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group_1_presentation_2_-_opioids [2018/03/02 23:21] mohameah |
group_1_presentation_2_-_opioids [2018/03/02 23:51] (current) alagicf |
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| ====== Adverse Effects of Opioid Use ====== | ====== Adverse Effects of Opioid Use ====== | ||
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| - | <box 25% round right | > {{ :screen_shot_2018-03-02_at_8.00.49_pm.png?200|}} </box| Figure 3: Opioid receptors in GI tract. http://slideplayer.com/slide/11681545/ > | ||
| There are various adverse effects associated with long term use of opioids (Voon, Karamouzian & Kerr, 2017). These effects have been shown to target the gastrointestinal, cardiovascular, respiratory and central nervous systems (Voon, Karamouzian & Kerr, 2017). With regards to the gastrointestinal system, constipation is a prevalent effect of chronic opiate therapy (Khansari, Sohrabi & Zamani, 2013). This process depends on the stimulation of μ and κ opioid receptors in the gastrointestinal tract. Studies show that 40-45% of patients on opiate therapy experience constipation. Treatment involves the use of stool softeners and laxatives, which is not always effective. In some cases, constipation can be so severe that patients reduce their medication dosage or discontinue opiate use altogether (Khansari, Sohrabi & Zamani, 2013). | There are various adverse effects associated with long term use of opioids (Voon, Karamouzian & Kerr, 2017). These effects have been shown to target the gastrointestinal, cardiovascular, respiratory and central nervous systems (Voon, Karamouzian & Kerr, 2017). With regards to the gastrointestinal system, constipation is a prevalent effect of chronic opiate therapy (Khansari, Sohrabi & Zamani, 2013). This process depends on the stimulation of μ and κ opioid receptors in the gastrointestinal tract. Studies show that 40-45% of patients on opiate therapy experience constipation. Treatment involves the use of stool softeners and laxatives, which is not always effective. In some cases, constipation can be so severe that patients reduce their medication dosage or discontinue opiate use altogether (Khansari, Sohrabi & Zamani, 2013). | ||
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| + | <box 35% round right | > {{ :screen_shot_2018-03-02_at_8.00.49_pm.png?350|}} </box| Figure 3: Opioid receptors in GI tract. http://slideplayer.com/slide/11681545/ > | ||
| Long term use of opioid therapy has been shown to have deleterious effects on the cardiovascular system (Chen & Ashburn, 2015). When the use of opioid therapy was compared to Nonsteroidal anti-inflammatory drugs (NSAIDs) and selective cyclooxygenase-2 (COX-2) inhibitors, opioid therapy was associated with a 77% increased risk of cardiovascular effects such as heart failure and myocardial infarction (MI) (Voon, Karamouzian & Kerr, 2017). After 30 days, the risk of cardiovascular events was similar across different opioid medications. However, after 180 days of therapy, codeine was associated with a 62% increase in adverse events when compared to hydrocodone (Voon, Karamouzian & Kerr, 2017). Furthermore, studies have shown an increased risk of MI among patients on chronic opioid therapy relative to the general population (Chen & Ashburn, 2015). | Long term use of opioid therapy has been shown to have deleterious effects on the cardiovascular system (Chen & Ashburn, 2015). When the use of opioid therapy was compared to Nonsteroidal anti-inflammatory drugs (NSAIDs) and selective cyclooxygenase-2 (COX-2) inhibitors, opioid therapy was associated with a 77% increased risk of cardiovascular effects such as heart failure and myocardial infarction (MI) (Voon, Karamouzian & Kerr, 2017). After 30 days, the risk of cardiovascular events was similar across different opioid medications. However, after 180 days of therapy, codeine was associated with a 62% increase in adverse events when compared to hydrocodone (Voon, Karamouzian & Kerr, 2017). Furthermore, studies have shown an increased risk of MI among patients on chronic opioid therapy relative to the general population (Chen & Ashburn, 2015). | ||
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| ==== Pain Management ==== | ==== Pain Management ==== | ||
| - | Pain is often inadequately addressed and managed in patients, which can in part be attributed to hesitation to employ the use of opioids, including fentanyl, stemming from fear that they will be abused. Fentanyl is utilized for the relief of severe chronic pain (such as pain associated with cancer). This drug operates in the brain to modulate how the body feels and responds to pain (Joranson et al., 2000). This can be achieved through the forms of transdermal patch and intravenously. The patch form of fentanyl should only be used when absolutely required, and not used in cases of mild pain or pain that is short-term. Fentanyl is not suited for occasional or “as needed” use. It may take up to 24 hours before a patient experiences pain relief from fentanyl patches. The patch is usually changed every 72 hours (Joranson et al., 2000) (“Fentanyl Transdermal”, 2018). | + | Pain is often inadequately addressed and managed in patients, which can in part be attributed to hesitation to employ the use of opioids, including fentanyl, stemming from fear that they will be abused (Joranson et al., 2000). Fentanyl is utilized for the relief of severe chronic pain (such as pain associated with cancer). This drug operates in the brain to modulate how the body feels and responds to pain (Joranson et al., 2000). This can be achieved through the forms of transdermal patch and intravenously (Joranson et al., 2000). The patch form of fentanyl should only be used when absolutely required, and not used in cases of mild pain or pain that is short-term (“Fentanyl Transdermal”, 2018; Joranson et al., 2000). Fentanyl is not suited for occasional or “as needed” use. It may take up to 24 hours before a patient experiences pain relief from fentanyl patches. The patch is usually changed every 72 hours (“Fentanyl Transdermal”, 2018; Joranson et al., 2000). |
| - | Intravenously, fentanyl is distributed under the name Sublimaze. It is mainly used for pain management prior to surgery and pain relief after medical procedures. This is always administered by health care professional. The usual dosage is 50 to 100 micrograms (1 to 2 mL) and is given intramuscularly. In elderly and poor-risk patients, a lesser dose of 25 to 50 micrograms (0.5 to 1mL) is recommended. The dose may be re-administered every one to two hours if required (Janssen, 2014). Dosage should of course be adjusted based on each patient’s individual needs, and some of the factors that are used to determine dose are: age, body weight, physical status, underlying pathological condition, use of other drugs, type of anaesthesia, and type of surgical procedure. Due to the many potential side effects, health care professionals monitor patients closely and regularly evaluate vital signs after administering this drug. | + | Intravenously, fentanyl is distributed under the name Sublimaze (Janssen, 2014). It is mainly used for pain management prior to surgery and pain relief after medical procedures. This is always administered by health care professional. The usual dosage is 50 to 100 micrograms (1 to 2 mL) and is given intramuscularly. In elderly and poor-risk patients, a lesser dose of 25 to 50 micrograms (0.5 to 1mL) is recommended. The dose may be re-administered every one to two hours if required. Dosage should of course be adjusted based on each patient’s individual needs, and some of the factors that are used to determine dose are: age, body weight, physical status, underlying pathological condition, use of other drugs, type of anaesthesia, and type of surgical procedure. Due to the many potential side effects, health care professionals monitor patients closely and regularly evaluate vital signs after administering this drug (Janssen, 2014). |
| ==== Emergence Delirium and Relaxation ==== | ==== Emergence Delirium and Relaxation ==== | ||
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| ====== Drug Cutting ====== | ====== Drug Cutting ====== | ||
| - | Drug cutting refers to the addition of different solvents to a pure drug product in order to either reduce the cost of drug production or increase the potency of the drug. The materials added to the drug include baking soda, rat poison as well as other drugs such as fentanyl. Additives such as baking soda and rat poison are used to dilute the product which increases profit for the drug seller. The addition of other drugs such as fentanyl is used to increase the potency of the drug, which increases consumer appeal. | + | Drug cutting refers to the addition of different solvents to a pure drug product in order to either reduce the cost of drug production or increase the potency of the drug (Fentanyl, 2016). The materials added to the drug include baking soda, rat poison as well as other drugs such as fentanyl. Additives such as baking soda and rat poison are used to dilute the product which increases profit for the drug seller. The addition of other drugs such as fentanyl is used to increase the potency of the drug, which increases consumer appeal (Fentanyl, 2016). |
| ==== Drug Trade and Trafficking of Opioids ==== | ==== Drug Trade and Trafficking of Opioids ==== | ||
| - | The “Beekeeper” was considered one of the Canada's most dangerous chemists for many years. He was well known for creating many synthetic opioids such as fentanyl. | + | The “Beekeeper” was considered one of the Canada's most dangerous chemists for many years (CBC, 2017). He was well known for creating many synthetic opioids such as fentanyl (CBC, 2017). |
| <box 50% round | > {{youtube>2NCofLChqU8?medium}} </box| Video: One of Canada’s most prolific chemists, The Beekeeper. > | <box 50% round | > {{youtube>2NCofLChqU8?medium}} </box| Video: One of Canada’s most prolific chemists, The Beekeeper. > | ||
