Opiates - Ley

Question 1

(blank) is a morphine derived alkaloid and is 2-3x more potent, a schedule I drug with a purity from 40-60%

Answer 1

diacetylmorphine

Question 2

what is the street value of a kilo of heroin?

Answer 2

130-150k

Question 3

What fraction of the world’s supply of heroin comes to the US?

Answer 3

half

Question 4

what percent of high schoolers have tried vicodin? oxycodone?

Answer 4

vicodin: %
oxycodone: 5%

Question 5

What percent of 12th graders develop lifetime use?

Answer 5

1.5%

Question 6

what percent of high schoolers have used IV drugs?

Answer 6

0.7%

Question 7

how many heroin addicts are there in the US?

Answer 7

800k

Question 8

What percent of the world’s supply of vicodin is in the US?

Answer 8

99%

Question 9

what percent of the world’s supply of oxycodone is in the US?

Answer 9

82%

Question 10

T/F: more people die of overdoses each than car crashes, crack in the 80s and heroin in the 70s

Answer 10

true

Question 11

T/F: male to female drug abuse is roughly similar

Answer 11

true

Question 12

What racial group is most likely to abuse heroin

Answer 12

whites

Question 13

What is the average age of the heroin useer? is this true in reno?

Answer 13

35; younger in reno

Question 14

what percent of people that try heroin will become addicted?

Answer 14

25%

Question 15

What are the risk factors for heroin addiction?

Answer 15

trying heroin
first degree relatives with SUD
the social learning of use (context, age of first use)
environmental stimuli

Question 16

What percent of heroin users OD?

Answer 16

75%

Question 17

the (blank) axis and opioid systems are linked via stress-induced analgesia

Answer 17

stress axis

Question 18

What are the three opioid peptides/

Answer 18

enkephalins
endorphins
dynorphins

Question 19

the opioid peptides are derived from….

Answer 19

POMC (pro-opiomelanocortin)

Question 20

What receptors do opiates act on?

Answer 20

mu
kappa
delta

Question 21

Opioids with abuse potential are selective for which receptor?

Answer 21

mu

Question 22

You are more likely to get sick from opiates if….

Answer 22

pain isn’t present (N/V, itching, apathy)

Question 23

T/F: there is a linear relationship between risk of respiratory depression and dose

Answer 23

true

Question 24

What neuro pathway is implemented in opioid reinforcement?

Answer 24

dopamine

Question 25

t/f: opioid reinforcement is separate from dependence and analgesia

Answer 25

true

Question 26

What are the negative physiological effects of opiates?

Answer 26

1. CV: suppression of vasoconstriction (important in shock) 2. depress cough reflex 3. CONSTRICT pupils 4. diminished response to CO2 in the brainstem 5. emesis, gastric motility, constipation 6. reduce testosterone and cortisol 7. hypogonadism via decreased GRF 8. dyslipidemia 9. concentration and attention imapired 10. robbed of will

Question 27

Heroin is a (full/partial) agonist

Answer 27

full agonist

Question 28

how well does heroin cross the BBB?

Answer 28

readily

Question 29

How long does heroin onset after: snorting subq IV

Answer 29

snort: 30 minutes subq: 15 minutes IV: instant

Question 30

what are the desired effects of heroin?

Answer 30

tranquility euphoria clouding of the sensorium

Question 31

use of heroin increases your overall mortality by how many fold?

Answer 31

7x

Question 32

What is codeine?

Answer 32

10% methylated to morphine

Question 33

Codeine has (low/high) affinity for opioid receptors

Answer 33

low affinity

Question 34

what are the alkaloid derivatives found in poppy sap?

Answer 34

morphine codeine thebaine papaverine

Question 35

What is tramadol?

Answer 35

a synthetic opioid analog

Question 36

(blank) can cause spasms of the sphincter of Oddi and has a risk of seizures

Answer 36

Demerol (meperidine)

Question 37

What is 100x more potent that morphine

Answer 37

Fentanyl

Question 38

vicodin use jumped what percent from 97-06?

Answer 38

270%

Question 39

oxy use jumped what fold from 97-06?

Answer 39

7 fold

Question 40

methadone use jumped what fold from 97-06?

Answer 40

15 fold

Question 41

Nevada is the number one state for (oxy/vicodin)

Answer 41

vicodin

Question 42

What is hyperalgesia?

Answer 42

actually makes one more sensitive to pain

Question 43

what drug is the dragon?

Answer 43

methadone

Question 44

How quickly do doses escalate in methadone?

Answer 44

really fucking fast

Question 45

Is methadone long or short acting?

Answer 45

long actign

Question 46

How is methodone cleared from the body?

Answer 46

CYP 3A4

Question 47

what are the negative side effects of methadone?

Answer 47

``` loss of teeth no libido wt. gain insomnia irregular menstruation ```

Question 48

Which is a prodrug, oxy or hydrocodone?

Answer 48

hydrocodone

Question 49

Oxycodone is cleared via what system?

Answer 49

CYP 2D6

Question 50

Oxycodone has (low/high) bioavailability

Answer 50

high

Question 51

What are the three stages of dependence?

Answer 51

1. initiation 2. continuation 3. detox/withdrawal

Question 52

initiation is reinforced via which receptors?

Answer 52

mu;

Question 53

conditioned responses and craving are which stage of dependence/

Answer 53

initiation

Question 54

Which stage of dependence is characterized by multiple nuerotransmitter involvement and dopamine in the nucleus accumbens/

Answer 54

continuation

Question 55

What two neurotransmitters are involved in detox and withdrawal?

Answer 55

glutamate and NE

Question 56

opioid receptors are (blank) style receptors

Answer 56

GPCRs

Question 57

(blank) of the opioid GPCR becomes sensitized as use progresses

Answer 57

adenlyl cyclase

Question 58

What are the molecular changes with opiate use?

Answer 58

1. adenyl cyclase sensitization 2. transcription factor upregulation 3. alterations in transmembrane signaling and transduction 4. reinforcement via inhibition of GABA (inhibition of DA in the VTA)

Question 59

what percent of HIV pts have injected opiates?

Answer 59

30%

Question 60

What percent of IV uses have hep C?

Answer 60

60-90%

Question 61

what drug is used to reverse coma in OD pts?

Answer 61

naloxone

Question 62

What are the methods of harm reduction in opiate tx?

Answer 62

reduce needle sharing injection rooms heroin maintanence substitution therapy

Question 63

what percent of opiate abusers relapse?

Answer 63

80%

Question 64

When do detox symptoms peak?

Answer 64

48-72 hours (methadone is longer)

Question 65

What drug isused for active optiate withdrawal?

Answer 65

suboxone (buprenorphine/naloxone)

Question 66

What are the Sx of protracted abstinence syndrome?

Answer 66

Can last up to 6-7 months after withdrawal Vague sense of feeling abnormal Depression (increased propensity to sleep) Abnormal response to stress Abnormal respiration and temperature Decreased self-esteem Anxiety Craving Confounded by high comorbidity with other psychiatric disorders

Question 67

During detox, clonidine has effects on the rewards system and may inhibit hyperactivation of (blank) pathways

Answer 67

NE

Question 68

What drugs do you give on a Sx basis during detox?

Answer 68

valium immodium Ibu trazodone

Question 69

What part of the brain mediates the sx of withdrawal?

Answer 69

locus ceruleus

Question 70

Suboxone can be used as an alternative for which two drugs?

Answer 70

methadone | heroin

Question 71

Abstinence based therapies have (good/poor) outcomes

Answer 71

poor

Question 72

What do you need to do to prevent relapse?

Answer 72

have contigency management and psychosocial therapy | 12 step also works well

Question 73

Patients in pain management often which psych co-morbidities?

Answer 73

anxiety and depression

Question 74

Lifetime substance use in context of pain management is up to (blank)%

Answer 74

56

Question 75

chronic pain patients have increased risk of....

Answer 75

addiction | abuse and dependenc> 30%

Question 76

What should you use to measure pain?

Answer 76

validated pain scales assess via PQRST assess physiological and psychological effects of pain

Question 77

What are the physiological effects of chronic pain?

Answer 77

heightened sensitivity to pain increased catabolic demand autonomic hyperactivity

Question 78

what are the psychological effects of chronic pain?

Answer 78

negativity sleep disturbance low energy struggle with personal meaning

Question 79

T/F: exercise, therapy, and mindfulness are effective pain management strategies

Answer 79

true

Question 80

T/F: medication is often the answer to chronic pain

Answer 80

false