Comparing Loperamide to Other Opioids — Transcript

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1. 0:01hi there and welcome back to
2. 0:03understanding medications we said that
3. 0:06loperamide was an opioid and in order to
4. 0:08get a really good clear picture of
5. 0:10loperamide we're going to have to
6. 0:13generally compare loperamide to other
7. 0:16opioid medications and also compare
8. 0:19those to the endogenous substances
9. 0:22within our body called opioids but we're
10. 0:27going to keep it really simple because
11. 0:29opioids are really a complicated subject
12. 0:33and we could spend a really long time
13. 0:35just understanding the opioids also in
14. 0:38this lesson I'll be explaining that the
15. 0:41natural opioids in the body act as
16. 0:43neurotransmitters
17. 0:45and in order to understand that we're
18. 0:47going to have to understand what the
19. 0:50neurotransmitters do
20. 0:52neurotransmitters are a neurons way of
21. 0:56talking to the next neuron in order to
22. 0:59talk from one neuron to the next
23. 1:02communicate from one neuron to the next
24. 1:04it needs some chemical Messengers that
25. 1:07are called neurotransmitters
26. 1:09and the opioids are neurotransmitters
27. 1:13the other thing to remember is that
28. 1:15those neurotransmitters can be one of
29. 1:17two flavors they can be excitory
30. 1:20neurotransmitters or inhibitory
31. 1:23neurotransmitters in other words they're
32. 1:25going to tell the next neuron to get
33. 1:27excited or they're going to tell the
34. 1:29next neuron to get inhibited and the
35. 1:32opioids are inhibitory neurotransmitters
36. 1:35so they're central nervous system
37. 1:37depressants
38. 1:40when you hear about the word opioids you
39. 1:42probably think of them as being
40. 1:44painkillers and you may also think about
41. 1:46them as being abused substances and you
42. 1:50would be right on both counts opioids
43. 1:53are some of the strongest medications
44. 1:55that we have with respect to being
45. 1:57analgesics or painkillers morphine
46. 2:00codeine heroin oxycodone Tramadol
47. 2:03they're all example of of opioids
48. 2:07and some of them are natural substances
49. 2:10derived from the Opium poppy plant and
50. 2:14others are synthetic and you may Wonder
51. 2:17at this point why is it that something
52. 2:19that comes from a plant is one of the
53. 2:21strongest painkillers that we have and
54. 2:24the answer is that the opioids from the
55. 2:27plants can act like our endogenous
56. 2:30opioids or in other words the opioids
57. 2:33that are in our body and what do the
58. 2:36natural opioids do
59. 2:38those are our natural analgesic or pain
60. 2:43killing system the opioids in the system
61. 2:47are are natural way of decreasing pain
62. 2:51but the pain relief is not the only
63. 2:54effects of the opioids because we have
64. 2:57opioid receptors at the level of the
65. 3:00brain at the level of the brain stem and
66. 3:04at the level of the gastrointestinal
67. 3:07intestinal tract in the brain the
68. 3:11opioids are responsible for giving the
69. 3:13person a euphoric effect at the level of
70. 3:17the brain stem the opioids are
71. 3:19responsible for respiratory depression
72. 3:22and at the level of the enteric nervous
73. 3:25system the nervous system of the
74. 3:28gastrointestinal tracts the opioids are
75. 3:31responsible for decreasing the motility
76. 3:34or in other words the movement of the
77. 3:37gut
78. 3:38so when a person takes an opioid for
79. 3:41pain
80. 3:42the actions at those other sites are
81. 3:46responsible for the adverse effects
82. 3:50now that you understand the basic
83. 3:52information about opioid analgesics we
84. 3:55can compare that to the actions of
85. 3:57loperamide
86. 3:59loperamide is used to treat diarrhea but
87. 4:03at normal doses it's not associated with
88. 4:05pain relief it's not associated with
89. 4:08cognitive depression or euphoric effects
90. 4:11or respiratory system depression either
91. 4:15so why is that so it's because of the
92. 4:19fact that loperamide cannot be absorbed
93. 4:22to any great extent and therefore most
94. 4:25of it stays in the gastrointestinal
95. 4:27tract
96. 4:28and in the gastrointestinal tract
97. 4:30there's an enteric nervous system
98. 4:33the enteric nervous system is in fairly
99. 4:36close proximity to the Lumen of the
100. 4:38gastrointestinal tract so the loperamide
101. 4:41has access to the enteric nervous system
102. 4:45but most of that loperamide only has
103. 4:48that local action rather than a systemic
104. 4:52action
105. 4:53and by the way all opioids that we just
106. 4:57mentioned are in just about all of the
107. 4:59other opioids
108. 5:00can help relieve diarrhea in people with
109. 5:04diarrhea or in people who have normal
110. 5:06bowel habits they can cause constipation
111. 5:09but loperamide is the preferred
112. 5:12treatment for diarrhea because it cannot
113. 5:15get into this system to any great extent
114. 5:18and therefore it's not associated with
115. 5:21all of those side effects
116. 5:23after a quick quiz we're going to use
117. 5:26loperamide to start understanding the
118. 5:29pharmacodynamics and specifically the
119. 5:32actions of drugs on cellular receptors
120. 5:36so we'll talk quite a bit about cellular
121. 5:39receptors and get a good idea of those
122. 5:41cellular receptors in the next couple
123. 5:43lessons
124. 5:57we've just found out that opioids work
125. 6:00all through the body exhibiting actions
126. 6:02such as Euphoria pain relief respiratory
127. 6:07depression and at the level of the git a
128. 6:11decreased motility resulting in
129. 6:14constipation
130. 6:16we found that loperamide doesn't
131. 6:18normally have the actions outside the
132. 6:21git because less than one half of one
133. 6:25percent gets absorbed
134. 6:27and I'd like you to think about this
135. 6:29scenario Joel is an 18 year old male who
136. 6:33has been addicted to opioids his Supply
137. 6:36is no longer available and while he's no
138. 6:39longer addicted to the opioids he still
139. 6:42craves them
140. 6:43Joel has heard that he can get an opioid
141. 6:46Hive from consuming several entire
142. 6:49packets of loperamide at the same time
143. 6:53I'd like you to predict what would
144. 6:55happen if Joel does indeed consume 30 or
145. 6:59more times the recommended dose of
146. 7:01loperamide a he will have almost no
147. 7:05movement in his bowels and very severe
148. 7:08constipation potentially resulting in
149. 7:12intestinal blockage acute peritonitis
150. 7:15hospitalization and possibly death from
151. 7:18septicemia
152. 7:19B he may get the opioid high that he had
153. 7:23hoped to get
154. 7:25C he may die of respiratory depression D
155. 7:30he may only have the git complications
156. 7:34with none of the other effects
157. 7:37or E all of the above are possible
158. 7:43and you're correct if you had predicted
159. 7:45e all of the above would be possible in
160. 7:48addition he may not get that opioid high
161. 7:51that he had hoped for but instead die of
162. 7:54an abnormal heartbeat called
163. 7:56dysrhythmias because improper use of
164. 8:00loperamide can be cardiotoxic
165. 8:04over 100
166. 8:07000 people die each year from opioid
167. 8:09overdose and many of those have died
168. 8:12from consuming more than the recommended
169. 8:14dose of loperamide