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opiates Flashcards

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1
Q

define opium

A

fluid obtained from the poppy plant

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2
Q

define opiate

A

a substance derived from opium

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3
Q

define opioid

A

substance with morphine-like actions, but not derived directly from the poppy plant

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4
Q

which plant does opium come from

A

papaver somniferum

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5
Q

where does this plant grow

A

SEA
Middle East
LATIN
SOUTH AMERICA

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6
Q

process of deriving opiuim from poppies

A

After flowering, the petals drop in a few days leaving bulbous green capsules atop the stalks.
• These are the seed pods.
Incisions are made in the pods and the milky fluid that oozes out is air dried.
• This must be done while the
pods are still green.

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7
Q

what opiates are derived from the poppy plant

A

MORPHINE 4-21

CODEINE 1-25

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8
Q

the main receptor that opiates work on

A

mu receptor

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9
Q

name the different opiate receptors and activation effect

A

mu1 - analgesia, euphoria
mu2 - constipation, respiratory depression
kappa - spinal analgesia
delta - analgesia through the endorphin, enkephalins, dynorphin system

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10
Q

define agonist

A

fully binds

morphine like effect ie heroin, weak binding except for fentanyl

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11
Q

define partial agonist

A

weak morphine-like effects with strong receptor affinity ie buprenorphine

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12
Q

define anatagonist

A

no effect in absence of an opiate or opiate dependence ie naltrexone

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13
Q

what’s the name of active metabolite of morphine

A

morphine-6-glucuronide
gets into the brain quicker than morphine
10X more potent than morphine

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14
Q

chemical name of codeine

A

3-O-methyl morphine

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15
Q

chemical name of heroin

A

diacetylmorphine

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16
Q

when heroin is hydrolysed what is the name of the byproduct

A

6-MAM

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17
Q

Which metabolite is only found when heroin is used

A

6-MAM

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18
Q

what can be seen in the urine when poopy seeds are eaten

A

morphine

codeine

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19
Q

what morphine level is indicative of abuse

A

above 5000ng/ml

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20
Q

which medications do not metabolise to morphine and codeine

A

hydrocodone
hydromorphone
methadone
oxycodone

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21
Q

what are opiate user’s desired effects

A

sedation
euphoria
analgesia

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22
Q

opiate effects after IV injection

A

warm skin rush
pruritus, morphine use which releases histamines
pleasure, relaxation and satisfaction in 45 seconds

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23
Q

effects of opiate intoxication

A 
miosis
nodding
hypotension
depressed respiration
bradycardia
euphoria
floated feeling
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24
Q

classic triad seen in opiate overdose

A

miosis
coma
respiratory depression

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25
other symptoms of opiate overdose
pulmonary oedema | seizures
26
opiate overdose treatment
Naloxone 0.4mg/ml IV push no response then 2mg/ml IV push every 2-3 minutes until a total dose of 10mg is given or a response
27
what do heroin users die of
overdose murder suicide street crime
28
name the different phases of withdrawal
early middle late
29
first phase of withdrawal symptoms
Lacrimation • Yawning • Rhinorrhoea • Sweating sense of anxiety and doom, though not life threatening
30
second phase of withdrawal symptoms
``` Restless sleep • Dilated pupils (mydriasis) • Anorexia • Goose-flesh • Irritability • Tremor ```
31
third phase of withdrawal symptoms
``` Increase in all previous signs and symptoms • Increase in heart rate • Increase in blood pressure • Nausea and vomiting • Diarrhoea • Abdominal cramps • Labile mood • Depression • Muscle spasm • Weakness • Bone pain ```
32
what is the 1/2 life of heroin
2-3 hours
33
onset of last dose for withdrawal
8-12 hours
34
peak of heroin withdrawal
48 hours
35
duration of heroin withdrawal
5-10 days
36
protracted opiate withdrawal symptoms
* Weight gain * Increased basal metabolic rate * Decreased temperature * Increased respiratory rate * Increased blood pressure * Menstrual irregularities (secondary to increased prolactin hormone levels)
37
what type of withdrawal treatment used
inpatient or ambulatory detox - clonidine - buprenorphine - parietal agonist, few deaths associated - methadone
38
what other symptoms and medications you give in opiate withdrawal treatment
Examples include: • Hydroxyzine,Vistaril®,formildtomoderateanxiety • Oxazepam(15-30mgq6hours)orotherbenzodiazepineifsevere anxiety • Ibuprofen,Motrin®,formuscleandjointaches • Trimethobenzamide,Tigan®,fornausea • Bismuth subsalicylate, Kaopectate®, Pepto-Bismol® ,for diarrhoea • Dicycloverine, dicyclomine, Bentyl® for abdominal cramps
39
what are the neurologic complications of opiates
* Toxic amblyopia (optic nerve pathology) * Mononeuropathy (dysfunction of a single nerve) * Polyneuropathy (dysfunction of several nerves) * Meningitis * Brain abscess
40
what are the dermatological complications. of opiates
abscess • Tracks • Lymphangitis (swelling and dysfunction of the lymph system)
41
what are the pulmonary complications of opiates
- Aspiration • Pneumonia • Lung abscess • Pulmonary emboli (clots going to the lung) • Pulmonary fibrosis (scarring of the lung) • Noncardiogenic pulmonary oedema (lung fills with fluid not as a result of heart dysfunction)
42
what are the hepatic complications of opiates
hep B C D G
43
What infections can you get from using opiates
endocarditis due to the needle use | tetanus in immigrants in california
44
what are the different formulations for hydromorphone
dilaudid | palladone
45
what are the different oxycodone formulations
oxycontin oxyir percodan Percocet
46
how can oxycontin be taken
oral crushed sniffed or dissolved in water and injected
47
different hydrocodone formulations
``` hycodan lorcet lortab tussionex Vicodin ``` used as schedule 2 analgesic and antitussive potency equals morphine
48
what is dextropropoxyphene
IV
49
what are the different formulations of fentanyl
sublimaze- IV Duragesic - transdermal patch Actiq - lollipop iv smoked snorted oral transdermal
50
name a fentanyl analog
carfentanil used to immobilise large animals
51
what does phase 1 of methadone maintenance consist of
methadone stabilisation - stabilise the patient for 3-9 months - Programs closely monitor and frequently counsel patients to help reach an effective methadone dose level and cease opioid use. • During inform patients about methadone and available services. Programs focus on medical issues and stable living arrangements. methadone induction dose depends on patient
52
at what dose of methadone do we start of with
30mg typical with known tolerance
53
what is phase 2 of methadone maintenance
social integration 9-24 months Programshelppatientsalterpre-treatmentbehaviourandadopt positive habits and lifestyles, while stabilized on methadone. • Duringthisphase,programscontinuetodeliverfrequent counseling, if needed. • Programsfocusonvocationaltraining,educationalassistance,or other productive activities that help patients become self-sufficient.
54
what is phase 3 of methadone maintenance
MAINTENANCE/ONGOING SUPPORT • 24to48monthsorlonger • Patientsmayreceivecounselingserviceslessfrequently,if appropriate, while stabilized on methadone, as needed. • Duringthisphase,programsfocusonlate-stagetreatmentneeds, including continued maintenance, or tapering, or other personal issues presented by the patient.
55
what symptoms does one have when they are addicted
* Loss of control over the use of a substance * Time spent in trying to obtain the substance * Bio-psycho-social dysfunction * Continued use despite problems * Associated denial and dishonesty * Progressive and potentially fatal
56
what is the theory on methadone mechanism
prevents the 'off and on' so its always bound allowing patient to function normally
57
what are the advantages of using the opiod agonist
``` Decreases in illicit opioid use • Decreases in other drug use • Decreases in criminal activity • Decreases in needle sharing • Improvements in prosocial activities • Improvements in mental health ```
58
what medications can decrease the level of methadone in the blood
``` Carbamazepine • Alcohol • Pentazocine • Phenobarbital • Phenytoin • Rifampicin • Rifabutin ```
59
what medications can increase the level of methadone in the blood
Cimetidine • Ketoconazole • Erythromycin
60
what is LAAM
1 alpha acetylmethadol acetate oral active analog
61
how is LAAM better than methadone
slower onset | longer duration of action
62
what's the disadvantage of LAAM
cardiac arryhthmias like TORSADES DE POINTES
63
what are the desirable properties of buprenorphine
low abuse potential lower level of physical dependence weak opioid effect compared to methadone
64
bioavilability of buprenorphine
poor oral | sublingual absorption through the oral mucosa
65
pharmacological uses of buprenorphine
potent analgesic | treatment of addictions

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