Lecture 20

Lecture 20 - Lecture 20 Historical Issues &...

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Lecture 20 – Historical Issues & Neurobiology of Opiates
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Key Concepts Doda Cycles of opiate withdrawal, detoxification Historical issues - China Opium Wars Opiate receptors (primary inhibitory action via cAMP, K + conductance) Endogenous opioid peptides – enkephalins, dynorphins, beta-endorphin Locus coeruleus (LC) – noradrenergic cell body region Clonidine (α2-adrenergic adrenergic agonist)
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http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/201003 19/doda_100320/20100320?hub=TopStoriesV2 Doda – CTV News broadcast
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Opiates Drug Equiv. Analgesic Dose (mg) Route Duration of Action (hrs) Strong Opioid Agonists Morphine 10 IM 4-5 60 PO 2-3 Hydromorphone 1.5-2 IM 4-5 (Dilaudid) 6-7.5 PO 4-5 Meperidine 75 IM 1-3 (Demerol) 300 PO 1-3 Anileridine 25 IM 2-3 (Leritine) 75 PO 2-3 Methadone 2.5-5 PO 18-24 Heroin 5-10* IV 3-4 * N.B. 1 point = 100mg
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The Slang of Opiates Heroin: Horse, Hoss, Junk, Smack, Shit, Anti-freeze, Aries, Aunt Hazel/Helen, Baretta, The Beast, Big-Time, Black Gold/Pearl/Tar, Blue Sky, Caballo, „Cotics, Crap, Golden Girl, H, Harry /Henry, Jazz, Jive, Racehorse Charlie, Tootsie Roll, White God, Witch Hazel, China White
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Opiate Withdrawal Restlessness (fidgety, leg jerks, tremor) , drug craving, sweating, extreme anxiety, depression, irritability, dysphoria, fever, chills, retching, panting, insomnia, explosive diarrhea, intense aches and pains Changes in temperature – fluctuating hot/cold Abdominal pain and cramps Sneezing Spontaneous ejaculations and orgasms Not life-threatening, but can seem unbearable
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Pharmacotherapy of Opioid Withdrawal- Detoxification Switch to longer acting drug e.g. Methadone, Buprenorphine Taper over 2 to 12 weeks depending on starting dose, duration of use, comorbidity (e.g. chronic pain), etc. First 50% rapid, second 50% slow Addition of other meds…see next slide
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Pharmacotherapy of Opioid Withdrawal Methadone (dose tailored to level of dependence- with initial dosing approximately equivalent to the daily amount of drug used) Clonidine 0.1 to 0.2mg QID PRN for general withdrawal symptoms monitor blood pressure
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Lecture 20 - Lecture 20 Historical Issues &...

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