Intoxication opioid

Glassification of Substance-Related Disorders. The DSM-IV classification system (1) divides substance-related disorders into two categories (/) substance use disorders, ie, abuse and dependence and (2) substance-induced disorders, intoxication, withdrawal, delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. The different classes of substances addressed herein are alcohol, amphetamines, caffeine, caimabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics or anxiolytics, polysubstance, and others. On the basis of their significant socioeconomic impact, alcohol, nicotine, cocaine, and opioids have been selected for discussion herein. 

CYP3A4, may contribute to methadone metabolism. Even with adequate methadone plasma levels, some patients continue to abuse drugs, such as sedatives, possibly because they are seeking some form of intoxication rather than relief of opioid hunger (Bell et al. 1990). Relapse to illicit drug use is also common during periods of high stress, even in patients with adequate plasma levels. 

Identify the typical signs and symptoms of intoxication associated with the use of alcohol, opioids, cocaine/amphetamines, and cannabis, and determine the appropriate treatment measures to produce a desired outcome following episodes of intoxication. 

The treatment goals for acute intoxication of ethanol, cocaine/amphetamines, and opioids include (1) management of psychological manifestations of intoxication, such as aggression, hostility, or psychosis, and (2) management of medical manifestations of intoxication such as respiratory depression, hyperthermia, hypertension, cardiac arrhythmias, or stroke. 

The intoxicating effects of opioids appear to be due to their action as agonists on mu (p) receptors of the opioid neurotransmitter system. Competitive p opioid antagonists such as naloxone and naltrexone acutely reverse many of the adverse effects of opioids. To date we do not have specific antagonists for most other abused substances, so rapid pharmacologic reversal of intoxication is usually not possible. 

The treatment goals for acute intoxication due to ethanol, cocaine/amphetamines, and opioids include (1) management of... 

Patients who are acutely intoxicated with an opioid usually present with miosis, euphoria, slow breathing and slow heart rate, low blood pressure, and constipation. Seizures may occur with certain agents such as meperidine (Demerol ). It is critically important to monitor patients carefully to avoid cardiac/ respiratory depression and death from an excessive dose of opioids. One strategy is to reverse the intoxication by utilizing naloxone (Narcan ) 0.4 to 2 mg IV every 2 to 3 minutes up to 10 mg. Alternatively, the IM/SC route may be used if IV access is not available. Because naloxone is shorter-acting than most abused opioids, it may need to be readministered at periodic intervals otherwise the patient could lapse into cardiopulmonary arrest after a symptom-free interval of reversed... 

Immunochemical methods have been reported for the determination of these substances in body fluids (see Table 8) in clinical and forensic analyses. In the case of illicit use of opioid drugs, methods have also been reported for the control of drug abuse and assessment of intoxication using body fluids, tissue extracts, post-mortem specimens, and seizure samples. For this reason there are several commercially available immunochemical methods (see Table 4). 

The antagonist action of partial agonists may result in an initial decrease in effect of a full agonist during changeover to the latter. Intoxication with buprenorphine cannot be reversed with antagonists, because the drug dissociates only very slowly from the opioid receptors and competitive occupancy of the receptors cannot be achieved as fast as the clinical situation demands. 

Drugs used to counteract drug overdosage are considered under the appropriate headings, e.g., physostigmine with atropine naloxone with opioids flu-mazenil with benzodiazepines antibody (Fab fragments) with digitalis and N-acetyl-cysteine with acetaminophen intoxication. 

Opioid agonists act first and foremost on /t-receptors. It is essential to know that use of compounds of this class should be avoided in the event of cranial trauma, bronchial asthma and other hypoxic conditions, severe alcohol intoxication, convulsive conditions, and severe pain of organs in the abdominal cavity. 

Tramadol Acute intoxication with alcohol, hypnotics, narcotics, centrally acting analgesics, opioids, or psychotropic drugs. 

Pain Action Unknown but may stimulate opioid sites, sedation and analgesia Dose Adults. Self administered inhalation (generally 25-50% w/ oxygen) until pain relief or pt drops mask/falls asleep Peds. Same as adult (onset w/in 2-5 min) Caution [ , ] Do not use after full meal Contra EtOH intox AMS following head injury COPD, thoracic trauma Disp Supplied in blue cylinders SE N/V, Light-headedness, AMS and hallucinations Interactions T CNS depression Wf opiates, EtOH, sedatives EMS Do not strap mask to pt s face, allow pt to hold the mask to their face dosing is self-limiting when pt drops mask d/t CNS depression typically used for bums and fractures... 

Musshoff et al. [35] developed a method for the enantiomeric separation of the synthetic opioid agonist tramadol and its desmethyl metabolite using a Chiralpak AD column containing amylose tris-(3,5-dimethylphenylcarbamate) as chiral selector and a n-hexane/ethanol, 97 3 v/v (5mM TEA) mobile phase nnder isocratic conditions (1 mL/min). After atmospheric pressure chemical ionization (APCI), detection was carried out in positive-ion MS-MS SRM mode. The method allowed the confirmation of diagnosis of overdose or intoxication as well as monitoring of patients compliance. 

Acute administration of opioids, particularly in non-tolerant individuals, produces a syndrome of intoxication characterized by pupillary dilation and initial euphoria, followed by apathy, psychomotor retardation, slurred speech, and impaired attention and memory. Opioid overdose can produce fatal respiratory depression and thus is a medical emergency. 

Clinically, these drugs have hypnotic and relaxant properties. The intoxication is characterized by impeded motor coordination, and the euphoria is not always obvious. To some extent, the attraction of use is more state dependent than in the case of opioids and central stimulants. Diazepam, for instance, is experienced as more rewarding in states of anxiety (negative reinforcement). It is also well known that expectancy factors have a significant role at low blood alcohol concentrations. The low-dose alcohol intake might be experienced as positive to a large extent by what one thinks will happen (Marlatt and Rohsenow 1980). 

Codeine Phosphate The presence of aspirin along with codeine, even at a low moisture level, leads to acetylation of codeine phosphate in solid dose forms and is incompatible.36 Codeine sulfate solutions are more stable than phosphate salts.37 Drug dependence and withdrawal resemble that of opioid analgesics. Overdose causes acute intoxication in children, as accidental or deliberate ingestion of cough preparations containing codeine.38... 

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