Addiction Julia E. Linton York College/ Wellspan Health Nurse Anesthesia Program
Objectives Identify patient populations at risk for drug abuse Identify several common drugs of abuse and the MOA Identify common pharmacologic cessation therapies and the MOA Discuss anesthetic management of patients with drug addiction Discuss anesthetic management of patients undergoing drug cessation therapy
Disclosures None All brand names used in this presentation are presented for ease of understanding and not endorsement of any specific product
DRUG ADDICTION DEMOGRAPHICS
Heroin Highways
ADDICTION RISKS http://www.drugabuse.gov/news-events/public-education-projects/nida-science-fair-award-addiction-science
THE NEURAL CIRCUITS OF PLEASURE PLEASURE CENTERS
Drugs we will discuss Marijuana Stimulants cocaine, amphetamines, ADHD MDMA Hallucinogens Opiates Heroin New, scary, designer drugs Methadone Buprenorphine
Marijuana Most widely used, most widely available, safest illegal drug MOA: non-ionized THC molecules bind to the CB1 receptor in the brain and spinal cord 97% protein-bound Anesthetic implication: THC modulates neurons in a similar fashion of our drugs. Potential for synergistic effect is currently intoxicated.
Gateway Drug?
Stimulants Cocaine, amphetamines, methamphetamines Includes common ADHD medical therapies Increase the amount of the monoamine neurotransmitters Norepi, epi, dopamine, serotonin
Stimulants - Cocaine Methods of ingestion oral, mucosal absorption, smoking, IV MOA: Blocks the dopamine transporter in nerve terminals Remember it s also a LA = seizures are very common
Cocaine CV Concerns Summary: There is no greater risk for the cocainepositive patient than any other patient
Amphetamines & Meth Pills, powders, chunks = ice Precursor is pseudoephedrine Meth ingredients Battery acid, drain cleaner, antifreeze, engine starter, lantern fuel MOA: Indirect sympathomimetic
Stimulants Ritalin & Adderall 30% of college students Methylphenidate (Ritalin) most prescribed ADHD drug, now abused by college students to gain an edge
MDMA 3,4-methylenedioxy-methamphetamine AKA: Ecstasy MOA: Increases levels of norepi, serotonin, and dopamine in the synapse. Most effective at increasing serotonin levels.
Hallucinogenics Population: white teenage males, Native Americans for religious ceremonies Schedule I with some exceptions (ketamine, dextromethorphan) Encompasses a wide variety of substances natural herbs to synthesized chemicals MOA: variable
Opiates Numbers most abused substance after ETOH and marijuana 2014 pills most abused (90%), but heroin still a significant problem
Heroin Purity varies 10 to 70% - avg 30% Cut with talc, quinine, baking powder MOA: Its just extra-lipid-soluble morphine
Other Drugs of Interest K2/Spice synthetic cannabis Bath salts MDOV or mephedrone stimulant Krokodile desomorphine
K2/ Spice Generally a mixture of dried herbs and plants that are then sprayed with synthetic cannabinoids Second in use among high-schoolers only to marijuana
Bath Salts MDOV or mephedrone stimulants Amphetamine derivatives Chemical alterations make effects unpredictable
Krokodil Codeine mixed with paint thinner, gasoline, red phosphorus, iodine, and hydrochloric acid Flesh-eating Drug
Cessation Medication
Methadone MOA NMDA antagonist, mu and delta opioid receptor agonist DOS protocol Take morning dose and resume ASAP. Additional analgesia as required. Patients on >200mg may have prolonged QT get baseline EKG
Buprenorphine Indications opioid addiction Subutex just buprenorphine Suboxone buprenorphine/ naloxone No effect from naloxone, included to prevent IV injection MOA partial mu agonist, kappa antagonist DOS protocol Two protocols Wean with stopping 72 hours prior to surgery Continue therapy as part of pain management
Naloxone Pure opioid agonist at mu, kappa, and delta receptors Duration shorter than heroin..
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