Prescription Drug Abuse课件.pptVIP

Prescription Drug Abuse Larissa Mooney, M.D. Assistant Professor of Psychiatry UCLA Integrated Substance Abuse Programs David Geffen School of Medicine at UCLA Overview Three classes of commonly abused Rx drugs (opioids, sedatives, stimulants) What are they? How do they act in the brain and body? What are their effects? Neurobiology What are opioids? Opiate: derivative of opium poppy Morphine Codeine Opioid: any compound that binds to opiate receptors Semisynthetic (including heroin) Synthetic Oral, transdermal and intravenous formulations Narcotic: legal designation Effects of Opioids Sedation Pupil constriction Slurred speech Impaired attention/memory Constipation, urinary retention Nausea Confusion, delirium Seizures Slowed heart rate Respiratory depression Opioid Receptors Receptor types mu, delta, kappa Receptors located throughout body Pain relief: central and peripheral nervous system Reward and reinforcement: deep brain structures Side effects: constipation, sedation, itch, mental status changes Receptor interactions Full agonists Partial agonists Antagonists Endogenous Opioids Produced naturally in body Act on opioid receptors Examples: endorphins, enkephalins, dynorphins, endomorphins Produce euphoria and pain relief; naturally increased when one feels pain or experiences pleasure Pain: the Fifth Vital Sign JACHO Guidelines 2000: Mandated pain assessment and treatment Nurse and physician education required When opioids prescribed properly for pain, addiction rare in patients without underlying risk factors Vulnerabilities same as for other addictions: genetic, peer and social influences, trauma and abuse history Pain Pathway Pain Control and Addiction “Pseudoaddiction”: Presence of drug-seeking behavior in context of inadequate pain control Behavior stops with adequate pain relief Description of a clinical interaction (not a true diagnosis) “Hyperalgesia”: exaggerated sense of pain with increasing opioid dose