This document provides an overview of the pharmacologic treatment of opiate dependence, including:
- A historical perspective on approaches to treatment such as methadone maintenance and more recent developments like buprenorphine treatment.
- Details on the mechanisms of action and effects of opioid agonists and partial agonists like buprenorphine, including their effects on opioid receptors in the brain.
- Guidelines for patient selection for buprenorphine treatment, which should assess a patient's opioid dependence, understanding of treatment options, ability to comply with treatment, and psychiatric stability.
This document summarizes a randomized trial that compared extended (12-week) buprenorphine-naloxone treatment to short-term (14-day) detoxification for opioid-addicted youth ages 14 to 21. The trial found that youth in the extended treatment group had significantly lower rates of positive opioid urine tests at months 6, 9 and 12 compared to the detoxification group. It also found that the extended treatment group had higher completion rates and fewer dropouts. The study provides evidence that extended buprenorphine treatment may be more effective than short-term detoxification for opioid-addicted youth.
This document provides an overview of the pharmacologic treatment of opiate dependence, including:
- A historical perspective on approaches to treatment such as methadone maintenance and more recent developments like buprenorphine.
- An explanation of how opioid agonists like methadone and buprenorphine work in the brain and body to reduce withdrawal symptoms and cravings while blocking the effects of other opioids.
- Guidance on patient selection criteria for buprenorphine treatment and considerations around its use as a replacement therapy in office-based settings to expand treatment access.
This document provides an overview of buprenorphine and its use in office-based treatment of opioid dependence. It discusses the pharmacology of buprenorphine, including how it acts as a partial opioid agonist and has a ceiling effect. It also outlines the legislation that allowed qualified physicians to treat opioid addiction with buprenorphine, reviews the induction and maintenance treatment process, and discusses outcomes research showing buprenorphine is effective for both detoxification and long-term maintenance treatment.
In this webinar, clinicians from two Ryan White clinics with successful buprenorphine programs describe what buprenorphine is, how it works, what opioids do to the brain, how buprenorphine differs from methadone, important drug-drug interactions, the concept of precipitated withdrawal and how to recognize it, how to determine patient eligibility, and clinical aspects of working with opiod-addicted people living with HIV.
Presenters Pamela Vergara-Rodriguez, MD, (CORE Center in Chicago), and Jacqueline Tulsky, MD (University of California at San Francisco and San Francisco General Hospital), also describe the challenges and successes of the SPNS buprenorphine projects at their institutions.
Visit the Integrating HIV Innovative Practices webpage to learn more about integrating buprenorphine into HIV primary care settings and to access additional training materials.
This document discusses the opioid epidemic in the United States. It provides definitions of opioid dependence and abuse, and details the epidemiology and costs of the crisis. The neuropharmacology and clinical effects of opioids are described. Methadone and buprenorphine are discussed as treatments for opioid dependence, including their mechanisms of action, efficacy, administration, and safety profiles. Buprenorphine is presented as a promising alternative to methadone with a lower risk of respiratory depression.
Affects of Substance Abuse on Mental Health - Opioids (Narcotics) zeeshan Shani
This slideshow is an endeavour to inculcate awareness and educate the youth and their parents about the usage, identification and affects of Narcotics (Opiods) Abuse.
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.
Opiate drugs like opium, morphine, and heroin have been used for centuries to relieve pain but also carry high risks of addiction and dependence. While initially hailed as a treatment for pain, opiates like heroin became a major problem in the late 19th century as addiction rose. Today, prescription opiate drug abuse has increased dramatically in the US, with drugs like Oxycontin being misused. Opiates work in the brain by mimicking endorphins and reducing pain, but long term use leads to tolerance and withdrawal symptoms.
This document summarizes a randomized trial that compared extended (12-week) buprenorphine-naloxone treatment to short-term (14-day) detoxification for opioid-addicted youth ages 14 to 21. The trial found that youth in the extended treatment group had significantly lower rates of positive opioid urine tests at months 6, 9 and 12 compared to the detoxification group. It also found that the extended treatment group had higher completion rates and fewer dropouts. The study provides evidence that extended buprenorphine treatment may be more effective than short-term detoxification for opioid-addicted youth.
This document provides an overview of the pharmacologic treatment of opiate dependence, including:
- A historical perspective on approaches to treatment such as methadone maintenance and more recent developments like buprenorphine.
- An explanation of how opioid agonists like methadone and buprenorphine work in the brain and body to reduce withdrawal symptoms and cravings while blocking the effects of other opioids.
- Guidance on patient selection criteria for buprenorphine treatment and considerations around its use as a replacement therapy in office-based settings to expand treatment access.
This document provides an overview of buprenorphine and its use in office-based treatment of opioid dependence. It discusses the pharmacology of buprenorphine, including how it acts as a partial opioid agonist and has a ceiling effect. It also outlines the legislation that allowed qualified physicians to treat opioid addiction with buprenorphine, reviews the induction and maintenance treatment process, and discusses outcomes research showing buprenorphine is effective for both detoxification and long-term maintenance treatment.
In this webinar, clinicians from two Ryan White clinics with successful buprenorphine programs describe what buprenorphine is, how it works, what opioids do to the brain, how buprenorphine differs from methadone, important drug-drug interactions, the concept of precipitated withdrawal and how to recognize it, how to determine patient eligibility, and clinical aspects of working with opiod-addicted people living with HIV.
Presenters Pamela Vergara-Rodriguez, MD, (CORE Center in Chicago), and Jacqueline Tulsky, MD (University of California at San Francisco and San Francisco General Hospital), also describe the challenges and successes of the SPNS buprenorphine projects at their institutions.
Visit the Integrating HIV Innovative Practices webpage to learn more about integrating buprenorphine into HIV primary care settings and to access additional training materials.
This document discusses the opioid epidemic in the United States. It provides definitions of opioid dependence and abuse, and details the epidemiology and costs of the crisis. The neuropharmacology and clinical effects of opioids are described. Methadone and buprenorphine are discussed as treatments for opioid dependence, including their mechanisms of action, efficacy, administration, and safety profiles. Buprenorphine is presented as a promising alternative to methadone with a lower risk of respiratory depression.
Affects of Substance Abuse on Mental Health - Opioids (Narcotics) zeeshan Shani
This slideshow is an endeavour to inculcate awareness and educate the youth and their parents about the usage, identification and affects of Narcotics (Opiods) Abuse.
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.
Opiate drugs like opium, morphine, and heroin have been used for centuries to relieve pain but also carry high risks of addiction and dependence. While initially hailed as a treatment for pain, opiates like heroin became a major problem in the late 19th century as addiction rose. Today, prescription opiate drug abuse has increased dramatically in the US, with drugs like Oxycontin being misused. Opiates work in the brain by mimicking endorphins and reducing pain, but long term use leads to tolerance and withdrawal symptoms.
The document discusses how addiction affects the brain. Genetics account for 40-60% of addiction risk, with low dopamine levels increasing risk. Addictive drugs increase dopamine levels in the brain's reward centers beyond normal levels. All addictions impact the lower central brain regions controlling automatic functions and the cortex. The brain's structure and chemistry can be permanently altered by addiction, though recovery is possible over many years as the brain heals.
Molecular Substrates of Drug Abuse in a Schizophrenic PopulationAlan Lesselyong
This presentation is a Work In Progress (WIP) covering experiments examining the molecular correlates of drug abuse in human brains diagnosed with schizophrenia
Sedative-hypnotics are central nervous system depressants that reduce excitement and induce sleep. Common classes include barbiturates, benzodiazepines, and newer nonbenzodiazepine drugs. Barbiturates such as phenobarbital are no longer primarily used due to risk of dependence and withdrawal symptoms. Benzodiazepines like diazepam are now preferred for treatment of insomnia and anxiety. Sleep involves different stages including REM sleep, which is important for dreaming. Classification, mechanisms of action, uses, and adverse effects of sedative-hypnotics are described.
Opioids are a class of drugs that have morphine-like effects on the central nervous system. They are commonly used analgesics but prolonged use can lead to tolerance and dependence. Opioid withdrawal can be managed in the hospital setting using buprenorphine or methadone to relieve symptoms, along with supportive medications for nausea, muscle aches, diarrhea and sleeplessness. It is important for hospital staff to continue patients' opioid maintenance treatment and provide adequate pain relief while avoiding precipitated withdrawal.
This document discusses sedative-hypnotic drugs, including their definitions, mechanisms of action, and classifications. It covers several classes of sedative-hypnotics such as barbiturates, benzodiazepines, and newer non-benzodiazepine hypnotics. Barbiturates act by enhancing GABA activity and can prolong chloride channel opening. Benzodiazepines also enhance GABA and are used as hypnotics, anxiolytics, anticonvulsants, and muscle relaxants. Newer agents like zolpidem, zaleplon and zopiclone bind selectively to GABA receptors with fewer side effects than benzodiazepines
Sedative hypnotics like barbiturates act as central nervous system depressants, inducing sedation, hypnosis, and anesthesia. They have therapeutic uses for anxiety, insomnia, and seizures but also carry risks of dependence and withdrawal symptoms. Nursing management focuses on monitoring for side effects like drowsiness, orthostatic hypotension, and paradoxical reactions while educating patients on safe use, dependence risks, and avoiding alcohol and other CNS depressants.
This document discusses substance abuse, specifically related to opioids. It defines addiction and intoxication, provides a brief history of opioid use dating back to 3000 BC, and outlines the typical pathways that lead to opioid addiction. It also includes statistics on prescription drug abuse and lists common opioid substances. The effects of opioids are described relating to the central nervous system, eyes, and gastrointestinal tract. Signs of opioid intoxication, withdrawal, and addiction are outlined. Nursing diagnoses for those with substance abuse issues are risk for injury, ineffective denial, and ineffective coping.
Addiction is a complex illness caused by changes in the brain due to repeated drug use. Drugs of abuse trigger the brain's reward system by increasing the neurotransmitter dopamine, especially in the nucleus accumbens. Over time, this causes long-lasting changes in other brain systems and behaviors. Current pharmacological treatments aim to manage withdrawal, achieve and maintain abstinence, and reduce harms. Methadone maintenance is effective by occupying opioid receptors and blocking the effects of other opioids. New treatments target other neurotransmitter systems and pathways involved in addiction and relapse.
Quazi Istiaque Bari presented on sedative and hypnotic drugs. The presentation covered the differences between sedatives and hypnotics, including their sites of action and effects. It also discussed dose response curves, the structures of benzodiazepines and barbiturates, and the pharmacokinetics of sedative hypnotic drugs. The presentation provided an overview of sedative and hypnotic drugs for a pharmacology course.
This document discusses central nervous system (CNS) depressants such as sedatives and hypnotics. It provides background on the history of CNS depressants including early uses of bromides and barbiturates. It describes the effects of CNS depressants such as reducing brain activity and awareness. Common types are discussed including benzodiazepines, barbiturates, and other depressants. Medical uses include treating anxiety and insomnia. Mechanisms of action involve enhancing the inhibitory neurotransmitter GABA. Patterns of abuse and dangers of overdose are also summarized.
This document discusses benzodiazepine use in elderly patients. It notes that benzodiazepines are commonly prescribed to elderly for anxiety and insomnia, accounting for 20-35% of prescriptions. However, elderly are more sensitive to their effects due to changes in pharmacokinetics and pharmacodynamics. Prolonged use can increase risks of cognitive impairment, falls and fractures. Dependence is a concern, with withdrawal requiring a slow taper to reduce confusion and other symptoms. Overall the document outlines risks and considerations for benzodiazepine prescribing and use in elderly populations.
This document discusses sedative, hypnotic, and anxiolytic drugs. It describes barbiturates and benzodiazepines, which are commonly used as sedative-hypnotics. Barbiturates act by potentiating the inhibitory neurotransmitter GABA, while benzodiazepines facilitate GABA effects by binding to GABAA receptors. The document outlines the mechanisms, effects on sleep, and adverse effects of these drug classes. It also discusses newer nonbenzodiazepine hypnotics and the benzodiazepine antagonist flumazenil.
1. A doctor wrongly told an arrested man he was drunk after the man performed a somersault in the police station. This incident highlighted the need for breathalyzers.
2. Drug use can cause addiction through changes in the brain's reward pathway and dopamine system. Withdrawal occurs when use is stopped due to physical dependence.
3. Common drugs of abuse include ethanol, opioids, cocaine, amphetamines, and MDMA. They cause euphoria through effects on dopamine, serotonin, and other neurotransmitters but have severe health risks with chronic use.
This document defines sedatives and hypnotics, and classifies common drugs used as such. It describes the mechanisms, pharmacokinetics, uses and side effects of barbiturates, benzodiazepines, zolpidem, and zaleplon. Barbiturates act by facilitating GABA activity and directly activating chloride channels, while benzodiazepines facilitate GABA activity at receptor sites. Both are metabolized in the liver and have risks of tolerance, dependence and withdrawal. Benzodiazepines generally have fewer side effects and less abuse potential than barbiturates. Zolpidem and zaleplon are shorter acting hypnotics that also facilitate G
Effective treatment for drug addiction in Mindheal Homeopathy clinic ,Chembur...Shewta shetty
"Treatment and remedies for drug addiction and its effective treatment in homeopathy.Personalised online consultancy & treatments provided at our clinic by efficient panel of doctors in our center at mumbai,Bombay,Chembur, India.Contact us."
This document discusses opioids and opioid overdoses. It begins with an introduction to opioids and their history of medical use. It then provides objectives which include discussing the pharmacology, epidemiology, and treatment of opioids. The presenter is introduced as having 15 years of paramedic experience. Various resources for educating oneself on opioids are provided, including Erowid.org and SAMHSA data on drug abuse. Statistics on the epidemiology of opioid overdoses from these sources are presented. Common opioids like heroin, oxycodone, fentanyl, and methadone are described. Naloxone is discussed as the first-line treatment for opioid overdoses. Considerations for naloxone administration
The document discusses central nervous system (CNS) depressants, including their history, effects, types, medical uses, and dangers of abuse. Some key points include: CNS depressants such as benzodiazepines and barbiturates were developed to treat conditions like anxiety, insomnia, and seizures. They work by enhancing the effects of the inhibitory neurotransmitter GABA. While usually prescribed medications, they can cause dependence and dangerous interactions if misused or abused. Long-term trends show a decline in barbiturate use due to safety issues, being replaced primarily by benzodiazepines which have a wider therapeutic margin.
Sedatives and hypnotics are central nervous system depressants that can calm or soothe the nervous system. Sedatives reduce nervousness and irritability without causing sleep, while hypnotics cause sleep. Sedative-hypnotics can have sedative effects at low doses and hypnotic effects at high doses. Barbiturates were commonly used as sedative-hypnotics but have been replaced in large part by benzodiazepines due to safety and efficacy concerns. Both classes work by inhibiting activity in the brain stem and cerebral cortex.
Pharmacotherapy for Tobacco Dependence -- Richard D. Hurt, M.D., Mayo ClinicGlobal Bridges
On April 4, 2012, Global Bridges presented the webinar "Pharmacotherapy for Tobacco Dependence," which featured Richard D. Hurt, M.D., founder and director of the Mayo Clinic Nicotine Dependence Center.
For the audio/video from this presentation, please visit http://www.youtube.com/watch?v=NqndR9wWfZo
The document summarizes various drugs of abuse including their mechanisms of action, effects, dependence, tolerance, withdrawal and treatment approaches. It discusses stimulants like cocaine and amphetamines, opioids, cannabinoids, nicotine, depressants like alcohol, barbiturates and benzodiazepines. It describes how these drugs activate the brain's reward system and how chronic use leads to tolerance and dependence characterized by drug-seeking behavior and withdrawal symptoms when use is discontinued. Treatment involves managing withdrawal symptoms, replacing opioids with longer-acting alternatives, and addressing psychological aspects through counseling and support groups.
This document discusses opioid abuse and how innovation in treatment can save lives. It focuses on buprenorphine treatment for opioid addiction. Buprenorphine is a partial opioid agonist that works by blocking other opioids while reducing cravings and withdrawal symptoms. Studies show buprenorphine treatment keeps more patients in treatment programs compared to placebo. The author's clinic has successfully treated over 100 patients with buprenorphine in group therapy settings combined with counseling. Motivational interviewing techniques are well-suited to engage patients in discussing treatment and recovery.
The document discusses how addiction affects the brain. Genetics account for 40-60% of addiction risk, with low dopamine levels increasing risk. Addictive drugs increase dopamine levels in the brain's reward centers beyond normal levels. All addictions impact the lower central brain regions controlling automatic functions and the cortex. The brain's structure and chemistry can be permanently altered by addiction, though recovery is possible over many years as the brain heals.
Molecular Substrates of Drug Abuse in a Schizophrenic PopulationAlan Lesselyong
This presentation is a Work In Progress (WIP) covering experiments examining the molecular correlates of drug abuse in human brains diagnosed with schizophrenia
Sedative-hypnotics are central nervous system depressants that reduce excitement and induce sleep. Common classes include barbiturates, benzodiazepines, and newer nonbenzodiazepine drugs. Barbiturates such as phenobarbital are no longer primarily used due to risk of dependence and withdrawal symptoms. Benzodiazepines like diazepam are now preferred for treatment of insomnia and anxiety. Sleep involves different stages including REM sleep, which is important for dreaming. Classification, mechanisms of action, uses, and adverse effects of sedative-hypnotics are described.
Opioids are a class of drugs that have morphine-like effects on the central nervous system. They are commonly used analgesics but prolonged use can lead to tolerance and dependence. Opioid withdrawal can be managed in the hospital setting using buprenorphine or methadone to relieve symptoms, along with supportive medications for nausea, muscle aches, diarrhea and sleeplessness. It is important for hospital staff to continue patients' opioid maintenance treatment and provide adequate pain relief while avoiding precipitated withdrawal.
This document discusses sedative-hypnotic drugs, including their definitions, mechanisms of action, and classifications. It covers several classes of sedative-hypnotics such as barbiturates, benzodiazepines, and newer non-benzodiazepine hypnotics. Barbiturates act by enhancing GABA activity and can prolong chloride channel opening. Benzodiazepines also enhance GABA and are used as hypnotics, anxiolytics, anticonvulsants, and muscle relaxants. Newer agents like zolpidem, zaleplon and zopiclone bind selectively to GABA receptors with fewer side effects than benzodiazepines
Sedative hypnotics like barbiturates act as central nervous system depressants, inducing sedation, hypnosis, and anesthesia. They have therapeutic uses for anxiety, insomnia, and seizures but also carry risks of dependence and withdrawal symptoms. Nursing management focuses on monitoring for side effects like drowsiness, orthostatic hypotension, and paradoxical reactions while educating patients on safe use, dependence risks, and avoiding alcohol and other CNS depressants.
This document discusses substance abuse, specifically related to opioids. It defines addiction and intoxication, provides a brief history of opioid use dating back to 3000 BC, and outlines the typical pathways that lead to opioid addiction. It also includes statistics on prescription drug abuse and lists common opioid substances. The effects of opioids are described relating to the central nervous system, eyes, and gastrointestinal tract. Signs of opioid intoxication, withdrawal, and addiction are outlined. Nursing diagnoses for those with substance abuse issues are risk for injury, ineffective denial, and ineffective coping.
Addiction is a complex illness caused by changes in the brain due to repeated drug use. Drugs of abuse trigger the brain's reward system by increasing the neurotransmitter dopamine, especially in the nucleus accumbens. Over time, this causes long-lasting changes in other brain systems and behaviors. Current pharmacological treatments aim to manage withdrawal, achieve and maintain abstinence, and reduce harms. Methadone maintenance is effective by occupying opioid receptors and blocking the effects of other opioids. New treatments target other neurotransmitter systems and pathways involved in addiction and relapse.
Quazi Istiaque Bari presented on sedative and hypnotic drugs. The presentation covered the differences between sedatives and hypnotics, including their sites of action and effects. It also discussed dose response curves, the structures of benzodiazepines and barbiturates, and the pharmacokinetics of sedative hypnotic drugs. The presentation provided an overview of sedative and hypnotic drugs for a pharmacology course.
This document discusses central nervous system (CNS) depressants such as sedatives and hypnotics. It provides background on the history of CNS depressants including early uses of bromides and barbiturates. It describes the effects of CNS depressants such as reducing brain activity and awareness. Common types are discussed including benzodiazepines, barbiturates, and other depressants. Medical uses include treating anxiety and insomnia. Mechanisms of action involve enhancing the inhibitory neurotransmitter GABA. Patterns of abuse and dangers of overdose are also summarized.
This document discusses benzodiazepine use in elderly patients. It notes that benzodiazepines are commonly prescribed to elderly for anxiety and insomnia, accounting for 20-35% of prescriptions. However, elderly are more sensitive to their effects due to changes in pharmacokinetics and pharmacodynamics. Prolonged use can increase risks of cognitive impairment, falls and fractures. Dependence is a concern, with withdrawal requiring a slow taper to reduce confusion and other symptoms. Overall the document outlines risks and considerations for benzodiazepine prescribing and use in elderly populations.
This document discusses sedative, hypnotic, and anxiolytic drugs. It describes barbiturates and benzodiazepines, which are commonly used as sedative-hypnotics. Barbiturates act by potentiating the inhibitory neurotransmitter GABA, while benzodiazepines facilitate GABA effects by binding to GABAA receptors. The document outlines the mechanisms, effects on sleep, and adverse effects of these drug classes. It also discusses newer nonbenzodiazepine hypnotics and the benzodiazepine antagonist flumazenil.
1. A doctor wrongly told an arrested man he was drunk after the man performed a somersault in the police station. This incident highlighted the need for breathalyzers.
2. Drug use can cause addiction through changes in the brain's reward pathway and dopamine system. Withdrawal occurs when use is stopped due to physical dependence.
3. Common drugs of abuse include ethanol, opioids, cocaine, amphetamines, and MDMA. They cause euphoria through effects on dopamine, serotonin, and other neurotransmitters but have severe health risks with chronic use.
This document defines sedatives and hypnotics, and classifies common drugs used as such. It describes the mechanisms, pharmacokinetics, uses and side effects of barbiturates, benzodiazepines, zolpidem, and zaleplon. Barbiturates act by facilitating GABA activity and directly activating chloride channels, while benzodiazepines facilitate GABA activity at receptor sites. Both are metabolized in the liver and have risks of tolerance, dependence and withdrawal. Benzodiazepines generally have fewer side effects and less abuse potential than barbiturates. Zolpidem and zaleplon are shorter acting hypnotics that also facilitate G
Effective treatment for drug addiction in Mindheal Homeopathy clinic ,Chembur...Shewta shetty
"Treatment and remedies for drug addiction and its effective treatment in homeopathy.Personalised online consultancy & treatments provided at our clinic by efficient panel of doctors in our center at mumbai,Bombay,Chembur, India.Contact us."
This document discusses opioids and opioid overdoses. It begins with an introduction to opioids and their history of medical use. It then provides objectives which include discussing the pharmacology, epidemiology, and treatment of opioids. The presenter is introduced as having 15 years of paramedic experience. Various resources for educating oneself on opioids are provided, including Erowid.org and SAMHSA data on drug abuse. Statistics on the epidemiology of opioid overdoses from these sources are presented. Common opioids like heroin, oxycodone, fentanyl, and methadone are described. Naloxone is discussed as the first-line treatment for opioid overdoses. Considerations for naloxone administration
The document discusses central nervous system (CNS) depressants, including their history, effects, types, medical uses, and dangers of abuse. Some key points include: CNS depressants such as benzodiazepines and barbiturates were developed to treat conditions like anxiety, insomnia, and seizures. They work by enhancing the effects of the inhibitory neurotransmitter GABA. While usually prescribed medications, they can cause dependence and dangerous interactions if misused or abused. Long-term trends show a decline in barbiturate use due to safety issues, being replaced primarily by benzodiazepines which have a wider therapeutic margin.
Sedatives and hypnotics are central nervous system depressants that can calm or soothe the nervous system. Sedatives reduce nervousness and irritability without causing sleep, while hypnotics cause sleep. Sedative-hypnotics can have sedative effects at low doses and hypnotic effects at high doses. Barbiturates were commonly used as sedative-hypnotics but have been replaced in large part by benzodiazepines due to safety and efficacy concerns. Both classes work by inhibiting activity in the brain stem and cerebral cortex.
Pharmacotherapy for Tobacco Dependence -- Richard D. Hurt, M.D., Mayo ClinicGlobal Bridges
On April 4, 2012, Global Bridges presented the webinar "Pharmacotherapy for Tobacco Dependence," which featured Richard D. Hurt, M.D., founder and director of the Mayo Clinic Nicotine Dependence Center.
For the audio/video from this presentation, please visit http://www.youtube.com/watch?v=NqndR9wWfZo
The document summarizes various drugs of abuse including their mechanisms of action, effects, dependence, tolerance, withdrawal and treatment approaches. It discusses stimulants like cocaine and amphetamines, opioids, cannabinoids, nicotine, depressants like alcohol, barbiturates and benzodiazepines. It describes how these drugs activate the brain's reward system and how chronic use leads to tolerance and dependence characterized by drug-seeking behavior and withdrawal symptoms when use is discontinued. Treatment involves managing withdrawal symptoms, replacing opioids with longer-acting alternatives, and addressing psychological aspects through counseling and support groups.
This document discusses opioid abuse and how innovation in treatment can save lives. It focuses on buprenorphine treatment for opioid addiction. Buprenorphine is a partial opioid agonist that works by blocking other opioids while reducing cravings and withdrawal symptoms. Studies show buprenorphine treatment keeps more patients in treatment programs compared to placebo. The author's clinic has successfully treated over 100 patients with buprenorphine in group therapy settings combined with counseling. Motivational interviewing techniques are well-suited to engage patients in discussing treatment and recovery.
This document discusses opioid abuse and how innovation in treatment can save lives. It focuses on buprenorphine treatment for opioid addiction. Buprenorphine is a partial opioid agonist that works by blocking other opioids while reducing withdrawal symptoms and cravings. Studies show buprenorphine treatment keeps more patients in treatment programs compared to placebo. The author's clinic has successfully treated over 100 patients through buprenorphine group visits combined with counseling and motivational interviewing techniques. Patients report buprenorphine saves lives and allows them to function while remaining sober. The document concludes buprenorphine access and substance use treatment saves lives.
The document discusses commonly abused substances like opioids, stimulants, depressants and their classification. It defines terms related to drug addiction like misuse, abuse, dependence, tolerance and withdrawal. The neuropharmacology of reward pathways activated by various drugs and the mechanisms of tolerance, dependence and withdrawal are explained.
Opioids and opiates act on mu, kappa, and delta opioid receptors throughout the body and brain. Mu receptors are responsible for analgesia, respiratory depression, and euphoria, making overdose dangerous. Chronic use can increase tolerance and risk of overdose. While prescription opioids started the current crisis, many users transition to highly dangerous illegal opioids like fentanyl and fentanyl analogs. Naloxone is used to treat overdoses but very potent synthetic opioids require high doses or continuous infusion.
This document discusses various topics related to drug dependence, addiction, abuse, tolerance, and interactions. It provides definitions and explanations of key concepts. Some main points include:
- Drug dependence develops from repeated drug use and results in withdrawal symptoms upon cessation. It is characterized by compulsive drug seeking despite negative consequences.
- Tolerance occurs when neurons adapt to repeated drug exposure and only function normally in the drug's presence. Withdrawal syndrome can range from mild to life-threatening depending on the drug.
- The CREB protein and CRF neuropeptide are involved in the biological mechanisms of psychological dependence, forcing the body to take higher doses to achieve the same effect.
- Successful treatment involves
Homeopathic Doctor - Dr. Anita Salunke homeopathic clinic for Drug Addiction ...Shewta shetty
Effective treatment for Drug addiction at hoemoapthic Clinic, Mumbai provides homeopathic treatment for drug addiction. The document defines addiction and substance use disorders, describing the stages and causes of addiction. It explains the pathophysiology of addiction including the role of dopamine in the brain's reward circuit and how drugs hijack the neuroplasticity mechanism. Management of addiction involves treatments tailored to the individual such as cognitive behavioral therapy, anti-addictive medications, and behavioral programming techniques. Mindheal Homeopathy in Mumbai specializes in homeopathic treatment for drug addiction.
The document discusses the neuroscience of drug addiction, including the brain regions and neurotransmitters involved in reward pathways that can become dysregulated with chronic drug use. It covers the stages of the addiction cycle and various animal models used to study different stages. The summary also outlines pharmacological and behavioral therapies used to treat drug addiction.
This document discusses substance use disorders, specifically opioid use disorder. It defines key terms related to substance dependence and provides details on the epidemiology, etiology, mechanisms of action, comorbidities, diagnosis, and treatment of opioid use disorder. The treatment of opioid use disorder involves opioid substitution therapy, with methadone and buprenorphine being the most commonly used replacement therapies globally. The history and goals of opioid substitution therapy in Nepal are also summarized.
The document defines various terms related to drug abuse and dependence, including drug abuse, drug dependence, drug addiction, drug tolerance, cross-dependence, and cross-tolerance. It then discusses specific classes of drugs in more detail, including opioids/narcotics, CNS depressants like alcohol and sedatives/hypnotics, stimulants, hallucinogens, and inhalants. For each drug class, it covers pharmacology, acute and chronic effects, toxicity, dependence and withdrawal symptoms, and treatment approaches.
Opioids and opiates act on opioid receptors in the brain, spinal cord and gut to reduce pain perception. They can cause respiratory depression, physical dependence and euphoria. Opioid overdose deaths have increased significantly in recent decades. Common signs of overdose include pinpoint pupils, decreased breathing and unconsciousness. History and examination may reveal signs of drug use as well as depressed breathing and mental status. Naloxone is used to reverse effects in an overdose.
Opioid --> are important drugs used in the pain management.
Employ appropriate pharmacological choice by knowing the pharmacology of the drugs --> both pharmaco dynamic and pharmaco kinetics.
Provide optimal effect and minimize side effects
Treatment Strategies for Women and Families with Substance AbuseErikaAGoyer
NATIONAL PERINATAL ASSOCIATION 2014 CONFERENCE
Treatment Strategies for Women and Families with
Substance Abuse: The participant will be able to:
Interpret the term “opioid use disorder,” explain the
benefits of Methadone Assisted Treatment (MAT) and
identify the characteristics of Neonatal Abstinence
Syndrome.
1) Synthetic opioids like fentanyl are much more potent than natural opioids like morphine and heroin. They work by binding to opioid receptors in the brain and spinal cord, triggering feelings of euphoria but also slowing respiration.
2) Synthetic opioids carry a high risk of overdose due to their potency and unpredictability. Overdose occurs when respiration slows to the point of stopping, depriving the brain of oxygen.
3) Signs of opioid addiction include an inability to control use, cravings, and changes in sleep, appetite, hygiene and social activities. Addiction results from the drugs' effects on the brain's reward pathways.
This document provides an overview and training for a program to train pharmacists in Maryland on responding to opioid overdoses. It begins with introducing the program and providing statistics on the opioid epidemic in Maryland. It then defines harm reduction and discusses recognizing and responding to overdoses, including administering naloxone. The document provides details on naloxone administration and storage/disposal, as well as information for pharmacists on dispensing naloxone. The goal is to equip pharmacists with knowledge to help prevent overdose deaths in their communities.
Drug abuse and drug dependences for Diploma pharmacy - 2nd year in Hospital and clinical pharmacy.
Some more valuable information about the Drug Addiction and drug dependences which is in concise manner.
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."/>
Heroin addiction involves dependence, abuse, and addiction. Heroin binds to mu opioid receptors in the brain's reward pathway, increasing dopamine and feelings of euphoria. Long term effects include physical dependence and withdrawal as well as infectious diseases. Withdrawal symptoms include restlessness, pain, insomnia, and diarrhea. Treatment includes detoxification, medication like methadone or buprenorphine, and behavioral therapies. Methadone and buprenorphine maintenance can help reduce cravings and criminal behavior while preventing overdose.
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Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
2. Objectives
The student will understand:
• The Brain changes in the addict
• The Historical Approaches of Treatment
• Agonist Treatment
• Blockade of the Opiate Receptor
• Those who qualify for
Buprenorphine/Naltrexone
• The Clitheroe Protocol
3. In Reflection
• 25 yo Native Female, IV heroin user ,being
released from Hiland Prison. She is tremulous
as she tells me she doesn’t think she can stay
clean.
• 30 yo white female, narcotic/heroin user, who
is in RSAT @ Hiland Prison. She confides to
me that despite treatment she fears her
inability to resist relapse.
8. OPIATES
Derived from extracts of the juice of opium poppy.
OPIOIDS
Any exogenous substance that acts as an agonist at any of
several receptors
Neurobiology of Addiction
George F. Koob
9. Take a Drug Change Your Brain
DRUG ADDICTION IS A COMPLEX ILLNESSDRUG ADDICTION IS A COMPLEX ILLNESS
www.drugabuse.gov
10.
11. Steward, 1987, p. 166
“It’s staying off that is the hard part. It
takes a lot of willpower. But seeing
smack eats away at your willpower; it
makes it very hard. When I stop I just
feel vacant with no direction or
energy and that lasts for months.’
12. Behavioral Mechanisms
of Addiction
“The special role the drug comes to play in the
personality organization of these patients. They
have not successfully established familiar defensive,
neurotic, characterological or other common
adaptive mechanisms as a way of dealing with their
distress. Instead, they have resorted to the use of
opioids as a way of coping with a range of problems
including ordinary human pain, disappointment,
anxiety, loss, anguish, sexual frustration, and other
suffering”
13. Opioids relieve emotional pain
and this is one of the behavioral
mechanisms implicated in the
addiction cycle
(Khantzian, 1985, 1990, 1997)
14.
15.
16.
17.
18.
19. Opioid Intoxication
1st Profound euphoria the rush
Visceral sensations, a facial flush, deepening of the voice. The
rush is resistant to tolerance.
2nd The High feeling of well-being over several
hours, no tolerance
3rd The Nod state of escape from reality ranging
from sleepiness to virtual unconsciousness
4th Being Straight User no longer experiencing
the rush or nod or high, but also not in withdrawal. This can
last up to 8 h following an injection or smoking of heroin.
22. Substance Dependence (brief)
• Organization around acquisition, use, recovery from
effects, of the drug—behavior is rewarding
• Dosage and frequency not the issue
• Consequences are the issue
• Adaptation and deterioration are hallmarks
• Ambivalence is the psychodynamic
– Loss of CONROL
33. Treatment Overview of
Opioid Dependence
DEATH
HARM REDUCTION
OPIOID
REPLACEMENT
Methadone or buprenorphine
ABSTINENCE
< 20% CAN ACHIEVE THIS
Naltrexone
Needle Exchange Program
34. Is Clean & Sober too Much to ask with
Opiates??
Opioid
Replacement
Methadone=76%
Buprenorphine=?
Abstinence
Detox only
3% @ 1 yr
MJ Kreek
<20% in
lifetime
WA state MDs
85% @ 10
yrs.
35. New History
1960-70s Dole, Nyswander, and Kreek
• Proposed addiction to be a change in brain from
prolonged exposure to opiates
• Started evaluating methadone in the early 1960s
• Methadone for dependence/addiction Rx in special clinics
37. 2000 Drug Addiction Treatment Act
• Addiction is a chronic disease
• Physicians may offer buprenorphine treatment, as a
replacement therapy in their office “OBOT” –Office Based
Opioid Therapy (need 8h CME)
• PCP knows the patient, the family, “the story”
• Reduces stigma, increases access to care
• Aligns addiction with other chronic relapsing conditions
(asthma, HBP, DM, Obesity, depression, mental illness, etc.)
38. Cognitive Behavioral Therapies
Substance abuse is related to maladaptive
social learning/adverse life situations.
• Improve interpersonal
&Coping skills
– Evaluating feelings,
thoughts
• Self-efficacy
– Teach problem solving
Reduce risk of relapse
– Triggers, cues
– Coping with urges
“As a Man thinks, so is he”
Solomon
40. Is Buprenorphine an Analgesic?
• Yes
• 20-40 X as potent as morphine
• Analgesic in US, Buprenex (IV/IM), for decades
• Worldwide use for pain as Temgesic
• There is no FDA approval for pain(SL), but it is
prescribed to pain patients “off-label”
[problematic]
42. Receptor Binding at Mu receptor
Agonist
Partial Agonist
Antagonists
Morphine-like effect, increasing dose
increases effect
Morphine-like effect with strong receptor
affinity, slow dissociation, ceiling effect
(bup)
No effect in absence of an opiate or opiate
dependence (e.g., naltrexone)
43. Function at Receptors: Full Agonists
Mu
receptor
Full agonist binding …
activates the mu receptor at higher levels
with higher doses
is highly reinforcing
is the most abused opioid type
includes, oxycodone, morphine,methadone, others
Slide Courtesy of John T. Pichot, MD
44. Opioid Receptor Partial Agonists
Mu
receptor
activates the receptor at lower levels but
plateaus at lower levels
is relatively less reinforcing
is a less abused opioid type
includes buprenorphine
Partial agonist binding …
Slide Courtesy of John T. Pichot, MD
45. Full Agonist
Bound to Receptor
Bup affinity is higher
Therefore
Full Agonist is displaced
Partial Agonist (Bup) Receptor Affinity
Mu
Receptor
• Strength: Drug physically binds to a receptor
Buprenorphine affinity is very strong and it will
displace full agonists like morphine and methadone
Can precipitate withdrawal
Slide Courtesy of John T. Pichot, MD
46. Receptor Dissociation
• Speed (slow or fast) of disengagement or uncoupling
of a drug from the receptor
• Buprenorphine’s dissociation is slow
– Blocks other opioids (ie morphine) from binding
– Prolonged therapeutic effect (> 24 hours)
Mu
Receptor
Bup dissociation is slow
Therefore
Full Agonists can’t bind
Slide Courtesy of John T. Pichot, MD
47. 0
10
20
30
40
50
60
70
80
90
100
2 mg 16 mg 32 mg
Dose
%ReceptorOccupancy
Source: Greenwald, MK et al, Neuropsychopharmacology 28, 2000-2009, 2003.
μ
Effects of Buprenorphine Maintenance Dose on
Mu Opioid Receptor Availability
27 to 47%
85 to 92%
94 to 98%
48. Benefits of Buprenorphine
• Mild withdrawal syndrome
• Prolonged therapeutic effect
• Safe and effective as an analgesic
• Blockade of “illicit” opioids
• Greater safety margin compared to methadone
• Decreased risk of abuse and diversion with
combination tablet
• Efficacy comparable to methadone
52. CESAR FAX
U n i v e r s i t y o f M a r y l a n d , C o l l e g e P a r k
A Weekly FAX from the Center for Substance Abuse Research
April 9, 2012
Vol. 21, Issue 14
Northeastern and Southern Regions of Country Account for
Largest Increases in Buprenorphine Found in Law Enforcement Drug Seizures
2003 2004 2005 2006 2007 2008 2009 2010
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
831
1,689
4,161
3,856
West
Midwest
Northeast
South
Estimated Number of Buprenorphine Reports,
U.S. Law Enforcement-Seized Drug Exhibits Analyzed by Forensic Laboratories,
by U.S. Census Region*, 2003-2010
*Northeast: CT, MA, ME, NH, NJ, NY, PA, RI, VT
South: AL, AR, DC, DE, FL, GA, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA WV
Midwest: IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, WI
West: AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, UT, WA, WY
Buprenorphine estimates for the South and West regions do not meet the DEA’s standard of precision and reliability.
54. Patient Selection:
10 Assessment Questions
• Is the patient dependent/addicted to opioids?
• Does the Client live in Anchorage?
• Is the patient aware of other available treatment
options?
• Does the patient understand the risks, benefits, and
limitations of buprenorphine treatment?
• Is the patient expected to be reasonably compliant,
with all treatment modalities?
• Is the patient able to follow safety procedures?
55. Patient Selection:
10 Assessment Questions
• Is the patient psychiatrically stable?
• Is the patient taking other medications that may
interact with buprenorphine?
• Are the psychosocial circumstances of the patient
stable and supportive?
• Is the patient interested in office-based
buprenorphine treatment?
• Are there resources available in the office to provide
appropriate treatment, and support?
• Do they have a means of paying for the Suboxone?
56. Less Likely to be an Appropriate Candidate:
• High BNZ doses, alcohol, other CNS depressants
• Significant psychiatric co-morbidity
• Multiple addiction treatment episodes (+ -??)
• Actively or chronic suicidal or homicidal ideation
• Needs that cannot be addressed with existing office-
based resources or through referrals
• High daily doses of methadone ( 40mg+/day)
• Poor social support system—Cannot be living with IV
opiate user . Cannot be employed by Business linked to
drug use
57. How do you determine Dependence?
DSM-IV requirements:
3 or more needed x 12 months
– Tolerance
– Withdrawal
– Larger amt. longer period than intended
– Any unsuccessful effort / persistent desire to cut down
/control substance use
– A lot of time spent obtaining / recovering
– Important social, occupational, or recreational
activities given up / reduced
– Continuation despite consequences caused or
exacerbated by the substance
58. Narcotic / Alcohol Dependent
• Do CIWA and COWS scale
• Treat according to the CIWA/ETOH protocol
• This patient is NOT a candidate for suboxone
• This patient is a good candidate for
NALTREXONE maintenance once they finish
withdrawing from ETOH.
• They can be made comfortable with BZDs,
clonidine, phenergan or zofran
59. The Narcotic/Alcohol Dependent
• Suboxone possible If
– they contract to remain in residential treatment for
90 days
– Their counselors confirm their investment in recovery
– They have no underlying psych co-morbidity
– Upon release they have a stable living situation
– Upon release they remain in IOP
– Upon release they have the finances to obtain
suboxone consistently.
– They agree to be on a monitored ANTABUSE
PROGRAM