Download CM 21- Stimulants, Benzo, Barbs, Opiates, Heroin Psychostimulants

CM 21- Stimulants, Benzo, Barbs, Opiates, Heroin
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Psychostimulants
Adderall (dextroamphetamine + amphetamine)
Ritalin (methylphenidate)
Cylert (pemoline)
Strattera
Provigil
Methamphetamine
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Class II
Third most common behind ETOH & Marijuana
Speed, meth, ice crystal, crank, chalk
Pseudoephedrine, phenylpropanolamine, and ephedrine
Better regulated = decreased manufacture
Short term effects = releases dopamine
o Increases wakefulness; decreases appetite
o Oral or snorting long-lasting high
o Injecting gm every 2-3 hours (“run”)
o Long lasting high
Long-term effects
o Anxiety, confusion, paranoia, hallucinations, aggression
o 50% dopamine & serotonin cells destroyed
Withdrawal
o Depression, fatigue, paranoia, aggression, and craving
Benzodiazepines
11-15% take benzodiazepine, most use judiciously
80% of abuse is part of polydrug abuse, esp. opioids
Enhances GABA actions
Withdrawal symptoms
The shorter the half-life > the addiction potential
Paradoxical disinhibition may occur
Alcohol + benzos can be fatal
Benzos contraindicated in alcoholics (dry drunk)
Class D teratogen
May increase cognitive deterioration and depression
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Half-life
 Xanax (alprazolam) = shortest
 Ativan (lorazepam) = short
 Klonopin (clonazepam) = intermediate
 Librium (chlordiazepoxide) = long half-life
 Valium (diazepam) = half-life approximately 96-hours
Withdrawal
 Withdrawal often occurs in hospital
 Post-op = Ativan IV
 Switch to long acting benzodiazepine (Valium or Librium) and taper very slowly
 Tapering with clonazepam also very effective
Treatment
 Depakote (valproic acid) mitigates withdrawal symptoms, decreases seizure potential, decreases craving
o Loading dose = 10 X body wt BID first 24 hours
CM 21- Stimulants, Benzo, Barbs, Opiates, Heroin
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Barbituates
First introduced for medical use in the early 1900s
More than 2500 have been synthesized
About a dozen are in use now
Barbiturate abusers prefer Schedule II short-acting barbiturates
o Nembutal, Seconal
o Produce mild sedation to coma
Opiates
the term opiate describes any of the narcotic opioid alkaloids found as natural products in the opium poppy
plant, Papaver somniferum
Opium is acquired in the dried latex form from the opium poppy (Papaver somniferum) seed pod. The unripened
pod is slit open, the sap seeps out and dries into yellow-brown latex containing morphine and codeine
Morphine, Codeine, Hydrocodone, Oxycodone
Oxycodone
 Marketed as:
o Oxycodone alone
o Oxycontin = time released
 OC, OX, OXY, Oxycotton, Hillbilly heroin, Kicker
o OxylR or OxyFast = immediate release
o Percodan = oxycodone + aspirin
o Percocet = oxycodone + Tylenol
 10 mg oral dose = 10 mg subcu morphine
 8-12 hour duration of action
 Most serious risk = respiratory depression
o Narcan 0.4-2 mg IV
Hydrocodone
 Vicodin
 Hycodan
 Oral dose is six times stronger than codeine
 Semi-synthetic drug derived from codeine
Hydromorphone
 Dilaudid
 Derrivative of morphine
 Semi-synthetic drug
 Six to Eight times stronger than morhpine
Fentanyl
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Synthetic narcotic analgesic with a rapid onset and short duration of action
100 times more potent than morphine
Actiq (lollipop)
Duragesic (patch)
Fentora (buccal tablet)
Intravenous- used for anesthesia
First synthesized by Paul Janssen in 1960
CM 21- Stimulants, Benzo, Barbs, Opiates, Heroin
Side effects from Opioids
 Long-term effects
o Heart valve infection, abscesses, pneumonia ., apnea
 Withdrawal
o Restlessness
o Muscle and bone pain
o Goose bumps (cold turkey)
o Diarrhea
o Vomiting
Treatment of Opioid withdrawal
 Clonidine 0.1-0.2 mg Q6 hours
o Stimulates alpha-2 adrenergic receptors reducing sympathetic outflow from the CNS and decreasing
autonomic hyperactivity
o Central actions on alpha 2 receptors may improve behavior changes in drug withdrawal
 Ibuprofen 800 mg every 8 hours
 Zofran 4 mg Q6 hours prn N & V
 Bentyl 20 mg Q6 hours prn GI cramping
 Imodium 4 mg Q4 hours prn diarrhea
 Seroquel 25 mg-800 mg Q6 hours prn craving
o 5HT2A, 5HT2C, 5HT1A
Suboxone
 Suboxone is a combination of:
o Buprenorphine = partial opiate agonist
o Naloxone (opiate blocker to prevent IV use)
 Subxone has potential for abuse and produces dependence of the opioid type
 Suboxone has a milder withdrawal syndrome than a full agonist
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Heroin
Derived from morphine, heroin is 2-3 times more potent
Rush 7-8 seconds after IV injection. Sniffed or smoked = rush in 10-15 minutes
Considerable controversy regarding three techniques
1. “Soft” = methadone
 12-hour half-life that exerts pleasant effects
 High doses may be required to block heroin override
2. “Tough” = no methadone or other opiate
3. Suboxone