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Opioids

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Mohammad Samin

The document discusses opioids, including their classification into natural, semi-synthetic, fully synthetic, and endogenous types. It provides examples of opioids that fall into each classification. The document also covers the clinical uses of opioids, their side effects, complications from misuse, overdose symptoms and management, neonatal withdrawal syndrome, and treatment for opioid addiction.

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E-mail: saminstanikzai@yahoo.com
Opioids Classification Natural Semi-synthetic Fully Synthetic Endogenous
1-Natural1-Natural • -Opiates. • 1-Morphine. • 2-Codeine. • 3-Thebaine.
2-Semi-synthetic2-Semi-synthetic • 1-diacetyl morphine(Heroin). • 2-Hydromorphone. • 3-Hydrocodone. • 4-Oxymorphone. • 5-Oxycodone. • 6-Desomorphine. • 7-Benzylmorphine.etc.
3- Fully synthetic3- Fully synthetic • 1-Fentanyl. • 2- Pethedine. • 3-Methadone. • 4-Propoxyphine. • 5- Pentazocine(benzomorphan derivative).
4-Endogenous4-Endogenous • 1-endorphins. • 2-Enkephalins. • 3-Dynorphins. • 4-Endomorphins.
Clinical useClinical use • 1-Moderate to sever pain. • 2-Cough . • 3-Diarrhea. • 4-Pulmonary oedema. • 5- Opioid dependence ( Methadone/buprenorphine only). • 6- Anesthesia.
Side effectsSide effects • 1- dry mouth. • 2-myosis. • 3-nuasea/vomiting. • 4-constipation. • 5-urin retention.
Side effects cont…Side effects cont… • 6- Ataxia. • 7-Somnolence. • 8-Euphoria. • 9-Itching. • 10-Disoreintation. • 11-Hypotention.
Side effects Cont…Side effects Cont… • 12-Dyspepsia. • 13-Dependence/ Addiction. • 14-Respiratory depression. • 15-Impotence. • 16-Convulsions and coma.etc.
Side effects in pregnant womenSide effects in pregnant women • 1-Spontaneous abortion. • 2-Mental retardation. • 3-Low birth weight. • 4-Congenital anomalies. • 5-Neonatal or congenital addiction.
ComplicationsComplications • 1-Cellulitis. • 2-Thrombophelibitis. • 3-Endocarditis. • 4-Septicemia. • 5-Hepatitis. • 6-HIV/AIDS. • 7- Respiratory infections . • 8-Sinusitis ( snorting heroin).9-Emboli and others.
Opioid overdoseOpioid overdose • S/S • 1-Respiratory depression. • 2-Myosis (pin point pupils). • 3-Pulmonary oedema. • 4-Bradycardia. • 5-Hypotention. • 6-Hypothermia. • 7-Stupor and coma.
Opioid overdose in childrenOpioid overdose in children • S/S • 1-Respiratory depression. • 2-Stridor. • 3-increase oropharangeal secretions. • 4- bradycardia. • 5-urinary retention. • 6-coma.
Overdose in children cont…Overdose in children cont… • Pulmonary oedema is rare. • Death is usually from • --the aspiration of gastric contents. • --Cardiac arrest. • --and cerebral oedema.
Overdose managementOverdose management • 1-Control of vital signs. • 2- ABCD • 3-Naloxone • Dosage Adult 0.4—2mg every 2-3min child 0.01—0.1mg every 2-3min 4-Activated charcoal or gastric lavage if the patient is not unconscious.
withdrawal syndromewithdrawal syndrome ..
‫ههه‬ ‫ههههههه‬ ‫هه‬ :‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬ ‫ههههههههه‬withdrawal‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬-)‫هه‬ ‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬( .-.
‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬‫ه‬ ‫هههه‬‫ه‬‫ه‬ ‫ههههه‬ •1224 •: •1421 ‫هههههه‬‫ه‬‫ه‬ ‫هههههه‬ •68 •710
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 DAYS Withdrawal signs & symptoms
No Acute effects of heroin Withdrawal symptoms 1 Relief Pain Induce pain 2 Suppress cough Induce cough 3 Dry mouth Lacrimation , Rhinorrhea , Sneezing 4 Euphoria Dysphoria 5 Hypertension & Bradycardia Hypertension & tachycardia 6 Muscle relaxation Muscle spasm 7 Hypothermia Hyperthermia 8 Constipation Diarrhea or Nausea / vomiting 9 Induce sleep Insomnia 10 Myosis Mydriasis 11 Ataxia 12 Itching 13 Urine retention Spontaneous Ejaculation 14 Respiratory Depression Tachypnea
• 1- • 2- . • 3-. • 4- • 5- . • 6- . • 7- . • 8- . • 9- . • 10-
...... • 11- • 12- . • 13- . • 14- . • 15- . • 16- . • 17- Piloerection. • 18-Spontaneous ejaculation. • 19-Hyperthermia . • 20- Dehydration .
Withdrawal4-0 -. - -. -WithdrawalHemoconcentration)()Ejaculation(
Neonatal withdrawal SyndromeNeonatal withdrawal Syndrome • S/S occur within the first 24 hrs and may last up to 8 days and may include, • Yawning. • Sneezing. • Decreased Moro reflex. • Increased tendon reflexes. • Tremor. { E. Moro (1874-1951) German pediatriacian.
Neonatal withdrawal Cont…Neonatal withdrawal Cont… • Hunger but irregular sucking. • Loud cry. • Watery diarrhea. • Vomiting. • Fever. • Cyanosis. • Convulsion and dehydration.
Confirmation of DiagnosisConfirmation of Diagnosis • 1- Finding of Opioid metabolites in mother’s or Neonate urine. • History of mother addiction.
.. .. --pre-treatment phasepre-treatment phase --Treatment phaseTreatment phase --Post- treatment phasePost- treatment phase
-- .. .
(Detoxification)(Detoxification) ..
Opioids
DetoxificationDetoxification :: DetoxificationDetoxification withdrawalwithdrawal
DetoxificationDetoxification AcupunctureAcupuncture
..
-- .. -- .. -- .. -- (self help groups(self help groups )) NANA .. -- ( twelve steps( twelve steps )) ..
Opioids
:: • • • •Overdose • • • - - - -
Opioids
These people are smoking Opium
Injecting drug user
It is too dangerous to share the syringe
Opioids

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