Opioid use in rheumatoid arthritis homework help

Opioids– are a class of drugs naturally found in the opium poppy plant that works in the brain to produce several effects including the relief of pain. They can be strong prescription pain relievers often referred to as painkillers or they can also be referred to as street medicine such as heroin and cocaine.

Opioid use in rheumatoid arthritis homework help

Opioid use in rheumatoid arthritis homework help

Rheumatoid arthritis is a chronic inflammatory disorder that can affect the joints and more including the skin, eyes, heart, lungs, and blood vessels. It occurs when the body’s immune system mistakenly attacks its body tissues.

Types of arthritis

 

The types of arthritis include the following:

  • Osteoarthritis- it is the wear and tear that happens when your joints are overused and usually happens with age, although it can also come from joint injuries or obesity. Being obese puts extra stress on the joints hence causing arthritis. It affects the joints that bear the weight like the hip, knees, spine, and feet, and often comes gradually over years or months.
  • Rheumatoid arthritis- is an autoimmune disease in which the immune system attacks parts of the body, especially the joints. That leads to inflammation which can cause severe joint damage if left untreated. Some people who have arthritis get lumps on their skin called rheumatoid nodules and they often form over joint areas that receive pressure. Eg elbows, heels, knuckles, etc.
  • Psoriatic arthritis- most people with this type of arthritis have inflammation of the skin (psoriasis) and joints (arthritis). Psoriasis usually causes patchy, raised, red, and white areas of inflamed skin with scales. It usually affects the tips of the elbows and knees, the scalp, navel, and skin around the genital area or anus. Some people with psoriasis will end up getting psoriatic arthritis.
  • Gout- this is a result of a buildup of uric acid crystals in a joint which sometimes happens in the big toe or another part of your body.
  • Lupus- it is also called SLE or systemic lupus erythematosus and is an autoimmune disease that affects the joints and many organs in the body.

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Risk factors for arthritis

 

The following are some of the risks for bone disease:

  • Unhealthy diet- a diet that is low in vitamin D and calcium can greatly increase the risk for osteopenia or osteoporosis. Vitamin D facilitates the absorption of calcium while calcium is an essential nutrient in the formation of healthy strong bones. Reduced intake of calcium can contribute to reduced bone density, early bone loss, and increased risk for fractures.
  • Sedentary lifestyle- people who are not physically active are at a greater risk of developing arthritis and osteoporosis compared to those who are active. Physical inactivity also contributes to many chronic illnesses which can be detrimental to your health.
  • Watching your body weight- maintaining a healthy body weight helps to manage your bone health. It is important to ask your healthcare provider about your ideal weight so that you can be able to stay healthy.
  • Smoking- is a risk for osteoarthritis, low bone density conditions, and inflammatory arthritis. Smoking can also increase the risk of fractures and increase the time it takes to heal from a fracture.
  • Some medications- the usage of some medications for a long time can make it harder to absorb calcium hence leading to damage to bones. Some of these medicines include corticosteroids used to treat mood disorders, hormonal contraceptives, ani-seizure medicines, proton pump inhibitors, etc.
  • Consuming excessive alcohol- heavy consumption of alcohol contributes to decreased bone remodeling increasing the risk of fractures hence delaying the healing of fractures. Alcohol can also interfere with the balance of calcium and the production of vitamin D.

Symptoms of arthritis

 

Symptoms of arthritis vary from person to person. Most people with arthritis have symptoms relating to the joints such as pain, redness, and warmth in a joint, stiffness and reduced movement of a joint, and pain. Others feel unwell, and tired and experience weight loss.

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Examples of opioids

 

Opioids can sometimes be referred to as narcotics and although they relieve pain, they are not classified in the same category as over-the-counter painkillers like aspirin and Tylenol. There are a variety of opioids which include:

  • Fentanyl (abstral, Duragesic, fentora)
  • Codeine
  • Hydrocodone/acetaminophen
  • Hydromorphone
  • Meperidine (dolphins, methadone)
  • Morphine (Kadian, MS Contin)
  • Methadone (methadone, dolphins)
  • Oxycodone (oxaydo, oxycontin)
  • Oliceridine (olynvik)
  • Oxycodone and naloxone

The work of opioid medicines

Opioids are a broad group of pain-relieving drugs that work by interacting with opioids receptors in your cells. They can be made from the poppy plant or synthesized in the laboratory. When the opioids travel through the blood and get attached to opioid receptors in the brain cells, the cells release signals that muffle the perception of pain and boost the feelings of pleasure.

Side effects of using opioids to treat arthritis

Opioids can cause side effects such as drowsiness, mental fog, nausea, and constipation. They may also cause slowed breathing, which can lead to overdose deaths.

Opioids have the following risks which may be very serious for elderly people:

  • Mental confusion and sedation- they can cause sleepiness or mental clouding which can increase the risk of falls and fractures.
  • Abnormal breathing- high doses of opioids can cause slow or shallow breathing patterns during sleep.
  • Constipation- older people are more likely to experience this problem while opioids make it worse.
  • Heart problems- opioids increase the risk of heart failure and heart attack.
  • Nausea- nausea which is a result of opioids makes it difficult to feed well and maintain good nutrition. This happens when there is stimulation on the chemoreceptor trigger zone which detects noxious chemicals in the blood and sends signals to the vomiting center in the medulla, which then initiates the vomiting reflex.
  • Urinary retention- they are the anticholinergic side effect of opioids and can be secondary to opioid-induced constipation.
  • Central nervous system adverse effects- a combination of opioids and other central nervous system drugs eg. Barbiturates, antidepressants, and antipsychotics can have addictive effects on sedation.
  • Pruritis- it happens in a small number of old people with opioid use and it resolves in one week.
  • Respiratory depression- opioids are the cause of an unwanted side effect which is marked by depression of breathing that can complicate their clinical administration and can be potentially life-threatening as the pattern of breathing becomes shallower and slower.
  • Opioid-induced hyperalgesia- patients who receive large doses of opioids may develop opioid-induced hyperalgesia which is the increase of sensitivity to both pain and non-painful stimuli.
  • Cardiovascular system- the opioid called methadone contributes to the development of arrhythmias.
  • Endocrine- opioids pose two effects on the endocrine system. Diminished bone density, impaired sexual performance, and decreased libido are reported with chronic opiate use.
  • Gastrointestinal problems- opioids cause nausea and vomiting which often passes after days. To avoid this, you can lie down for an hour after taking the dose.

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 signs of an overdose of opioids for treating arthritis

 

The signs of an overdose with opioids include-

  • The fingernails have a blue or purple color
  • The body goes limp
  • The face becomes extremely pale and feels clammy to touch
  • They vomit and make gurgling noises
  • Their breathing becomes slow and they also experience slow heart rates.

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Risk factors for opioid overuse

The risks of opioid overdose include:

  • Taking opioids by injection
  • Having an opioid use disorder
  • Resumption of opioid use after a long period of abstinence after detoxification, cessation of treatment, or release from incarceration.
  • High prescribed dosage of opioids
  • Using opioids together with alcohol, other substances, or medicines that support respiratory function.
  • Having concurrent medical conditions such as HIV liver or lung disease or mental health conditions.

Reasons for overdose

 

Taking an overdose may be:

  • Accidental- this is where a person takes the wrong substance or combination of substances in the wrong amounts or at the wrong time which causes them harm. This includes people who take a drug to get a certain desired effect. This includes those who want to get high and reduce unpleasant emotions.
  • Intentional- a person takes an overdose to inflict self-harm which may be a suicide attempt or maybe cry for help.

Prevention of an opioid overdose

 

Beyond approaches to reducing drug use, the following are measures to help reduce the chances of opioid overdose:

  • Limiting appropriate over the counter sales of opioids
  • Increasing the availability of opioid dependence treatment including for those dependent on prescription opioids
  • Reducing and preventing irrational or inappropriate opioid prescribing
  • Monitoring opioid prescribing and dispensing

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Safety tips to follow while using opioids

 

You can follow the following safety tips if you have been prescribed opioids:

  • Ensure you watch out for side effects- opioids cause multiple side effects, some of them are mild for example sleepiness and constipation, while others which include shallow breathing, slowed heart rate and loss of consciousness can be serious and life-threatening. Remember to ask your physician what you should be aware of and what you can do to prevent potential problems in the future. In case you experience symptoms of a possible overdose call 911.
  • Remember to take opioids only as directed by your physician- ensure to follow your physician’s directions and read the label of the opioid drug before use. Ensure you let your physician know about other drugs you are taking before embarking on opioids to know if it is safe to combine the drugs or not.
  • Preparing for surgery- in case you are taking opioids and preparing for an operation, tell your surgeon or anesthesiologist about the drugs you are taking. Chronic use of opioids can raise your risk of complications after surgery and can cause you to stay in hospital for a long time. Speaking out can help your medical care team safely manage your pain.

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How to stop taking prescribed opioids

Patients who suddenly stop taking opioids can sometimes experience symptoms such as insomnia or jittery nerves. It is therefore important to work with your physician, doctors, or anesthesiologist to wean or taper yourself off in a safe manner and gradually stop the medication. If you work closely with your doctor or physician, they can:

  • Monitor your withdrawal symptoms
  • Individualize your tapering plan hence minimizing symptoms of opioid withdrawal
  • Adjust the rate and duration of the tapering based on your response
  • Guide you to additional sources of support

Therefore, it is important to know what to expect if you start cutting back on opioid medication. Opioid withdrawal symptoms can include the following:

  • Anxiety
  • Abdominal pain’
  • Drug cravings
  • Insomnia or lack of sleep
  • Vomiting
  • Diarrhea
  • Shaking (tremors)

These kinds of symptoms can be reduced or minimized through taking measures such as a slow reduction in dosage, consultation with the appropriate specialists, and getting psychological support for anxiety.

Signs that you are getting addicted to opioids

The following are the warning sign of addiction that you need to watch out for:

  • Feeling the urge to take someone else’s opioids
  • Regularly taking more medicine than you are supposed to
  • Feeling that you want to take the medicine to make you feel high
  • Having mood swings, anxiety, or depression
  • Having some trouble making important decisions
  • Feeling that you need too much or too little sleep
  • The pleasurable feeling of being high or sedated

In case you think you have a risk of overdose; you can consider getting a prescription for naloxone. This is a drug that can reverse the effects of an opioid overdose.

Ways to safely take opioid medicine

 

It is always important to be careful when taking opioid medicine but even more important you need to be more serious when taking opioids. The following are ways you need to observe safety while taking opioids:

  • Keep checking the instructions every time you are taking your dose
  • Ensure that you take your medicine exactly as prescribed ensuring you do not take an overdose
  • Do not break, crush, chew or dissolve opioid pills
  • Since opioids can cause drowsiness, do not drive or operate any machinery that may injure you especially when it is your first-time using opioids.
  • In case of any side effects, contact your physician or healthcare provider.
  • If you can stick to one pharmacy for all your drugs. The computer system at the pharmacy’s computer will alert the pharmacist in case you are using two or more medicines that could cause a dangerous interaction.

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Complications of arthritis

 

If left untreated, symptoms of arthritis worsen over time and affect your day-to-day life. The following are some of the possible complications associated with arthritis:

  • Reduced mobility- as arthritis continues to progress, you may experience less comfortable movements which can interfere with your daily routine and may stop you from performing your favorite activities as well as socializing.
  • Possible weight gain is normally attributed to fewer movements as well as discomfort that keeps you from exercising.
  • There is an increased risk of metabolic disorders- being overweight as a result of reduced movements and exercise because of inflammatory arthritis, may increase your chances of developing type 2 diabetes, high cholesterol, high blood pressure, and heart disease.
  • Risk of falls- people with osteoarthritis are more likely to experience falls and fractures which are usually caused by muscle weakness and dizziness from pain medications
  • Inflammation in other parts of your body- the cause of arthritis is attributed to an autoimmune disease like rheumatoid arthritis, the inflammation can spread affecting the eyes, skin, blood vessels, and lungs.
  • Decreased ability to work- most people with arthritis are within the working age. Arthritis affects the ability to move around in the workplace or even get from your mode of transport to the job site.
  • Causes effects on mental health- arthritis increases the risk of anxiety and depression due to pain, inflammation, and social isolation.

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Conclusion

Pain management can be subjective and fraught with potential adversity. Therefore, the goal for healthcare providers should be to take control of patients’ pain while controlling side effects. The knowledge about pain therapy can assist physicians in achieving the goals of pain management. The elderly population is usually very challenging when one has to consider all the pharmacodynamic changes that occur with normal aging. The elderly are at a greater risk of developing side effects considering there are comorbidities and a high incidence of polypharmacy.

Therefore, sing opioid medications appropriately and the most efficacious dosage for the severity and type of pain is very critical in the elderly. Therefore, knowing how to increase medications and how to move between the different classes is also necessary for the safe and successful management of pain. Adjuvant therapy and other non-opioid pain relievers should be encouraged as a standard practice in pain management. Evaluating and treating pain properly in elderly people should be the goal of every physician.

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