Teaching Materials Episode Three: Analgesic Anxiety © 2001 Rice University The Reconstructors™ is a product of the Center for Technology in Teaching and Learning, Rice University and is funded by the Science Education Drug Abuse Partnership Award, R25DA11785, from the National Institute on Drug Abuse, National Institutes of Health. The Reconstructors Analgesic Anxiety Episode Three: Contents OVERVIEW We hope that you and your students extend The Reconstructors™ adventures with activities designed to cover related learning objectives. The activities described in the teaching package are intended for use both before and after students have “played” Episode 3: Analgesic Anxiety of The Reconstructors™. The files may be printed for classroom use ONLY. Feel free to adapt these activities to your own classroom needs. Another resource that we suggest is the National Institutes of Health (NIH) web site at http://www.nih.gov. For specific information on drugs, go to the National Institute on Drug Abuse at http://www.nida.nih.gov. This site contains some excellent resources and teaching materials. If you have specific questions, please contact us. The Reconstructors Team [email protected] EPISODE BRIEFING Synopsis of Ancient Alarm (for Teachers)................................... 3 National Science Education Content Standard Correlation ....... 5 Vocabulary Terms .......................................................................... 6 Mission Log .................................................................................... 8 EPISODE DEBRIEFING Activity 1: Brain Match ................................................................ 10 The student will match parts of the brain to the functions each controls. Activity 2: Drug Watch ................................................................. 17 The students will learn about the risks and benefits of different analgesics. The Reconstructors 2 Analgesic Anxiety Episode Three: Analgesic Anxiety Synopsis This synopsis is provided as an overview for TEACHERS. We advise teachers NOT to hand this out to the students prior to playing the adventure since much of the suspense will be eliminated. The episode story begins with a news story from CyNN. Sedapa, the lead reporter, relates that rumors are rampant about research on pain-relieving drugs. In a related story, there is still no word on the disappearance of Beta, the top scientist from ORB. The student then gets a secret message from Sedapa on the VIV. After answering several verification questions, Sedapa tells the student that she does not think ORB should release opium without knowing all the facts. She sends the student to CyNN’s Virtual Vault, which contains important information on the effects and history of opium and its derivatives. In order to enter the Virtual Vault, the student must play a game to inactivate drones guarding this archive. Within the Virtual Vault, the student uncovers six data chips containing valuable information on opium; the student can view them in any order. Data chip 1: Opium and its derivatives. Opium and its derivatives are called opiates, and they are subgroup of a class of chemicals known as opioids. Opiates are sometimes referred to as narcotics. Morphine and codeine are two opiates that are naturally produced in opium. Heroin (diacetylmorphine) is an opium derivative made by chemically altering morphine. Data chip 2: A personal account of morphine addiction. A Civil War veteran becomes addicted to morphine, which was given to him to relieve his pain from injuries. When he tries to stop taking the morphine, he goes through withdrawal. His symptoms include intense body heat and skin that becomes painfully sensitive to touch. Data chip 3: Story of Dr. Wood and his theory on addiction. Dr. Wood wrongly believed that, if morphine were injected instead of swallowed, people would not become addicted to it. Opiates can be taken by mouth (enters through the digestive system and is partially metabolized before reaching the brain), by smoking (enters the bloodstream by the lungs before going to the brain), and by snorting (enters the bloodstream through the lining of the nose and lungs before reaching the brain). Data chip 4: Parts of the brain affected by opiates. An animation demonstrates how opiates affect the limbic system (controls emotions), the brain stem (controls involuntary actions such as breathing), and the spinal cord (relays messages of pain from the body to the brain). The Reconstructors 3 Analgesic Anxiety Episode Three: Analgesic Anxiety Synopsis Data chip 5: Analgesic stepladder. Pain can be classified at three levels: mild, moderate, and severe. For mild pain, treatment usually consists of non-opioid medicines like nonsteroidal anti-inflammatory drugs (NSAIDs). For moderate pain, treatment can include an opiate such as codeine. For severe pain, treatment can include a stronger opiate like morphine. Data chip 6: The history of heroin. Heroin was originally marketed by the Bayer Drug Company as a non-addictive form of morphine. It is, however, very addictive. Heroin usually appears as a white, brownish powder or as a sticky, black substance. Some of its street names are ‘H’, horse, smack, skag, and junk. After the student finishes reading all of the data chips, Sedapa asks the student a question to make sure they understood the information. Next, Alpha sends a message telling the student that there have been media leaks and that the news cannot always be trusted. He tells the student that Beta is not missing; instead, she has been sent on a secret mission to the old Neuropolis Research Center (NRC) facilities. He sends the student and Delta to help Beta continue her research. Upon the student’s arrival at the NRC, Beta greets him/her and says that she is almost finished separating opium into its different components. Beta tells the student how she used high performance liquid chromatography (HPLC) to separate opium into its alkaloids. She then tested each of the alkaloids for its analgesic potential. Her results show that, of the different alkaloids, morphine had the greatest analgesic effect. The student then gets a message from Sedapa, in which she urges him/her to "share what you know" with Beta and Alpha. The student can then submit what they learned from the Virtual Vault. The student reviews what he/she has learned on the history and effects of opium by drafting a letter to the people of Neuropolis. After reviewing the letter, Alpha urges that more information is required about the brain. Delta says that an expert on the brain, Dr. Morpheus, has a lab that they should visit to get more information. The episode ends. The Reconstructors 4 Analgesic Anxiety Episode Three: Correlation with Standards National Science Education Content Standard Correlation Grades 5-8 Instructional Objective Science Content Standard Recognize that opiates affect the brain no matter how they are introduced into the body. Discover that opium consists of different alkaloids/compounds that relieve pain. Standard F: All students should develop understanding of personal health. Standard B: All students should develop an understanding of properties and changes of properties in matter. Observe that chromatography is a way of separating the components of a mixture. Standard C: All students should develop understanding of structure and function in living things. Learn that morphine is the most potent analgesic derived from opium. Recognize that severity and nature of pain is a Standard F: All students should develop primary consideration in the selection of a drug understanding about personal health. treatment. Re-trace the scientific thinking and social policies that led to the discovery and widespread use of opiates in the 1800s. Standard G: All students should develop understanding of history of science. Paraphrase the plot and story line. N/A The Reconstructors 5 Analgesic Anxiety Episode Three: Vocabulary Terms All of the words below are ones that students will encounter while playing Episode Three: Analgesic Anxiety. Their definitions are contained within the adventure in either the InfoArchives or the Glossary. Teachers should alert the students to the ability to click on the hot-linked words in the game. After the game, teachers may want to review the new vocabulary words. Analgesic: a substance that relives pain without a complete loss of feeling. Alkaloids: a type of chemical with basic properties that is made within a living thing. Brain: located in the skull, it is the organ that controls all body activities through the spinal cord and peripheral nerves of the nervous system. Codeine: a naturally occurring component (alkaloid) of opium; it is capable of inducing sleep, relieving pain, and causing addiction, but it is weaker than the opiates morphine and heroin in producing these effects. Derivative: a substance that is made from and is structurally similar to another substance. Drug addiction: a chronic, relapsing disease characterized by the compulsion to see and use drugs and by neurochemical and molecular changes in the brain. Extract: a preparation made by separating the ingredients from a mixture by using a solvent. Heroin: an illegal, highly addictive drug. It is both the most abused and the most rapidly acting of the opiates. It is made from morphine, a naturally occurring substance extracted from the fruit of certain varieties of poppy plant. The Reconstructors 6 Analgesic Anxiety Episode Three: Vocabulary Terms High performance liquid chromatography (HPLC): a type of chromatography that uses liquids at high pressure to separate the chemicals in a mixture based on differences in the chemicals’ properties. Morphine: a naturally occurring component (alkaloid) of opium. It is the principal analgesic found in opium and is capable of inducing sleep and causing addiction. Narcotic: a type of drug that can relieve pain and cause a dulling of the senses, sluggishness, sleep, and sometimes addiction. Also, narcotic can refer to any type of drug that can cause addiction or whose use is controlled by law (for example, LSD). Nervous system: a network composed of the brain, spinal cord, and the peripheral nerves. The nervous system receives, interprets, and transmits signals in order to coordinate bodily activities. Opiate: Opium, or a drug made from opium. Opium: the juice from the fruit of the opium poppy. It is capable of relieving pain, inducing sleep, and causing addiction. It has a milky-white appearance and turns brown and gummy upon exposure to air. Spinal cord: a bundle of nerves coming from the base of the brain. The spinal cord carries signals from the brain to the body, relays information from the body to the brain, and coordinates many reflexes. The Reconstructors 7 Analgesic Anxiety Episode Three: Mission Log Teacher Version TEACHER DIRECTIONS: Ask students to complete the right-hand column as they move through the game. Answers are provided here, but Page 9 has a master that can be copied for students as a handout. Question Answer You start the mission with a news alert from CyNN. Sedapa is presenting a story on the rumors about a group of drugs. What are the drugs in question? pain-relieving drugs In the Virtual Vault, you must review a number of data chips containing information on pain-relieving drugs. In Data Chip 1, you learn about the derivatives of opium. What are two opiates that are naturally produced from opium? morphine codeine In Data Chip 2, you learn of a Civil War soldier who became addicted to morphine. Name two of his withdrawal symptoms. 1. diarrhea 2. body is “firey hot” 3. sensitive to touch In Data Chip 3, you learn about Dr. Wood’s theory on addiction. He believed that addiction couldn’t occur if morphine is injected. Was his theory true or false? false In Data Chip 4, you learn about the different parts of the brain that are affected by opiates. Which part of the brain controls things that your body does involuntarily? brain stem In Data Chip 5, you learn about different levels of pain medication. What is an example of a pain reliever that is given for severe pain? morphine In Data Chip 6, you learned about heroin. What chemical is modified to make heroin? Is heroin addictive? It is illegal? morphine Yes, it’s very addictive. Yes, it’s illegal. In the NRC, Beta is performing an experiment to separate opium into its parts. Which component of opium has the greatest analgesic effect? morphine Conclusion: Should the same type of pain medication be used for all kinds of pain? No. The medication that should be used depends upon the type of pain and its severity. The Reconstructors 8 Analgesic Anxiety Episode Three: Mission Log Name: Class: Date STUDENT INSTRUCTIONS: Record your observations by correctly answering the following questions as you play The Reconstructors™ Episode 3: Analgesic Anxiety. Question Answer You start the mission with a news alert from CyNN. Sedapa is presenting a story on the rumors about a group of drugs. What are the drugs in question? In the Virtual Vault, you must review a number of data chips containing information on pain-relieving drugs. In Data Chip 1, you learn about the derivatives of opium. What are two opiates that are naturally produced from opium? In Data Chip 2, you learn of a Civil War soldier who became addicted to morphine. Name two of his withdrawal symptoms. In Data Chip 3, you learn about Dr. Wood’s theory on addiction. He believed that addiction couldn’t occur if morphine is injected. Was his theory true or false? In Data Chip 4, you learn about the different parts of the brain that are affected by opiates. Which part of the brain controls things that your body does involuntarily? In Data Chip 5, you learn about different levels of pain medication. What is an example of an opioid pain reliever that is given for severe pain? In Data Chip 6, you learned about heroin. What chemical is modified to make heroin? Is heroin addictive? It is illegal? In the NRC, Beta is performing an experiment to separate opium into its parts. Which component of opium has the greatest analgesic effect? Conclusion: Should the same type of pain medication be used for all kinds of pain? The Reconstructors 9 Analgesic Anxiety Episode Three: Teacher Guide BRAIN MATCH The human brain has many parts that control many different functions. These functions range from breathing to memory. In this activity, the student will learn different parts of the brain and their functions. Background The ancient Egyptians believed that the heart was responsible for emotions and thought. However, it is the brain that controls these activities, as well as all other body functions. The brain is a complicated organ that is made up of many different parts. Some of the parts and functions are: Cerebrum: this wrinkled structure makes up the largest portion of the human brain. It is divided into 2 parts known as hemispheres. The right hemisphere controls the left side of the body and left hemisphere controls the body’s right side. Sight, smell, taste, touch, hearing, speech, thinking, planning, problem solving, emotion, memory, voluntary movement, and perception of pain are functions controlled by this structure. Cerebellum: this area is located behind the brain stem. It is responsible for posture, balance, and coordinating movements so that they are not jerky or uncontrolled. Brain Stem: this structure is located at the base of the brain. It is responsible for regulating heart rate, swallowing, breathing rate, sleep, and blood pressure. Opiates act on this structure to affect coughing, which is another function controlled by this part. Limbic System: located deep with in the brain, the limbic system is made up of many structures. The limbic system is an important memory center. Also, emotions are controlled here. For example, when opiates act on this group of structures, feelings of pleasure are produced. The Reconstructors 10 Analgesic Anxiety Episode Three: Teacher Guide Learning Objectives The student will: • Identify different parts of the brain. • Play a game in which he/she matches brain parts with the actions they control. Materials • • • • Brain Match Student Activity Sheet Parts of the Brain and Limbic System Transparencies index cards timers or clock Procedure 1. Prior to class, make transparencies of the Parts of the Brain and the Limbic System diagrams. Also, make the “brain cards” students will need to play the “Brain Match” game that will be played later in this lesson. To make the cards, write the name of an action and the brain part that is primarily responsible for it on an index card (see the table in Step #2). Note: Some functions are associated with more than one brain part. Make sure you write down all the parts that are responsible for each function on the card. 2. Present the Parts of the Brain transparency to the class. As you point out each brain structure’s location and function, have the students fill in this information on the Parts of the Brain diagram in the student activity sheet. Brain Part Activities Controlled Cerebrum sight, smell, taste, touch, hearing, speech, thinking, planning, problem-Solving, emotion, memory, voluntary movement, and perception of pain Cerebellum coordinated movement, balance, posture Brain Stem heart rate, coughing, swallowing, breathing rate, sleep, blood pressure Limbic System emotions, memory 3. Ask students what effect is produced when opiates act on the brain stem. The Reconstructors 11 Analgesic Anxiety Episode Three: Teacher Guide 4. Next, present the Limbic System transparency. Note the location of limbic system relative to the cerebrum and the fact that it is made of many parts. Ask students what effect is produced when opiates act on the limbic system. 5. Tell the class that the Reconstructors are developing a game, “Brain Match,” to teach the public about the different parts of the brain and the functions/actions they control. 6. Next, have the students play “Brain Match.” The rules of the game are explained in the student activity sheet and are as follows: a. One student will act as the referee for a pair of competing teams. He/she will hand out the “brain cards” and keep time and score. b. Each team will have an equal number of players. c. The referee will give a player from Team #1 a “brain card” that has the name of a brain part and a function/action it controls. The player acts out the function. d. Team #1 has a maximum of five minutes in which to guess the function. Team #1 will receive one point for naming the function and one point for identifying a brain part that controls this activity. If Team #1 supplies only part of the required information, i.e., either the function OR a brain part controlling the activity, they will receive only one point, and Team #2 can score a point by supplying the missing information. If Team #1 fails to supply either the function or a part of the brain that controls the function being acted out, Team #2 can score 2 points if they can name the function and the part. e. Next, the referee will give a player from Team #2 a “brain card” to act out. f. The game play continues until all members of each team have acted out an activity at least once. g. The winner is the team with the highest score after an equal number of players from each team has acted out an activity. The Reconstructors 12 Analgesic Anxiety Episode Three: Teacher Guide Extension Activities • History: Research how the functions of different parts of the brain were discovered. • Visual Arts: Create a collage showing activities that are controlled by a particular part of the brain. Standards National Science Education Standards, Grades 5-8 • Science Content Standard C: All students should develop understanding of structure and function in living systems. Books • Matthews, G. C. 2001. Neurobiology: Molecules, Cells, and Systems. Malden, MA: Blackwell Science • National Research Council. 1996. National Science Education Standards. Washington, DC: National Academy Press. Pamphlets/Booklets • Brain Facts: A Primer on the Brain and Nervous System. Society for Neuroscience, 1997. Web Sites • The Ancient Egyptian Heart http://www.touregypt.net/featurestories/heart.htm • Neuroscience for Kids http://faculty.washington.edu/chudler/neurok.html • Brain Briefings: From the Society for Neuroscience http://www.sfn.org/index.cfm?pagename=brainBriefings_main The Reconstructors 13 Analgesic Anxiety Episode Three: Student Activity Sheet BRAIN MATCH Prepare yourself for the mind-boggling fun of “Brain Match”, the Reconstructors’ new science game. You’ll score big if you know the parts of the brain and what each controls. Good luck! Materials • • “Brain cards” timer or clock Procedure 1. Label the diagrams in the Parts of the Brain and Limbic System student activity sheets by writing in the name of each structure and the activities it controls. Review this information prior to playing “Brain Match”. 2. To play “Brain Match”: a. Divide into two teams. Each team has an equal number of players. b. A student who is not a member of any team will act as referee. His/her job will be to hand out the “brain cards” and keep time and score. c. A player from Team #1 gets a “brain card” from the referee. It has the name of a brain part and an activity it controls. The player acts out the activity. d. Team #1 has a maximum of five minutes in which to guess the activity that is being acted out. It will receive one point for naming the activity and one point for identifying the brain part. If Team #1 supplies only part of the required information, i.e., either the function OR a brain part controlling the activity, they will receive only one point, and Team #2 can score a point by supplying the missing information. If Team #1 fails to supply either the function or a part of the brain that controls the function being acted out, Team #2 can score 2 points if they can name the function and the part. e. Next, a student from Team #2 takes a “brain card” and acts out the activity on the card. f. Play continues until all members of each team have acted out an activity at least once. g. The winning team is the one with the highest score after an equal number of players from each team has acted out an activity. The Reconstructors 14 Analgesic Anxiety Episode Three: Student Activity Sheet Parts of the Brain cerebrum cerebellum brain stem The Reconstructors 15 Analgesic Anxiety Episode Three: Student Activity Sheet Limbic System cerebrum limbic system cerebellum brain stem The Reconstructors 16 Analgesic Anxiety Episode Three: Teacher Guide DRUG WATCH In this activity, the students will learn about the risks and benefits of different analgesics. Background Over-the-counter (OTC) analgesics are medications that can be taken without a doctor's supervision. Generally, a prescription from a doctor is required if the drug: • can be addictive; • has a high risk of producing toxic effects; • requires special equipment to use; and • is for a condition that cannot be easily self-diagnosed. The use of OTC analgesics may be less restricted than that of their prescription counterparts, but that does not mean that these medicines do not carry risks. Just like the prescription variety, OTC analgesics can produce powerful effects on the body, some of which can be dangerous. The type of analgesic needed for relief depends on the level of pain. For most mild pain, an OTC pain medication such as ibuprofen (Advil) can be taken. However, for more severe pain, a prescription analgesic may be required. For example, an opiate like codeine is often prescribed for moderate pain, and morphine is given for moderate to severe pain. Both codeine and morphine can be addictive, but when used with proper medical supervision, the risk of addiction from these substances is very low. Heroin is another opiate analgesic that is effective in treating severe pain. However, this drug is illegal in the United States, which means that it is not available OTC or by prescription. The use of heroin is banned because it is a HIGHLY addictive substance. It can produce other dangerous effects as well. Therefore, the risk this drug poses to the user’s health has been deemed to outweigh its benefit as an analgesic. The Reconstructors 17 Analgesic Anxiety Activity 3.2 Episode Three: Teacher Guide Learning Objectives The student will: • Research the health risks and benefits of OTC and prescription analgesics. • Research the health risks of heroin. • Write a poem about the health risks of using heroin. Materials • • Drug Watch Student Activity Sheets computer with Internet access Procedure 1. Discuss with students the similarities and differences between OTC and prescription drugs. In the discussion, include an explanation of why some drugs are only available by prescription. 2. Give examples of OTC and prescription analgesics, including ibuprofen (OTC), codeine (prescription), and morphine (prescription). Inform the students of the risks and benefits of codeine and morphine, which are opiates. 3. Tell students that, as part of their Reconstructor mission, they need to determine the risks and benefits of analgesics. 4. Divide the class into groups of two or three students. Hand out the Drug Watch Student Activity Sheets. 5. Have the students determine the degree(s) of pain each drug is used for (a benefit) and the risks of using the drug. Drugs can have many types of risks. The students should find information on the drug’s side effects and whether it is habit-forming (addictive). A suggested site for students’ research is: • Medline Plus: Health Information. http://www.nlm.nih.gov/medlineplus/druginformation.html 6. Have the students complete the table on the student activity sheet. The Reconstructors 18 Analgesic Anxiety Activity 3.2 Episode Three: Teacher Guide 7. Next, have the students read about the health risks of heroin use. Suggested sites are: • NIDA InfoFacts: Heroin http://www.nida.nih.gov/Infofax/heroin.html • Neuroscience for Kids: Heroin http://faculty.washington.edu/chudler/hero.html 8. Explain to students what an acrostic poem is and then have them make one with the word HEROIN on the health risks of using the drug. This poem will help the people of Neuropolis remember the drug’s dangers. An acrostic poem is one in which the first letter of each line of the poem represents a letter in the word that is being spelled out. In the case of the word heroin, the first line of the poem could be “Highly addictive drug”. See sample poem layout below: Highly addictive drug E_________________________ R_________________________ O_________________________ I__________________________ N__________________________ The Reconstructors 19 Analgesic Anxiety Activity 3.2 Episode Three: Teacher Guide Extension Activities • History: Investigate the history of a particular pain medication. • Science: Interview a doctor or pharmacist on what types of pain medications he/she believes have changed the medical field. • Science: Examine the process a drug must go through in order to be approved by the FDA for OTC use and/or prescription use. Standards National Science Education Standards, Grades 5-8 • Science Content Standard F: All students should develop understanding of personal health. • Science Content Standard F: All students should develop understanding of risks and benefits. • National Research Council. 1996. National Science Education Standards. Washington, DC: National Academy Press. Books Web Sites • Food and Drug Administration: Consumer Drug Information http://www.fda.gov/cder/drug/DrugSafety/DrugIndex.htm • Food and Drug Administration: Over-the-Counter Drug Products http://www.fda.gov/cder/offices/otc/default.htm • Food and Drug Administration: Rx to OTC http://www.fda.gov/bbs/topics/CONSUMER/CN00012c.html • MEDLINEplus: About Your Medicines http://www.nlm.nih.gov/medlineplus/aboutyourmedicines.html • Ohio State University Senior Series: Prescription and Over-the-Counter (OTC) Medications http://ohioline.osu.edu/ss-fact/0134.html The Reconstructors 20 Analgesic Anxiety Activity 3.2 Episode Three: Student Activity Sheet DRUG WATCH Stories and documents from the past refer to powerful drugs, but what are their risks and benefits? Can you find this information? All depends on you! Materials computer with Internet access Procedure Part I: OTC and Prescription Analgesics 1. Research the drugs listed in the table. Find the level of pain each drug is used to manage (a benefit), two side effects of using the drug, and whether it is addictive (habit-forming). 2. You can research the drugs using this reference or with references suggested by your teacher. • MEDLINEplus: Health Information. http://www.nlm.nih.gov/medlineplus/druginformation.html (On the page above, use the MedMaster entries for each drug.) Part II: Heroin 1. Read about the health risks of heroin use. Suggested sites are: NIDA InfoFacts: Heroin http://www.nida.nih.gov/Infofax/heroin.html Neuroscience for Kids: Heroin http://faculty.washington.edu/chudler/hero.html 2. Write an acrostic poem on the health risks from heroin use in the “Heroin” section of the student activity sheet. This poem will help the people of Neuropolis remember heroin’s dangers. The Reconstructors 21 Analgesic Anxiety Activity 3.2 Episode Three: Student Activity Sheet Name ______________________________Class ____________ Date ___________ Drug Watch List of Over-the-Counter (OTC) and Prescription Pain Medications Instructions: Fill in the missing information. Name OTC or Prescription Only Acetaminophen OTC Aspirin OTC Methadone Oral (by mouth) Prescription Only Meperidine Prescription Only Oxycodone Prescription Only Propoxyphene Prescription Only The Reconstructors Level of pain (Benefits) 22 Two Side Effects (Risks) Habit-forming? (Risk) Analgesic Anxiety Activity 3.2 Episode Three: Student Activity Sheet Name ______________________________Class ____________ Date ___________ Drug Watch: Heroin Instructions: Write an acrostic poem on heroin’s health risks. H________________________________________________________ E________________________________________________________ R________________________________________________________ O________________________________________________________ I________________________________________________________ N________________________________________________________ The Reconstructors 23 Analgesic Anxiety Activity 3.2
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