazepam
treatment for barbiturate withdrawal
7-10 day taper or 10-14 day taper
what is a benzodiazepine reversal drug
flumazenil
mechanism of action of alcohol (2)
cause cns depression by dissolving lipid membranes in the cns, enhance gaba
effects of alcohol (5)
vasodilation, sweating, diuretic effect, respiratory stimulation or depression
what are systemic uses of alcohol (what can it treat)
methyl alcohol and ethylene glycol intoxication (drinking automotive antifreeze)
what are 5 adverse effects of long term excessive ingestion
neurological and mental health disorders, seizures, alcoholic hepatitis, cardiomyopathy, vitamin b deficiency
what 4 things can vitamin b deficiency lead to
wernicke’s encephalopathy, korsakoff’s psychosis, polyneuritis, nicotinic acid deficiency encephalopathy
what is fetal alcohol syndrome characterized by (3)
craniofacial abnormalities, cns depression, prenatal and postnatal growth restriction
when can alcohol withdrawal begin
6-12hrs after the last drink
peak period of alcohol withdrawal
2-3 days
how long can alcohol withdrawal symptoms last for
7 days
mild signs and symptoms of alcohol withdrawal (bp, hr, temp)
systolic bp greater than 150mmhg, diastolic bp higher than 90mmgh, hr greater than 110, temp above 37.7
moderate signs and symptoms of alcohol withdrawal (bp, hr, temp)
systolic bp 150-200mmhg, diastolic bp 90-140mmhg, hr 110-140, temp 37.7-38.3
severe signs and symptoms of alcohol withdrawal (bp, hr, temp)
systolic bp above 200mmhg, diastolic bp above 140mmhg, hr above 140, temp above 38.3
treatment for alcohol withdrawal
supportive to stabilize the patient and maintain airway. can use benzodiazepines
what does disulfiram do
alter metabolism of alcohol so that severe effects are seen which much lower amounts of alcohol
what happens if a patient drank alcohol within 3-4 days of taking disulfiram. what 6 specific signs and symptoms are seen
acetaldehyde syndrome. signs and symptoms include whole body vasodilation, hypotension, chest pain, intense headache, vertigo, difficulty breathing
why is acamprosate used for alcoholics/overdose
prevents relapse, restores balance between glutamate and gaba
3 mechanisms of action of nicotine
stimulate autonomic ganglia followed by depression of ganglia, stimulate cns and respiratory system, cause the release of epinephrine
3 effects of nicotine
increased heart rate and bp, increase activity in the bowels, increased stress
what can large doses of nicotine lead to. why
death due to respiratory failure
3 manifestations of nicotine withdrawal
cigarette craving, irritability, decrease in hr and bp
what 3 things can be used to help with nicotine withdrawal. how do these things help
nicotine transdermal patch, nicotine polacrilex (gum), inhalers. provide a lower dose of nicotine to gradually decrease dose
what drug is used as first line therapy for smoking cessation
bupropion
mechanism of action of varenicline
activate and antagonize nicotinic receptors in the brain
3 effects of varenicline
reduce the pleasurable effects of smoking, drowsiness, psychiatric symptoms such as depression and suicidality
is varenicline safe to use during pregnancy
no
