Opiods

Question 1

What are Endorphins? (3)

Answer 1

• naturally occurring substances in the body
• acts on the OPIOID receptors
• 3 groups: Enkephalins, Dynorphins, Endorphins

Question 2

Where are opioid receptors found and what are the different types? (2)

Answer 2

• found in the ON NEURONES in the PNS and CNS
• Mu receptors: highest affinity for ENDORPHINS
• Delta Receptors: enkephalins
• Kappa receptors: dynorphins

Question 3

What occurs with the stimulation of the opioid receptors?

Answer 3

• Pre-synaptic Neurones: Closure of Ca2+ channels (so stops NT release)
• Post-synaptic neurones: opens K+ channels causing HYPERPOLARIZATION making it harder for neurotransmission
• results in REDUCED release of NTs (Glutamate, ACh, Serotonin, NE, Subs.P

Question 4

Name a drug of ABUSE. (no medical use).

Answer 4

Heroine aka Diamorphine

Question 5

What are other complications that may occur due to IV heroine use?

Answer 5

• the use of dirty needles predisposes one to:
  >Hep. B and C
  > HIV
  > Bacterimia (>tricuspid endorcarditis)

Question 6

Why do people take OPIOIDS? (3)

Answer 6

• axn on Mu receptors
• PAIN RELIEF
• EUPHORIA
• SEDATION

Question 7

What are PNS effects of Opioids?

Answer 7

• warmth, flushing

- constipation

Question 8

What are the CNS effects of Opioids?

Answer 8

• In OD: > Respiratory Depression
• cough suppression
• miosis (pin-point pupils )

Question 9

What are clinical uses of opioids? (5)

Answer 9

• pain control
• diarrhoea (Loperamide)
• Acute pulmonary Edema (IV morphine helps calms the nerves)
• Cough suppression (Codeine)
• shivering from infection (give Meperidine)

Question 10

What is tolerance? (3)

Answer 10

• LESS effect of drugs over time
• HIGHER dosages of the drug is required to bring out the same affect
• —except MIOSIS and constipation persists despite tolerance

Question 11

How does acute intoxication present as?

Answer 11

• mood ranging from EUPHORIA to DEPRESSED mental status
• decr. BOWEL sounds
• decr. Respiratory rate
• miotic pupils
• —seizures (esp. with TRAMADOL and MEPERIDINE)

Question 12

How to treat acute intoxication?

Answer 12

• administer NALOXONE
• short-acting opioid antagonists
• high naloxone dose may cause WITHDRAWAL

Question 13

When and how does opioid withdrawal present as?

Answer 13

• in opioid dependant pts; withdrawal symptoms set in 6-12 hrs after last dose
• RESTLESSNESS (opp. of CNS depress.)
• yawning
• Rhinorrhea and lacrimation
• piloerection
• N.V.D
• abdominal cramps

Question 14

What drugs could be taken daily to prevent relapse?

Answer 14

• BUPRENORPHIN —a sublingual tablet
  (a partial agonist at OPIOID receptors; therefore partially activates OPIOID receptors)
• because it has antagonist effects; it can cause withdrawal symptoms

Question 15

What precaution is taken with the buprenorphin tablets to prevents its abuse?

Answer 15

• Buprenorphine tablet is combined with Naloxone
• naloxone is not absorbed sublingually
• if pt attempts to crush the tablet and inject it Intravenously —-NALOXONE kicks in to prevent a “high”

Question 16

What is another highly controlled treatment for opioid abuse?

Answer 16

• Methadone, a LONG-ACTING opiate

- reduces craving

Question 17

How does naltrexone prevent heroine abuse?

Answer 17

• stops the pt from getting a high from the shooting up

- (blocks opioid effect if taken) - prevents them from getting addicted again.

Question 18

Psychosis occurs which substances?

Answer 18

• cannabis
  LDS
  -Cocaine
  -NPS

Question 19

Some mental health issues a/w substance abuse?

Answer 19

-PTSD, Mania, Depression, ADHD, Anxiety, DSH

Question 20

WHAT STRENGTH to score on breathalyser to be charged?

Answer 20

-22mg

Question 21

Withdrawal symptoms of OPIATES?

Answer 21

• explosive diarrhea

- vomiting