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Okay let's finish up this um toxicology drugs of abuse lecture. So FLUoxetine um

and discipline means. So these are S. S. R. I. S. And tries to look antidepressants.

So S. S. Ri selective serotonin re uptake inhibitor.

Now we're gonna talk more about this on Tuesday.

Um But what that does is think about it serotonin re uptake inhibitor.

Remember I told you anything that's called a re uptake inhibitor

inhibits the reuptake of the neurotransmitter back into the pre synaptic so it

keeps it in the synapse so that it can activate the receptors longer.

So in the case of flu oxytocin um it's going to

be working on serotonin to keep serotonin in the synapse longer.

Um serotonin will be used in depression along with other things.

Tricyclic antidepressants work more on norepinephrine and

serotonin but it does kind of both.

So tricyclic antidepressants.

Our re uptake inhibitors of norepinephrine

and serotonin. Um

Those are antidepressants.

Although the tricyclic antidepressants have a lot of other uses other than just um

antidepressant. They can be used for pain. They can be used for. Um

What else contracted

bed wedding?

Like a lot of weird things you know somebody's going to

be like this is an antidepressant that's not what I have.

It's used for weird things. Um.

Yeah

both antidepressants have been shown to reduce drug cravings for opiates.

So here you go. Weird things um

opiates and alcohol but not cocaine. So um um

they can use these to help somebody who's going

through trying to get clean that sort of thing.

So nicotine

um

one of those nicotine receptors and we're gonna use,

there's two different ways that you can treat quitting smoking cessation,

you can give them a replacement.

So like a gum, the Nicotrol inhaler HLA singers and um the transdermal patch.

Okay so the HLA singers you park them in your cheek.

Um The thing is is when you swallow a

nicotine into the stomach it can make you nauseous.

So with one called the nick the nicotine minis

minis are smaller and you can put them in

your cheek and let's just going to get into

the stomach which is going to cause less nausea.

There's also dozing.

So if you have a cigarette within 30 minutes of waking up you get a

higher dose than if you don't have a cigarette within 30 minutes of waking up.

That's kind of how they tell how addicted you are and I

always think about that when it comes to like my phone addiction.

You know like a lot of us are really addicted to our phones.

Do you look at your iphone like immediately when you wake up you're

like I gotta look at it and my thought is if you do something

within 30 minutes of waking up you have a strong addiction and if you

don't I am definitely addicted to this um I'm definitely addicted to caffeine,

we have that within 30 minutes of waking up.

So um

it just makes you think a little bit different but you could also treat it with Zyban.

Zyban is be appropriate.

Be appropriate is an antidepressant that works on norepinephrine and dopamine. Um

We use it and depression at like 150 mg,

300 mg but at 75 mg we can use it to try to help people stop smoking.

There's also, sorry I meant to say there's three ways.

There's also Chantix, Chantix is very selling. Um

basically what you wanna do comes in a pack

And you're gonna start at a low dose .5.

And then um you're going to increase the amount of nicotine,

very selling to one and you pick a stop date.

So sometime let's say on Tuesday we're going to quit smoking.

So your body kind of gets used to the medication and then you stop smoking

at a certain date and then now you have the medication that takes over.

Um it stimulates the nicotine receptors

and reduces cravings and withdrawal symptoms.

Now the issue it has um it's about almost 40% more effective than trying to do it

you know

alone without any drugs.

Um I will say that my husband used this uh it is really effective.

It works it works good but here's the issue with it.

I got myself in trouble when I was an intern on rotations.

Um Because I did a rotation at the V. A. And a lot of the V. A.

Veterans were complaining that the army got them addicted to cigarettes.

They put them in their M. R. E. S. R.

And their packs and and gave it to them and then now they're

not giving them the good stuff to get them off of it.

So they're not giving them good treatment.

And I thought well yeah you're right like why would we

not pay for smoking cessation um agents in our veterans who

are addicted to cigarettes in the first place because of the

government And my precept er who was not very nice.

She's like known for being for making interns cry said but

she had a very valid point and I was very wrong.

Very Celine increases the risk for suicide.

And veterans are a high risk population for suicide.

So it would not be smart of us as clinicians to give

gasoline or Chantix to high risk population for suicide.

So unfortunately that was my error to speak out of turn. And um I was 100% incorrect.

We should not be giving Chantix to veterans because of that high risk for suicide

lesson learned.

Okay so Narcan Narcan is our opiate mu receptor antagonist.

Um It comes in a solution for it comes an injection and it comes in a pen.

So this now is we have a lot of legislation

passed where a pharmacist can dispense us without a prescription.

We have a protocol that we right up under our physicians protocol.

Police can keep it in the car. I think obviously paramedics can have it.

This drug will turn you around. Um you have an opiate overdose.

You give this medication you turn around. It also comes in a pill form.

naloxone and it's used for various different things. Um Let me see if I can get

like a lot of people that I know have been using it for weird.

Not just for open overdose.

No locks on.

Yes,

so opiate overdose. Um

that's in the pen blah blah blah. What else here? So they don't have the weird uses.

Somebody had like a skin itching where they couldn't get their

skin under control and they were using it for that.

One of my employees. Just some weird things. So anyways um

competitive inhibitor of the mu receptor

helps curve those actions of um

euphoria, sedation, respiratory depression, Ding ding ding.

This is going to save your life. You have this bradycardia and physical dependence.

Um

mm hmm.

Don't take it if you're alerted, don't you talk about that all the time.

Common side effects are injection site reactions, dizziness, headaches,

swelling, nausea, vomiting, tremors serious as opiates for jaw, pulmonary edema,

hypertension, Tachycardia.

Um

cardiac arrest seizures, coma, encephalopathy.

Um

naloxone may be administered and it

perceived opiate overdose.

Um in caution with patients with history of seizure but as I said before,

it is combined with

an orphan to make Suboxone.

So Suboxone has that opiate partial agonist and

an opiate antagonist in one to prevent um

the the abuse on top of just the opiate partial agonist by itself.

Oh here's more about it. So here's the pill form. Um

Let's see what this is all should be about the same.

I wouldn't say anything different from the pill form than it was for the injection.

Okay so this is saying um drugs should be initiated only

after a patient is opiate free for at least 7-10 days.

Um

High risk for for participating withdrawal symptoms.

So they do use it in combination with the pupil orphan I would say less than 7-10 days.

I think they use it right away after withdrawal within a day or two maybe two days.

Um to prevent them from having a relapse.

Okay methadone this is our

slow peeking long acting opiate.

It's a synthetic opiate um agonist of the new receptors. It has a long PK profile.

methadone is useful for the maintenance of opiate dependency and withdrawal.

The reason why we're giving this is because we don't want them to take heroin.

Um opiate detoxification

opiate abuse treatment. You have to have a special license called.

I can't think of the name of it but you're you have a regular D. A.

Number and then you can have an X. D. E.

A number where they replace the first letter of the D. E. A. With an X.

And that means that you've done special training in um

Patients trying to get off of opiates.

And you can only have 30 patients and there's

all these other rules that are associated with it.

So I just want you to be aware of that.

Um Don't use in significant respiratory depression period. Uh Periodic Elliot's.

Remember that opiates will learn a little bit more next week.

Really stop up that gut.

So um if you already have a backup

system this can really cause some bowel obstructions.

Um And acute bronchial asthma.

The side effects are nausea, vomiting, dizziness, lightheaded sedation.

Just like it looks like regular stuff here. Um But a serious stuff.

QT prolongation a lot of medications call that

heart arrhythmias to assad's which is heart arrhythmia.

Um General inefficiency, hypoglycemia, respiratory arrest drug dependency.

Right So we're treating this is where the tricky

part is we're treating an opiate with an opiate.

So it can cause drug dependency. I mean I've had patients on super high doses of this.

I don't know how they're ever going to get off of it.

Um

They can do this in treatment where you have to go to the

treatment center or you are in house or they can do it outpatient.

This is metabolized by a lot of systemic

enzymes which means high for drug interactions.

You gotta be careful with other medications that cause QT

prolongation other medications that cause

respiratory depression cns depression.

Um

And step interactions.

So you can orphan. This is um not Buchanan exits subtext.

The branding of the subtext that we see.

Um Remember subtext is buprenorphine by itself.

Suboxone is buford orphan with a naloxone attached to it. Um

There are indications of

an orphan for pain.

So um the bell Bucha and the trans patch are broken orphan, indicated for pain.

Not for opiate. Um

Getting stopping opiates this for opiate dependency. You can also use it for pain.

So my company will fill this medication for pain if you get the Bell

bucha or the nutrients patches but not just straight people are from by itself.

If you're using it for opiate dependence you

have to have a dispense with the naloxone.

Um can cause vomiting, somnolence depression, fatigue.

The serious same ones as the methadone. Qt prolongation

uh drug withdrawal syndrome

and neonatal. Oh yeah, for sure.

We don't want to do opiates with the little munchkins. For sure,

mm hmm.

Let's see here t half. Look at that. 48 hour half life. 48 hour half life.

So when you're getting off this, you know they say it's

It's easier to get off of this than um like a short acting opiates.

But I don't know man. 48 hour half life is a long time to get a drug out of your system.

Um so I'm not sure how I feel about that. It is 96% protein

which is a significant member over 80% of significant does have 7384 interactions.

We need to be careful with those for drug depression, um

accidental exposure to to the bugle films and transdermal

patches and a child can cause an overdose.

Um

Yeah, you have to be careful with, with kids,

especially with the films because you just put them

on your tongue the films and they just dissolve.

So a kid could put that in their mouth and it could be really dangerous.

So cannabinoids um

I can't I can't read these, They're so tiny.

Okay,

cannabinoids are drugs that make our in Dodge Innis

cannabinoids and work on the CB one receptors.

They can be an agonist or a partial agonist.

The mechanism of action um is that they work on the CB one receptor agonist.

They can be anti american anti medics but that mechanism

is not known by working on the chemo receptor triggers.

And we're going to talk about that in our next lecture.

Um So the CB one receptors are in the cns, the lungs,

the liver and the kidneys and the CB two is an immune and the hepatic poetic itself.

Um They have high first pass metabolism

um which really decreases their bio availability.

So um they're highly lipid soluble,

which means they can get in probably to the blood brain barrier.

They can get into the cells really well, they're highly protein bound,

which can be significant

and their metabolites are active

half lights really range.

Um

You can have tolerance with this where you just need more and more and more to

have the same effect shoot amount of time and I only have a couple more.

I need to do. Okay, we're gonna have to stop. Sorry.

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