3- Opioid Epidemic and OUD Flashcards
How does the strength of heroin, oxycodone, methadone, fentanyl and carfentanil compare to that of morphine?
Oxycodone- 2x
Methadone- 3x
Heroin- 5x
Fentanyl- 50-100x
Carfentanil- 10,000x
What sxs are a/w mild doses of opioids? (6)
Pupil constriction → Nausea → Cough suppression → Pain relief → Mild sedation → Euphoria
What sxs are a/w moderate doses of opioids? (3)
Mod sedation → Memory impairment → AMS
What sxs are a/w severe/ overdose of opioids? (6)
Confusion → Respiratory depression → LOC → Apnea → Coma → Death
What opioid receptor is responsible for the greatest SEs (+ greatest dependence, least dysphoria)?
Mu receptor
Pt presents with pupillary constriction, respiratory depression, lower body temp/ BP, muscle relaxation, and stupor nodding. What are you concerned for?
Signs of abuse/ OD
Pt presents with pupillary dilation, panting/ yawning, diarrhea, elevated temp/ BP, muscle contractions, insomnia, and flu-like sxs. What are you concerned for?
Opioid acute withdrawal
Rate of progression from use to addiction is dependent on what?
Genetics, childhood abuse, specific drug
All drugs a/w a vicious cycle of addition work through what pathway?
Dopamine system = euphoria
Continued use of opioids after addiction can lead to what negative consequences?
Loss of behavioral control
Little regard for consequences of action
Brain is working on drive systems- stimulus driven (no off switch)
What is prescribed for mild pain according to the WHO pain ladder?
Non-opioid +/- adjuvant
(acetaminophen, aspirin, NSAID)
What is prescribed for mild-mod pain according to the WHO pain ladder?
Opioid +/- non-opioid +/- adjuvant
(codeine, tramadol)
What is prescribed for mod-severe pain according to the WHO pain ladder?
Opioid +/- non-opioid +/- adjuvant
(morphine, fentanyl)
When should CII opioids be used? (time frame)
Short-term
When does risk of continued opioid use increase?
4-5 days
How is drug-seeking behavior defined?
Over-reporting/ fabrication of sxs to obtain prescriptions for controlled substances
What pharmacologic properties are a/w drug seeking behavior?
Euphorigenic
Rapid onset/ high potency/ short duration
High purity/ water soluble
Brand name drugs
What pain meds are often sought after w/ drug seeking behavior?
Opiates- percocet, vicodin, morphine
What sleep aids are often sought after w/ drug seeking behavior?
Benzos- xanax, valium, ambien
What muscle relaxants are often sought after w/ drug seeking behavior?
Barbiturates- soma
Opioid use disorder is defined as a problematic pattern of use leading to impairment with 2 of what criteria? (11) :/ sorry
- Craving
- Tolerance
- Withdrawal
- Continued use despite social problems
- Continued use despite knowledge of problem
- Activities given up to use
- Failure to fulfill obligations
- Larger amounts for longer time
- Unsuccessful at controlling use
- Time to acquire, use, recover
- Use in physically hazardous situations
What are the specifiers for OUD? (3)
Early (> 3 mos) or late remission (> 12 mos)
On maintenance therapy (MAT)
Severity
How do you differentiate between mild, mod and severe OUD?
Mild- 2-3 sxs
Mod- 4-5 sxs
Severe- 6+ sxs
What is the protocol for detox if mod to severe independence?
In-patient
