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X Waiver > Buprenorphine > Flashcards

Buprenorphine Flashcards

1
Q

What type of drug is Buprenorphine

A

Partial agonist of Mu receptor

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2
Q

What is the half life of Buprenorphine

A

24 - 36 hour

long

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3
Q

What type of affinity does buprenorphine have to mu receptors

A

High

It will displace other Opioids - precipitated withdrawals

If you take this with Methadone or Heroine, you will not get full euphoria effect.

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4
Q

How is Buprenorphine metabolized

A

Liver

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5
Q

How is Buprenorphine taken

A

Sublingual due to low first pass

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6
Q

How does Buprenorphine work

A

High affinity displaces other opioids.

Slow dissociation allows for decrease withdrawal , decreased cravings and decreased effects of other opiods.

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7
Q

Types of Buprenorphine formularies used for analgesic

A

Patch

IV

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8
Q

Rationale to prescribe Buprenorphine/Naloxane

A

Reduce IV drug use

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9
Q

Major features of Naltroxene

A

High affinity for Mu receptors

Long acting: oral ( 24 hours), Injection (5 - 10 days)

Full antagonist

Need to be off of Opioids for several days prior to injection to prevent precipitated withdrawals.

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10
Q

How does naltrexone work:

A

it decreases craving of opioids (Behavioral component).

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11
Q

Usual dosage for Buprenorphine

A

4 - 32 mg (oral tab)

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12
Q

Usual dosage for Naltrexone

A

380 mg Depot Injection

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13
Q

Best option for anyone trying to avoid Opioids

A

Naltrexone

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14
Q

Relative, where do we see a good therapeutic dosage response for buprenorphine

A

8 - 12 mgs

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15
Q

Relative, what is the typical max dosage of mono buprenorphine?

A

16 mgs

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16
Q

Special consideration for Buprenorphine

A

Risk of diversion

17
Q

Special consideration for Naltroxene

A

Patients must be opioid free before starting

Risk of overdose for patients who stop it

Pain management - non pharmological usage

18
Q

Maintenance vs taper

A

Tapering seems to cause less retention. Maintenance treatment seems like best option for prevention of Opioid relapse.

19
Q

Common side effects of Buprenorphine

A

Headaches - manage with OTC meds

Constipation - High fiber diet, hydration and stool softener

Dry mouth - Hydration, good oral mouth

20
Q

Explain Buprenorphine role in causing clarity in patients and brightening affect

A

It is a kappa agonist which leads to this expression

Kappa antagonist would do the opposite of such

21
Q

Can you overdose on Buprenorphine

A

Technically no. Although the med at higher doses can decrease respiration, it has not known to cause increase in carbon dioxide retention of the body.

Usually the cases is multiple drug interaction

22
Q

Which is better: Buprenorphine or the injection of naltrexone

A

Both seemingly even in effectiveness. The caveat being, we have to get individuals pass the initial stage of detox to start them on an naltrexone injection.

23
Q

What cytochrome is Buprenorphine metabolized by?

A

CYP3A4

24
Q

What does CYP3A4 inducers do to Buprenorphine

A

It causes it to leave the blood stream a lot quicker

Consequence: withdrawal and cravings

25
Q

What does CYP3A4 inhibitors do to Buprenorphine

A

It causes higher levels of the medication

Consequence: Sedation and nausea

26
Q

Medication to watch out for when administering Buprenorphine

A

Anything that may cause sedations such as benzos

Think about alcoholism

27
Q

What happens to receptors if Buprenorphine is used alone

A

It stays on that receptor

28
Q

What happens if an opioid agonist follows buprenorphine

A

Buprenorphine will stay on that receptor. Agonist would have lesser effects

29
Q

What happens if buprenorphine follows an opioid agonist

A

Buprenorphine will displace that agonist leading to precipitated withdrawals

30
Q

What happens if buprenorphine is followed by an Opioid antagonist

A

Not much. Buprenorphine will remain on that receptor.

Antagonist will work slower leading to precipitated withdrawals

31
Q

FDA recommendations when treating a patient with Buprenorphine, If they are in fact on a benzo

A

We should still give them it as it has not shown to cause over doses at therapeutic dose range.

Rationale: Overdosing on Opioids is a much more adverse event

Response: Educate, potentially taper the Benzo or CNS depressant, Verify the dx of the patient for taking these medications.

32
Q

When to initiate Naltrexone when opioid free:

A

7 - 10 day wait period

33
Q

Why is long acting injectable considered better option than oral Naltrexone

A

Better adherence with long acting

Lower risk of relapse

lower risk of overdose

34
Q

Potential side effects after initiation of naltrexone injection

A

Subacute withdrawal but usually recovers after a week.

Pain at injection site

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