This document discusses opioid dependence and addiction. It begins with an overview of opioids and their mechanism of action in the body. It then defines addiction, dependence, and tolerance. The mechanisms of dependence and addiction involve both negative reinforcement from withdrawal and positive reinforcement from rewarding effects. Physical dependence theory and positive incentive theory are described as models of addiction. The document outlines treatment options including drug substitution therapy with methadone or buprenorphine, abstinence-based treatment, and psychosocial treatments. It discusses opioid withdrawal and post-acute withdrawal syndrome. The six stages of recovery are defined. Special considerations for treating opioid addicts are noted.
antipsychotics history, managment of psychosis,side effect of antipsychotics, mechanism of antipsychotics, atypical antipsychotics,2nd generation antipsychotics.
This presentation gives detailed description of symptoms of catatonia with its etiologies and differential diagnoses. It should help to differentiate catatonia in neurological and psychiatric disorders.
antipsychotics history, managment of psychosis,side effect of antipsychotics, mechanism of antipsychotics, atypical antipsychotics,2nd generation antipsychotics.
This presentation gives detailed description of symptoms of catatonia with its etiologies and differential diagnoses. It should help to differentiate catatonia in neurological and psychiatric disorders.
Homeopathic Doctor - Dr. Anita Salunke homeopathic clinic for Drug Addiction ...Shewta shetty
Homeopathic Doctor Anita Salunke practices in Chembur, Mumbai, India in her homeopathic clinic Mindheal. Find more information about homeopathic treatment at Mindheal. Welcome to safe, sure and effective homeopathic treatment Drug Addiction
Effective treatment for drug addiction in Mindheal Homeopathy clinic ,Chembur...Shewta shetty
"Drug Addiction- drug addiction is characterized by the use of narcotic drugs or alcohol excessively so that when its usage is stopped withdrawal symptoms are manifested in the body. Drug addiction is a complex but treatable condition. It can be treated by proper rehabilitation of the patient along with mindheal therapy."/>
Therapeutic Drug Monitoring (TDM)
Discuss the logic for therapeutic drug monitoring, which refer to as (TDM)
List various classes of drugs that require TDM
General description of this therapeutic drag TD
Discuss the proper sample timing and method for TDM
And Discuss analytical methods available for TDM
List various drugs that not require TDM
Steady state
Therapeutic Drug Groups
Digoxin, quinidine, procainamide, disopyramide.
- Aminoglycosides (amikacin, gentamicin, kanamycin, tobramycin) - vancomycin
leucovorin rescue ?
First-pass metabolism
HPLC methods
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. WHAT ARE OPIOIDS? (A QUICK
REVIEW!)
Opioids are a class of drugs that act
primarily on the body’s opioid
receptors.
Opioids are often referred to as
narcotics.
They act by blocking μ, κ, σ and possibly
δ receptor classes.
Most opioid receptors are found in the
central nervous system and in the
gastrointestinal tract.
Morphine
3. ADDICTION, DEPENDENCE AND
TOLERANCE
Drug addiction: is a condition in which an individual has lost
the power of self-control with reference to a drug and
abuses the drug to such an extent that the individual,
society, or both are harmed.
Dependence: refers to a state resulting from habitual use of
a drug, where negative physical withdrawal symptoms result
from abrupt discontinuation.
Tolerance: describes the need for a drug user to administer
larger and larger doses of the drug to achieve the same
psychoactive effect.
4. MECHANISM OF DEPENDENCE
AND ADDICTION
a) Negative Reinforcement Models:
• Physical dependence (withdrawal) theory
–driven largely by opiates, barbiturates, alcohol
–based largely on tolerance and physical
dependence
• Self-Medication Hypothesis
b) Positive Reinforcement Models:
• Positive incentive (reward) theory
–driven largely by cocaine, amphetamine, nicotine
–based largely on reward and reinforcement
5. PHYSICAL DEPENDENCE THEORY
•Take drug -> nasty withdrawal goes away
•So by this theory, if we treat withdrawal (or wait for it to go
away), we treat addiction.
•Note that this theory assumes addiction = dependence
6. POSITIVE INCENTIVE THEORY
• Positive reinforcement - response that is followed by
pleasant consequences likely to be repeated
• Take drug to get euphoria or drug "high"
• Can account for addictiveness (most to least):
Amphetamine > Heroin = Cocaine >Morphine
7. •Initial exposure to a drug of abuse may produce effects
which are interpreted by the individual as “desirable” or
“pleasurable”, i.e. “rewarding”.
• These effects may lead to “craving” or “hunger” for the
drug, with resultant spontaneous activity or work for drug
acquisition and self-administration.
REINFORCING OR “REWARD”
EFFECTS
Kreek, 1987; 2005
9. NEURO CHEMICAL MEDIATORS
OF “REWARDING” OR
“REINFORCING”
Dopamine
Mu opioid receptor agonists (e.g., beta-endorphin and
enkephlins)
CRF and ACTH (e.g., cocaine and alcoholism)
+/- serotonin,
+/- norepinephrine
Kreek, 2003; 2007
10. MECHANISM OF TOLERANCE
Two factors have been isolated
1. Receptor Downregulation: Opioid receptors in the
body are actively reduced due to overexposure to
opioids. This can also have an effect on regular
functioning of endorphins.
2. Antiopiates: Chemicals like neuropeptide, orphanin,
nociceptin, have all been found to block the function of
opioids.
11. DSM-IV CRITERIA OF
DEPENDENCE
3+ in same 12 months
Tolerance
Withdrawal
Larger & longer use than intended
Can’t quit
Much time obtaining, using, or recovering
↓ activities
Continued use despite problems
12. DSM IV CRITERIA OF ABUSE
1 in 12 months:
Failure to fulfill role
Use in hazardous situations
Legal problems
Use despite problems
14. SYMPTOMS OF OPIOID WITHDRAWAL
After quit or ↓chronic use or use of opioid antagonist
DSM-IV criteria: 3+ (minutes to days):
Unhappy mood
Muscle aches
Tearing/runny nose
Pupillary dilation
Goose bumps or sweating
Nausea/Vomiting
Diarrhea – Fever - Yawning
16. WHO ARE IN THE RISK OF
ADDICTION
Rates of abuse and/or addiction in chronic pain
populations are 3-19%
Known risk factors for addiction are-
-Past cocaine use,
-History of alcohol or cannabis use,
-Lifetime history of substance use disorder
-Family history of substance abuse,
-Tobacco use
- History of severe depression or anxiety
17. OPIOID ADDICTION TREATMENT
OUTLINE
The three most prevalent approaches:
•Drug Substitution Treatment, which is also called “medication-
assisted treatment”
•Abstinence-Based Treatment, in which total abstinence
following a brief detoxification
•Psychosocial and Behavioral Treatments
18. TRADITIONAL DRUG BASED
TREATMENTS
The primary method of treating and managing opioid
addiction and dependence has been with the use of other
opioid drugs.
These drugs are-
-Methadone
-Buprenorphine
These replacement drugs function to essentially wean the
user off of opioid use in case of chronic relapsing
dependence.
19. METHADONE
Properties:
u opioid receptor agonist
produces the typical morphine like effect.
Methadone suppresses opioid withdrawal effects
Doses:
starting dose 20-30 mg, with 5 to 10 mg increases every other
day as tolerated.
Target dose 50 mg/day, highest dose 100 mg/day
20. METHADONE BENEFITS
Methadone Maintenance Therapy (MMT) is widely used
because-
reduces illicit drug use;
Reduces relapse, improves psychological factors
advances personal, academic and workplace functionality;
increases treatment retention;
and reduces chances of accidental overdose
Can be used for a long time
21. BUPRENORPHINE
Properties
Partial µ agonist activity with ceiling
Long half life
Decreased risk of respiratory, CNS depression
“Combo” tablet with naloxone limits abuse
Doses:
Starting dose- 4/1 mg buprenorphine/ naloxone .
Maintaince dose- 12/3 to 16/4 mg per day
Three times weekly dosing as generally recommended
22. BUPRENORPHINE SAFETY
No alteration of cognitive functioning
feel “normal”
No organ damage
Early concern of hepatic toxicity unconfirmed
No evidence of QT prolongation
No clinically significant interactions with other drugs
23. METHADONE VS. BUPRENORPHINE
Methadone Buprenorphine
• Criteria:
Withdrawal symp
>12 months use
• Criteria:
DSM IV of abuse
No time criteria
• Age > 18 • Age > 16
Duration of treatment is still debatable, but most addiction
clinics continue these drugs indefinitely.
24. OPIOID ANTAGONIST
PHARMACOTHERAPY
Naltrexone
Properties:
Competitive opioid antagonist
Orally effective and
can block opioid effects for 24 hours
Doses:
Initial dose of 25 mg or 50 mg, the following dose schedules
have been used for naltrexone :(1) 50 mg daily (2) 100 mg every
other day
25. Criteria for Naltrexone use:
To minimize the precipitations of opioid withdrawal,
naltrexone treatment should not be initiated until the patient
is opioid free for 7 to 10 days
Recommended for acute opioid intoxication, but it does not
reduce opioid curving, so not recommended for long time use.
26. ABSTINENCE-BASED TREATMENT
Quitting opioid use abruptly and completely is the cheapest
method.
Significant withdrawal symptoms occurs.
The symptoms increase in severity over two to three days.
Within a week to 10 days the illness is over.
But not very much recommended because of the withdrawal
symptoms and tendency to relapse.
27. OPIOID TAPERING
It is not wise to quit opioid abruptly in out patient setting. So
tapering of opioid is advised.
Katrina Disaster Working Group Suggested Tapering
Regimens [AAPM 2005]
Reduction of daily dose by 10% each day, or…
Reduction of daily dose by 20% every 3-5 days, or…
Reduction of daily dose by 25% each week.
28. VA CLINICAL GUIDELINE
TAPERING REGIMENS
Short-Acting Opioids [2003]
Decrease dose by 10% every 3-7 days, or…
Decrease dose by 20%-50% per day until lowest available
dosage form is reached
Then increase the dosing interval, eliminating one dose every
2-5 days.
29. LONG ACTING OPIOIDS
Methadone
Decrease dose by 20%-50% per day to 30 mg/day, then…
Decrease by 5 mg/day every 3-5 days to 10 mg/day, then...
Decrease by 2.5 mg/day every 3-5 days.
Morphine CR (controlled-release)
Decrease dose by 20%-50% per day to 45 mg/day, then…
Decrease by 15 mg/day every 2-5 days.
30. Oxycodone CR (controlled-release)
Decrease by 20%-50% per day to 30 mg/day, then…
Decrease by 10 mg/day every 2-5 days.
Fentanyl
first rotate to another opioid, such as morphine CR or
methadone, then tapering done according to previous
guideline.
31. DETOXIFICATION
It is the management of withdrawal.
Categorized according to their duration :
long term (typically 180 days),
short term (upto 30 days),
rapid (typically 3-10 days), and
ultra-rapid (1-2 days)
Long term and short term detoxification are practically
applied.
32. The Pharmacologic agents used during detoxification-
Methadone , 10-40mg/24 hrs, tapered after control of
abstinence symptoms
Buprenorphine , 2-4 mg/day sublingually, well tolerated and
effective for withdrawal symps.
Naloxone/Naltrexone, used in rapid detoxification
Clonidine, used with Naloxone
Benzodiazepines, for muscle cramp
33. PSYCHOSOCIAL TREATMENTS
5 modalities of treatment-
Cognitive Behavioral Therapies
Behavioral Therapies
Group and Family Therapy
Psychodynamic Psychotherapies
Self-Help Groups
34. POST ACUTE WITHDRAWAL
SYNDROME
Starts after acute withdrawal ends. This syndrome often lasts
for several months.
Symptoms include difficulty with…
Thinking clearly
Remembering
Stress management
Emotion management
Sleeping restfully
Physical coordination
35. MANAGEMENT
Some things that are helpful for management of including-
Having a structured lifestyle
Getting enough rest
Healthy diet and eating habits
Regular exercise
Social support
Deep-breathing relaxation skills
Emotion management skills
Conflict management skills
H.A.L.T. – Don’t get too Hungry, Angry, Lonely or Tired.
36. ADDICTIVE PREOCCUPATION
A type of delusional thinking associated with-
Euphoric recall (recalling only the positives about using)
“Awfulizing” sobriety (focusing on only the negatives
about sobriety)
Magical thinking about future use (thinking using will
somehow make things better)
Left unattended, this becomes obsession, compulsion and
craving.
37. MANAGEMENT
Euphoric recall
Force yourself to remember specific negative experiences
involving using.
“Awfulizing” sobriety
Force yourself to consider positive things about recovery.
Magical thinking about future use
Force yourself to consider what would actually happen if you
used.
38. RECOVERY
There are 6 stages of recovery-
1. Transition-
The person is still using, but gradually motivated to give up
using.
2. Stabilization-
physically recover from acute withdrawal and learn to manage
post acute withdrawal.
39. 3. Early recovery-
the person becomes fully conscious recognition of addictive
disease
Learns non-chemical coping skills
4. Middle recovery-
The person faces and resolves the demoralization crisis
Repairing addiction-caused social damage.
40. 5. Late recovery
Recognizing the effects problems on sobriety
Change in lifestyle
6. Maintenance Stage:
Balanced living and continued day to day coping
41. SPECIAL CONSIDERATIONS IN
TREATING
OPIATE ADDICTS
After stopping using, opiate addicts commonly experience…
Discomfort of body, mind and spirit
Vivid using dreams, drug cravings
Depression and anxiety
Strong urge to abort treatment due to discomfort of early
abstinence
So we need to approach them with empathic listening and
attempt to understand their distress throughout the
treatment .
42. CONCLUSIONS
Opioid dependence is a serious issue that must be given
more thought than at present.
Current treatments are only partially successful in
breaking the hold of addiction and dependence on the
addict.
Evident euphoria – deceased individuals described as “really stoned” before the are later found VSA.
Unconciousness – unrousable despite vigorous efforts – progress to coma
Respiratory depression and failure the mechanism by which opioids cause death
Pulmonary edema – common finding at autopsy in the case of opioid overdose and deaths due to opioid use.
TOP TO BOTTOM
Physical dependence – the development of physical dependence is clear in that the failure to continue administration of a drug results in a characteristic withdrawal or abstinence syndrome that reflects an exaggerated rebound from the acute phamacologic effects of the opioid.
The severity of phsyiological withdrawal will depend on the frequency and duration of drug use. Withdrawal can begin as early as 6-8 hours after the last dose and is maximial at 36-72 hours following the last dose (from text).