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5. Psychiatry > 3- Opioid Epidemic and OUD > Flashcards

3- Opioid Epidemic and OUD Flashcards

1
Q

How does the strength of heroin, oxycodone, methadone, fentanyl and carfentanil compare to that of morphine?

A

Oxycodone- 2x

Methadone- 3x

Heroin- 5x

Fentanyl- 50-100x

Carfentanil- 10,000x

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2
Q

What sxs are a/w mild doses of opioids? (6)

A

Pupil constriction → Nausea → Cough suppression → Pain relief → Mild sedation → Euphoria

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3
Q

What sxs are a/w moderate doses of opioids? (3)

A

Mod sedation → Memory impairment → AMS

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4
Q

What sxs are a/w severe/ overdose of opioids? (6)

A

Confusion → Respiratory depression → LOC → Apnea → Coma → Death

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5
Q

What opioid receptor is responsible for the greatest SEs (+ greatest dependence, least dysphoria)?

A

Mu receptor

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6
Q

Pt presents with pupillary constriction, respiratory depression, lower body temp/ BP, muscle relaxation, and stupor nodding. What are you concerned for?

A

Signs of abuse/ OD

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7
Q

Pt presents with pupillary dilation, panting/ yawning, diarrhea, elevated temp/ BP, muscle contractions, insomnia, and flu-like sxs. What are you concerned for?

A

Opioid acute withdrawal

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8
Q

Rate of progression from use to addiction is dependent on what?

A

Genetics, childhood abuse, specific drug

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9
Q

All drugs a/w a vicious cycle of addition work through what pathway?

A

Dopamine system = euphoria

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10
Q

Continued use of opioids after addiction can lead to what negative consequences?

A

Loss of behavioral control

Little regard for consequences of action

Brain is working on drive systems- stimulus driven (no off switch)

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11
Q

What is prescribed for mild pain according to the WHO pain ladder?

A

Non-opioid +/- adjuvant

(acetaminophen, aspirin, NSAID)

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12
Q

What is prescribed for mild-mod pain according to the WHO pain ladder?

A

Opioid +/- non-opioid +/- adjuvant

(codeine, tramadol)

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13
Q

What is prescribed for mod-severe pain according to the WHO pain ladder?

A

Opioid +/- non-opioid +/- adjuvant

(morphine, fentanyl)

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14
Q

When should CII opioids be used? (time frame)

A

Short-term

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15
Q

When does risk of continued opioid use increase?

A

4-5 days

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16
Q

How is drug-seeking behavior defined?

A

Over-reporting/ fabrication of sxs to obtain prescriptions for controlled substances

17
Q

What pharmacologic properties are a/w drug seeking behavior?

A

Euphorigenic

Rapid onset/ high potency/ short duration

High purity/ water soluble

Brand name drugs

18
Q

What pain meds are often sought after w/ drug seeking behavior?

A

Opiates- percocet, vicodin, morphine

19
Q

What sleep aids are often sought after w/ drug seeking behavior?

A

Benzos- xanax, valium, ambien

20
Q

What muscle relaxants are often sought after w/ drug seeking behavior?

A

Barbiturates- soma

21
Q

Opioid use disorder is defined as a problematic pattern of use leading to impairment with 2 of what criteria? (11) :/ sorry

A
  1. Craving
  2. Tolerance
  3. Withdrawal
  4. Continued use despite social problems
  5. Continued use despite knowledge of problem
  6. Activities given up to use
  7. Failure to fulfill obligations
  8. Larger amounts for longer time
  9. Unsuccessful at controlling use
  10. Time to acquire, use, recover
  11. Use in physically hazardous situations
22
Q

What are the specifiers for OUD? (3)

A

Early (> 3 mos) or late remission (> 12 mos)

On maintenance therapy (MAT)

Severity

23
Q

How do you differentiate between mild, mod and severe OUD?

A

Mild- 2-3 sxs

Mod- 4-5 sxs

Severe- 6+ sxs

24
Q

What is the protocol for detox if mod to severe independence?

A

In-patient

25
Q

What drugs are used for overdose and SNS overstimulation respectively?

A

Overdose- naloxone (Narcan)

SNS overstimulation- Clonidine

26
Q

What can be used for detox as a substitution of longer acting opioid?

A

Methadone

(also taper)

27
Q

What drugs are used for extended tx for OUD?

A

Methadone or Buprenorphine

(taper)

28
Q

What non-pharm tx is included in the extended tx for OUD?

A

Individual and group counseling

(narcotics anonymous)

29
Q

What was the 1st med developed to tx opiate addiction in physicians office?

A

Buprenorphine (suboxone)

30
Q

Although buprenorphine binds to the same my receptors, why is used for tx of OUD? (3)

A

Weak agonist- reduces cravings

Partial antagonist- prevents euphoria

Long acting/ decreased respiratory depression

31
Q

What med requires DEA ‘X’ license/ MAT training and has best success with careful monitoring?

A

Buprenorphine

32
Q

What Acts have contributed to medication assisted tx of OUD?

A

Drug abuse tx act (clinicians to prescribe narcotics to tx OUD out-pt)

Comprehensive addiction and recovery act (NPs and PAs becoem DATA waive eligible)

5. Psychiatry (19 decks)

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