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CM 21- Stimulants, Benzo, Barbs, Opiates, Heroin Psychostimulants Adderall (dextroamphetamine + amphetamine) Ritalin (methylphenidate) Cylert (pemoline) Strattera Provigil Methamphetamine 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 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 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 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 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