4 Methods of Drug Intake

Advantages

Disadvantages

1. IV- Titratable- No turning back

2. Smoked

3. IM- Rapid Onset- Discomfort, Tissue damage

4. Oral- Reversible, safe- Poor/slow absorption

Sedatives/Hypnotics

Alc-H, Barbituates-L

Stimulants

Nic-H, Cocaine- H

Opiates

Hero-H, Morph-H

Dependence

vs

dependence

Compulsive drug use with LOSS OF CONTROL over intake and emergence of negative emotional state upon cessation of chronic drug use

The manifestation of a withdrawl syndrome; you can have abstinence syndrome without addiction

DSM IV

definition of dependence

***

Tolerance

Withdrawl

Large Amounts

Time

Want to cut down, can not reduce

Activities reduced

Phys + Psych prob

Sched 1

No accepted medical use and high abuse potential

Heroin, Marijuana, LSD, MDM

Sched 2

High abuse potential and sever psychic and phys dependence

Opium, Morphine, Codeine, Methamphetamines

Sched 3

Less abuse potential than 1 and 2 and have compounds containing limited quantities of certain narcotic and nonnarcotics drugs

Nalorphine

Sched 4

Less abuse potential than 3

Barbital, Lorazepam

Sched 5

Less abuse potential than 4 and have moderate, limited quantities of certain narcotic drugs

Generally for antitussive or antidiarrheal purposes

Derived from opium, has morphine-like effect

Natural, Semi-synethic

Any drug natural or synethic that has morphine like effect

Natural, Endorphins, Semi-Synthetics, Synthetic

Any drug of abuse

(used to be sleep inducing drug)

Painful response to nonpainful stimulus

(opioid withdrawl)

Medical Uses

of

OPIOIDS

1. Analgeisa

-Acute-- pre/post surgery

-Chronic- cancer

-Epidural- baby

2. Cough

3. Dysentary+Severa Diarrhea

Stops you up/ Constipates you

Dose required to produce an effect relative to a standard

Potency is relative dose required to produce a desired effects

left less potent

right more potent

Percent maximum response a drug has

up inc in effective

down dec in effective

LD50/ED50

Alc = 1.0 = BAD

Imodium

Does not cross blood brain barrier

Half life 11 hours

Lomotil

Crosses the blood brain barrier but atropine prevents abuse

Half life 13 hours

-Analgesia selective to pain

raising of pain threshold

lowering pain

OTHER SENSORY MODALITIES NOT ALTERED

(touch, vibration, vision, hearing)

-Type of pain

better on continuous dull pain, not sharp intermitten pain

-Type of analgesic

Pain is present but patient feels more comfortable

POTENTIATION OF ANALGESIC EFFECT

CYP2D6 Enzyme

Breaks down coding or hydrocodine so you can not get the analgesic effect :(

Outpatient Analgesia

Oral, patch-trandermal

Inpatient Analgesia

IV titration possible

Patient controlled

-self admin

-doese less than oral

-greater relief

Balanced anesthesic

Aid in amnesia and analgesia

Remove autonomic effects

Often reduce post op pain

Use less anesthetic which lowers repiratory rate

Fentanyl 80x more potent than morphine

Respiratory depression

Nausea

Constipation

Mental clouding (sleepy, decrease in mem)

Itching (interaction with histamine)

NO BODY HARM!

No liver

No frontal cortex

No holes in brain

Euphoric effects

Most commonly taken parentenally either

1. sucataneously (skin popping)

2. intravenously (main lining)

4 STAGES

Heroin

1. Rush, Kick Thrill

2. Nod

3. High

4. Being Straight

Rush, Kick, Thrill

Heroin

Pronounced euphoria

45 seconds

Nod

Heroin

Feeling of drowsiness/solemness

"out of it"

Escape reality

Morpheous (God of Dreams)

Calm, distracted, content

Uninterested

Tolerance develops

15-20 minutes

High

Heroin

Feeling of general well being

1. Boundless strenght and energy

2. Pleasant/dreamlike state

ELIMINATION OF CARE+WORRIES

**BEING STRAIGHT**

Heroin

Hours 3-10/12

Normal- not sick, not suffering from withdrawl

Anxious at end for next fix

Drug use can begin with medical treatment (minor contribution)

"Recreational" drug use- primarily adolscents

Oral opaites- methadone from treatment cetners

1. Junkie

2. Chipper

Junkie

Opiates

Classic Addict

Longtime (chronic) user- only wants to know where it will come from next

Greatest fear is intense sickness that will come from withdrawl

95% of users inject

(D/d)ependent

Chipper

Opiates

Occasional opiate use, nondependent

Occasional use may go on for years

RULES

Refuse to inject

Plan for their use

Caution when getting drug

Budget money

Able to deter when opiates are NOT available

Drug use involves complex social relations

Little evidence of physicological pathology

No mental deteriation

Opiates

16-24 hours

*******

*************

Withdrawl

Short Acting

VS

Long Acting

drugs

Short Acting

Heroine

Short onset withdrawl

Short duration

Intense

Long Acting

Methadone

Long onset withdrawl (24+hours)

Long duration

Milder-less intense

Depedent

Substance Dependence Addiction

TREATMENT

Opiates

DETOX

Methadone

Buprenorphine

Cold Turkey

METHADONE MAINTENANCE

No illicit drug use

Subsititue of oral methadone for IV Heroine

Buprenorphine MAINTENANCE

No illicit drug use

Partial agnostic

Dexadrine

Methadrine

Preludin

Ritalin

Addy

**MADE UP OF 4 DIFFERENT AMPHETAMINE SALTS***

all these drugs indirectly push out NE

COKE

VS

METH
*********** 

Coke

Half life- 60 min

Potency- Less Potent

Effectiveness- Equal

Meth

Half Life- 12 hrs

Potency- More Potent

Effectiveness- Equal