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PAS > WK 8- OPIATES, BENZODIAZEPINES AND AMPHETAMINES > Flashcards

WK 8- OPIATES, BENZODIAZEPINES AND AMPHETAMINES Flashcards

1
Q

What is the MOA of opioids

A

Agonises Mu opiod receptor-> decreases release of GABA and increases the release of dopamine into the cortex

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2
Q

Are opioids depressants or stimulants

A

Depressants

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3
Q

What is an example of a short acting and long acting opioid

A

SA: Heroin
LA: methadone

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4
Q

What are opioids used for therapeutcially

A

Treating pain (acute more than chronic)

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5
Q

What are the major risks associated with using opioids

A

Accidental overdose leading to respiratory depression-> opioids suppress your respiratory drive

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6
Q

What is the difference between opiates and opioids

A

Opioids are synthetic versions that mimic the action of natural opiates

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7
Q

What are some of the effects of opioids (acute)

A

Pain relief, Heightened sense of well being, intense pleasure (not all people like this feeling- this is the driver of whether the person can develop addiction), warm, sleepy, impaired balance & incoordination, Slow breathing & HR and low BP, dry mouth, small pupils, Reduced appetite & sexual urges, Nausea, vomiting

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8
Q

What are some of the symptoms of overdose/high doses of opioids

A

Impaired concentration, drowsiness, Nausea, vomiting, Sweating, itching, increased urinary output or retention, Pinpoint pupils, drop in temperature, Breathing slow and shallow -Respiratory depression, Leukoencephalopathy (smoked heroin), Hypotension, bradycardia, irregular heart, Coma, Death

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9
Q

How are companies making pharmaceutical opioids ‘injection/tamper proof’

A

adding naloxone→ causes opiates to inactivate and prevent the high-> if taken orally though, the naloxone binds to opiate receptors in the GIT and prevents opiate induced constipation

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10
Q

What are the 5 steps to take to treat an opioid overdose

A
  1. DRABC→ danger, response, airway, breathing, consciousness
  2. Recovery position
  3. Ambulance
  4. Oxygen
  5. IV/IM Naloxone (Narcan)→ boot of the opiate from the opiate receptors and cause respiratory depression to be removed and person will begin to breathe on their own and wake up (if they respond, you then repeat→ 8-10mg should be max dosage)
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11
Q

What are the key symptoms of opiate withdrawal

A

symptoms (runny nose, yawning, goosebumps, fatigue)- subjectively very difficult to cope with, often accompanied by a sense of doom

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12
Q

What are the risks associated with opioid withdrawal

A

safe unless there are severe medical or psychiatric co-morbidities→ except in pregnancy where opiate withdrawal is FATAL TO FOETUS (will cause miscarriage)

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13
Q

When does the onset of heroin withdrawal begin

A

8-24 hours and lasts around 4-10 days

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14
Q

When does the onset of methadone withdrawal begin

A

12-48 hours after and lasts for 10-20 days

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15
Q

What withdrawal scale is used to assess opioid withdrawal

A

COWS/SOWS (subjective opiod withdrawal scale (report from patient), one is a report from the practitioner

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16
Q

What approach should be used to cease opioid use

A

Any can be used, ‘swap’ therapies hold the best long term functional success in established dependence

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17
Q

What pharmaceuticals are used in opioid withdrawal

A

Buprenorphine or methadone can be used in withdrawal or as substitution therapy

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18
Q

What is the public health program used to target opioid use

A

AIMS-
Aims to; Reduce the spread of BBV, Reduce injection related harms, Reduce crime rates, Improve engagement in treatment
Requirements→ generally over 18 and opiate DEPENDENT

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19
Q

What are some risk reductions to take when prescribing opioids in general pop

A

-lowest dose, shortest time, avoid in chronic pain, avoid combinations with other CNS depressants (including alcohol)

20
Q

What are benzodiazepines

A

Sedative hypnotics that are dissociative and create a sense of wellbeing and euphoria
eg diazepam, alprazolam, oxazepam, temazepam

21
Q

Are benzodiazepines a stimulant or depressant

A

depressant

22
Q

What is the no.1 risk when taking benzo’s

A

Respiratory depression- takes out your 2nd respiratory drive

23
Q

What are the side effects of benzo use

A
  • Memory impairment (used for repeated procedures to prevent build up trauma)
  • Falls (sedation, drop BP, dizziness)
  • Mimic borderline personality disorder with chronic use (should get off benzos before detox)
  • Mimic ADHD (paradoxical excitation, mania on withdrawal)
  • Increase all-cause mortality
  • Suicide risk increase
  • Ataxia
  • Cognitive impairment
  • Reflex tachycardia
  • Seizures (hard to treat)
24
Q

What are the key symptoms of benzo withdrawal

A

Nausea and vomiting, headache, HTN, agitation, confusion, hallucinations, tremor

25
Q

What are the key risks with benzo withdrawal

A

Can be fatal, seizures relatively common -> have to be careful as benzos are used to treat seizures-> if you give a benzo can potentially take out second resp drive

26
Q

When does withdrawal from benzo’s begin

A

short half-life benzodiazepines occurs after 1-2 days and lasts around 2-4 weeks (longer in some case), withdrawal from long half-life benzodiazepines occurs 2-7 days after and can lasts 2-8 weeks (longer in some cases)

27
Q

What withdrawal scale is used to assess the withdrawal from benzo

A

CIWA-B

-clinical institute of withdrawal assessment- benzodiazepine

28
Q

What approach is taken towards benzo withdrawal (what methdo)

A

Generally try to avoid severe withdrawal by tapering the dose.
-If taking a short acting benzodiazepine, usually swap to a long acting (at approx 50% equivalent dose) and taper

29
Q

What is an amphetamine

A

A stimulant drug that activates the CNS (psychostimulant)- includes nicotines, cocaine, caffeine, amyl nitrate, ecstasy

30
Q

What are the harms of amphetamine use

A

rhabdomyolosis, renal failure, stroke, MI, seizures, cardiac failure, malnutrition, Increase HR (irregular), RR, T and BP. Veins damage from injection (30% Psychotic episode-20% hospitalised), Tetanus, Damage to heart, lungs, liver and brain, Accidental overdose

31
Q

What are the effects of acute amphetamine use

A

Loss of inhibition, restlessness, increased libido, excitement, panic, confidence, reckless behaviour, seizures, strokes, pyschosis, pallor, headache, dizziness, blurred vision, tremors, irregular heartbeat and breathing, nausea, cramps

32
Q

What are the effects of chronic amphetamine use

A

Long-term effects of amphetamines:
- Chronic insomnia, hypertension, rapid and irregular heart beat, heart attack, failure, self medication with psycho-depressants, unsafe sex, malnutrition, less resistance to infections, blood borne disease, psychosis, anxiety, depression, brain damage

33
Q

What is amphetamine psychosis

A

imaging shows bleeding, ischaemia with infarct of brain, significant changes in blood flow with permanent cognitive impairment such as memory loss-> tactile hallucinations

34
Q

What is the difficulty with diagnosis amphetamine psychosis

A

Due to the insomnia suffered by users, it is hard to tell whether the erratic bizarre behaviour is due to lack of sleep, or psychosis

35
Q

What are the complications of using amphetamine during pregnancy

A

Bleeding, premature labour, miscarriage

  • Increased HR→ less O2 to baby – small birth weight and slow growth and development
  • Overactive and agitated at birth if amphetamines used near delivery→ fetus will display withdrawal symptoms (neonatal absence syndrome)
36
Q

What are the features of withdrawal from amphetamines

A

Mimics depressant intoxication
-Sweating, Nausea, Vomiting, appetite disturbances, Restless, Irritability, cranky, angry, violent reactions, Loss of self-control, Anxiety, panic attack, Depression, Headaches, Muscles/abdominal cramps, aches and pain

37
Q

What are the risks associated with amphetamine withdrawal

A

predominately left over from intoxication- heart complications, stroke, rhabdomyolysis, renal failure, psychosis, self harm, treatment resistant sever depression

38
Q

What scale is used to assess withdrawal from amphetamines

A

amphetamine withdrawl scale

39
Q

What approach is used for the withdrawal of amphetamines

A

usually symptomatic relief and psychotherapy, Can sometimes use a SLOW approach-> there are no pharmacotherapies that allows you to treat the cravings-> can only treat the symptoms

40
Q

When does withdrawal from amphetamines begin

A

occurs 12-24 hours after last amphetamine use and subsides by 2-4 days

41
Q

When does withdrawal from cocaine begin

A

2-4 days, duration 10 weeks

42
Q

What harms can chronic cocaine use cause

A

hyperthermia, pulmonary oedema, seizures, muscle rigidity
-Snorting: chronic nose run/sniffing, nose bleeds, septal erosion and back into the sinuses and sometimes even the palate (nasal collapse)→ bacteria can move through the collapsed nasal passage into the brain and can cause meningitis/septicaemia

43
Q

What symptoms are representative of the ‘crash’ phase in amphetamine use

A

Similar to those experienced in withdrawal-> Exhaustion, fatigue, sleep disturbances, mood disturbances, anxiety, agitation, generalised aches and pains, low cravings

44
Q

What harms can result from chronic ecstasy use

A

Like amphetamines with more prominent hyperthermia, hyponatremia

  • Possible liver toxicity, neurotoxicity
  • high dose is known to kill serotinergic brain neurons
45
Q

What are the symptoms of overdose of GHB- gamma hydroxybuterate

A

hypnotic with narrow therapeutic window so OD is a real risk→ N&V, seizures, aggression, respiratory depression, coma

PAS (11 decks)

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