Opiates, PEDs + Alcohol Flashcards
(26 cards)
How is opium extracted from the poppy seed plant?
Seedpod is incised with a blade
Milky fluid seeps from cuts in the unripe poppy seed pod
Scraped off and air-dried to produce opium
Dried in open wooden boxes
Resin is placed in bags or rolled into balls for sale
How is opium transformed for illicit use?
- Raw opium + hot water/Ca2+ oxide (lime) - Alkali pH dissolves morphine
- Ammonium chloride added after filtration to precipitate morphine
- Crude morphine powder ~50%
- Crude morphine + acetic anhydride/boiling to acetylate
- Brown heroin precipitation
- Hydrochloric acid purification - 75% diacetyl morphine = 6% yield
Which receptors do opioids work on and what reactions do they elicit?
Mu and Delta opioid receptors = reinforcement, reward and euphoria
Kappa (k) receptors = aversion, hallucinations, dysphoria (state of unease0
Describe how the euphoric effects of opiates arise
Euphoric effects of opiates arise from activation of opioid receptors on GABAergic neurons that inhibit dopaminergic neurons in the ventral tegmental area causing disinhibition and greater dopamine release from VTA presynapses terminating in the nucleus accumbens
What are the side effects of opioids?
Respiratory depression:
reduces sensitivity of respiratory centre; most common cause of death from overdose with street use of opioids
Euphoria:
action on reward pathway in the brain to increase dopamine release
Cough suppression (anti-tussive)
Nausea:
activate the chemoreceptor trigger zone (which in turn activates the vomiting centre)
Aspiration of vomit when unconscious common
Constipation:
due to maintained contraction of smooth muscle
Small pupils
Nausea, vomiting
Confusion or poor judgment
What are the long term effects of opioid use?
Addiction and tolerance leads to:
Ignore pain
Social withdrawal/job loss
Overdose
Describe some of the withdrawal symptoms?
Anxiety Irritability Craving for the drug Rapid breathing Yawning Runny nose Salivation Goosebumps Nasal stuffiness Muscle aches Vomiting Abdominal cramping Diarrhoea Sweating Confusion Enlarged pupils Tremors Loss of appetite
What are signs of an acute opioid overdose?
Sleepiness Loss of consciousness Widening of pupils Coldness, Clamminess, blue skin Slowed, shallow breathing Seizures
What is the procedure to deal with an overdose?
Assess patient to clear airway.
Provide support ventilation, if needed.
Assess and support cardiac function.
Provide IV fluids.
Frequently monitor the vital signs and cardiopulmonary status until the patient has cleared opioids from the system.
Give IV naloxone if necessary (opioid antagonist)
Administered intravenously or subcutaneously
Rapidly reverses the respiratory depression and sedation caused by heroin intoxication.
Naloxone (Evzio) as an autoinjector dosage form for home
Since 01/10/2015 any worker in a commissioned drug service can provide naloxone without a prescription
What is given as an opioid antagonist in a case of overdose?
Naloxone
What can be used as opioid drug replacement for therapy?
Opioid maintenance
Methadone maintenance (longer lasting effects, can be overdosed)
Buprenorphine/naloxone maintenance: 4/1 ratio (naloxone gives withdrawal symptom if used i.v.
Alpha-2 adrenoceptor agonists, such as clonidine and lofexidine
Diacetyl morphine:
Recent trials show better outcome
Societal resistance (see also approval of foil in kits)
Cognitive behavioural, supportive, or analytical-oriented psychotherapies
What are PEDs? Regulated by who?
Performance enhancing drugs
Regulated by WADA - World Anti-Doping Association
Give examples of groups of drugs that are PED types
Stimulants (such as amphetamines)
Anabolic steroids (such as nandrolone)
Diuretics (to help lower body weight)
Blood doping agents (such as EPO)
How would they boost oxygen in blood?
Homologous transfusion
Autologous transfusion
EPO treatment - hormone produced by kidney enhance oxygen during hypoxia 0 to 19mU/ml
Artificial blood substitutes
What are the side effects and risks of increasing oxygen levels in the blood?
Misuse can lead to thickening the blood
Heart disease, stroke, and cerebral or pulmonary embolism
May also lead to autoimmune diseases
When can using EPO be beneficial?
Proper use of EPO has an enormous therapeutic benefit in the treatment of anaemia related to kidney disease
What percentage of total deaths in the age group 20-39 are attributed to alcohol?
25%
How many units does a Standard glass of wine Large glass of wine Bottle of wine (750ml) contain?
Standard glass of wine: 2
Large glass of wine: 3
Bottle of wine (750ml): 9
How many units does a Pint of strong beer/lager Pint of normal strength beer/lager Can of normal strength beer/lager contain?
Pint of strong beer/lager: 3
Pint of normal strength beer/lager: 2
Can of normal strength beer/lager: 2
How many units does a Spirits double Alcopop bottle (250ml) Spirits single contain?
Spirits double: 2 Alcopop bottle (250ml): 1.4 Spirits single: 1
At the following % of alcohol in blood what effects are seen? 0.05 >0.1 0.3 0.4
0.05 = Stimulant, social relaxation >0.1 = Incoordination 0.3 = Unconsciousness 0.4 = Possible lethal level
What are 12 health risks of chronic heavy drinking?
Anemia Cancer Cardiovascular disease Cirrhosis Dementia Depression Seizures Gout Hypertension Infectious disease Nerve damage Pancreatitis
What are the scales of dependence in terms of detoxification?
Mild dependence (<20 units): home with no drugs Heavy dependence (>20 units): home with tranquilizers, chlordiaxepoxide Extreme cases: hospitalisation and drug administration
What are detoxification symptoms?
Withdrawal symptoms will be at their worst for the first 48 hours
This usually takes 3-7 days from the time of your last drink
Sleep is disturbed. Sleep patterns should return to normal within a month.
During detox, drink plenty of fluids (about three litres a day). Water, squash or fruit juice arebetter choices.
Risk of seizures during detox
