Draft 1.docx

Draft 1 Benzodiazepines are not the first-line treatment for OCD. Hallucinogens may have additional actions at other serotonin Hallucinogenic drugs Agonism of 5HT2A receptors, additional actions at other serotonin receptors (particularly 5HT1A and 5HT2C) and at other neurotransmitter systems, and MD...

Draft 1 Benzodiazepines are not the first-line treatment for OCD. Hallucinogens may have additional actions at other serotonin Hallucinogenic drugs Agonism of 5HT2A receptors, additional actions at other serotonin receptors (particularly 5HT1A and 5HT2C) and at other neurotransmitter systems, and MDMA in particular also blocks the serotonin transporter (SERT). The hypothalamus serves as the brain center that controls appetite by utilizing a complex set of circuits and regulators in the appetite stimulating pathways mediated by two peptides neuropeptide Y & agouti-related peptide. Phentermine acts much like amphetamine, blocking both the dopamine transporter (DAT) and the norepinephrine transporter (NET) and, at high doses, the vesicular monoamine transporter (VMAT). Buprenorphine is approved for persons < 18 years of age. disulfiram-alcohol reaction may occur within 2 weeks of alcohol ingestion. Methadone is a full mu-receptor agonist with a long half-life, which can prevent withdrawal symptoms for 24 hours and provide steady control of cravings throughout the day. In addition to its opioid receptor activity, it is also an antagonist of the N-methyl-D-aspartate (NMDA) receptor. disulfiram irreversibly inhibits aldehyde dehydrogenase resulting in build of toxic levels of acetaldehyde naltrexone blocks the enjoyment of heaving drinking through its action on reward circuitry Fentanyl and carfentanyl drugs are thousands of times more potent than morphine Naloxone (Narcan), an opioid antagonist, is the drug of choice for an emergency opioid overdose. Naloxone is also available without a prescription from some pharmacies High Risk for Opioid Overdose : High-dose, long-term pain/chronic pain management Use of rotating opioid medications Previous opioid overdose Uses extended-release opioids Users who have had a period of abstinence Recently released from incarceration Clients who mix opioids and other drugs/alcohol & is on opioids after a MVA Signs of Opioid Overdose Inability to wake or respond to voice/touch Slow or absent breathing (ex: RR<6 min) Pinpoint pupils Blue lips Adverse effects of opioids: itching, urinary retention, respiratory depression, constipation, sedation. Naltrexone & buprenorphine are not recommended for breastfeeding mothers. Methadone can be prescribed with special consideration given to feeding intervals (breastfeed prior to or 2-6 hours after dose). Methadone This is a long-acting opioid that binds to and occupies mu-opioid receptors, reducing craving for opioids and prevents withdrawal symptoms for 24 hours. Over time, with high levels of opioid tolerance maintained, the euphoric effects of further illicit opioid use are decreased.  Methadone has high potential for drug interactions, QT prolongation, and is difficult to titrate in eldery due to risk of accumulation from long half-life. Hydromorphone is an opioid agonist more potent than morphine