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Pharmacologically, ritalin works on the neurotransmitter dopamine, and in that respect resembles the stimulant characteristics of cocaine.
Patients are as physically dependent on methadone as they were to heroin or other opiates, such as Oxycotin or Vicodin.
Cocaine's immediate physical effects include raised breathing rate, raised blood pressure and body temperature, and dilated pupils.
At intoxicating doses, alcohol can decrease heart rate, lower blood pressure and respiration rate, and result in decreased reflex responses and slower reaction times.
OxyContin, approved by the
FDA in 1995, an opium derivative, which is the same active ingredient in Percodan
and Percocet. OxyContin is intended for use by terminal cancer patients and
chronic pain sufferers. It has been linked to at least 120 overdose deaths nationwide.
is the chief hazard from all opioid usage. Respiratory depression occurs
most frequently in elderly or debilitated patients, usually following
large initial doses in non-tolerant patients, or when opioids are given
in conjunction with other agents that depress respiration. Common opioid
side effects are constipation, nausea, sedation, dizziness, vomiting,
headache, dry mouth, sweating, and weakness.
Oxycodone should be
used with extreme caution in patients with significant chronic obstructive
pulmonary disease and in patients having a substantially decreased respiratory
reserve, hypoxia, hypercapnia, or preexisting respiratory depression.
In such patients, even usual therapeutic doses of oxycodone may decrease
respiratory drive to the point of apnea. In these patients alternative
non-opioid analgesics should be considered, and opioids should be employed
only under careful medical supervision at the lowest effective dose. Oxycodone
causes miosis, even in total darkness. Pinpoint pupils are a sign of opioid
overdose but are not pathognomonic. Marked mydriasisrather than miosis
may be seen due to hypoxia in overdose situations.
- Gastrointestinal Tract
and Other Smooth Muscle
Oxycodone causes a reduction in motility associated with an increase in smooth
muscle tone in the antrum of the stomach and duodenum. Digestion of food in
the small intestine is delayed and propulsive contractions are decreased.
Propulsive peristaltic waves in the colon are decreased, while tone may be
increased to the point of spasm resulting in constipation. Other opioid-induced
effects may include a reduction in gastric, biliary and pancreatic secretions,
spasm of sphincter of Oddi, and transient elevations in serum amylase.
- Cardiovascular System
Oxycodone may produce release of histamine with or without associated peripheral
vasodilation. Manifestations of histamine release and/or peripheral vasodilation
may include pruritus, flushing, red eyes, sweating, and/or orthostatic hypotension.
Studies in normal volunteers and patients reveal predictable relationships
between oxycodone dosage and plasma oxycodone concentrations, as well as between
concentration and certain expected opioid effects. In normal volunteers these
include pupillary constriction, sedation and overall "drug effect"
and in patients, analgesia and feelings of "relaxation." In non-tolerant
patients, analgesia is not usually seen at a plasma oxycodone concentration
of less than 5&10 ng/mL.
As with all opioids,
the minimum effective plasma concentration for analgesia will vary widely
among patients, especially among patients who have been previously treated
with potent agonist opioids. As a result, patients need to be treated
with individualized titration of dosage to the desired effect. The minimum
effective analgesic concentration of oxycodone for any individual patient
may increase with repeated dosing due to an increase in pain and/or the
development of tolerance.
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