drugs in opioid dependence

Question 1

buprenorphine MOA

Answer 1

opioid receptor partial agonist
has opioid agonist and antagonist properties

Question 2

buprenorphine injection can be given as adjunct in the treatment of opioid dependence under expert supervision. they are available as monthly or weekly formulations. what type of parenteral administration?

Answer 2

SC

Question 3

Sixmo is a SC implant of buprenorphine. when can it be used.

Answer 3

Adjunct in the treatment of opioid dependence [in clinically stable patients who require no more than 8 mg per day of sublingual buprenorphine] (under expert supervision)

Question 4

Sixmo is buprenorphine SC implant, which can be used as adjunct in the treatment of opioid dependence [in clinically stable patients who require no more than ……. per day of sublingual buprenorphine] (under expert supervision)

Answer 4

8mg

Question 5

If you are on Sixmo, 4 implants are left in place for how many months?

Answer 5

6

Question 6

If you are to be on Sixmo, discontinue SL buprenorphine …. hours before insertion

Answer 6

12-24

Question 7

why are all opioids contraindicated in head injury or raised intracranial pressure

Answer 7

opioid analgesics interfere with pupillary responses vital for neurological assessment

Question 8

Sixmo contraindications (2)

Answer 8

magnetic resonance imaging (MRI); history of keloid or hypertrophic scar formation

Question 9

these antibiotics increases exposure to buprenorphine. monitor and adjust dose

Answer 9

clarith, erythromycin

Question 10

the effects of buprenorphine are only partially reversed by

Answer 10

naloxone

buprenorphine’s partial agonist nature and high receptor affinity make it only partially reversible by naloxone, as naloxone cannot fully displace buprenorphine from the opioid receptors.

Question 11

what is recommended as pre treatment screening before commencing therapy for opioid dependence

Answer 11

Documentation of viral hepatitis status

Question 12

buprenorphine monitoring + for SC implant Sixmo

Answer 12

baseline liver function test is recommended before commencing therapy, and regular liver function tests should be performed throughout treatment.

For subcutaneous implant, monitor for signs of infection and problems with wound healing 1 week after insertion and regularly thereafter.

Question 13

how to take oral lyophilisates of buprenorphine

Answer 13

placed on the tongue and allowed to dissolve. Patients should be advised not to swallow for 2 minutes and not to consume food or drink for at least 5 minutes after administration.

Question 14

specific contraindication for methadone

Answer 14

phaeochromocytoma

Question 15

methadone prolongs

Answer 15

QT interval

Question 16

severe interactions with methadone - drugs that prolong QT interval

Answer 16

avoid using two or more drugs that are associated with this

e.g. amiodarone, antipsychotics, citalopram

also drugs that cause hypokalaemia

e.g. theophylline, loop and thiazide diuretics, anti fungals, CCs, b2 agonists,

Question 17

methadone - other RF that predispose to QT prolongation

Answer 17

increasing age
female
cardiac disease
some metabolic disturbances e.g. hypokalaemia

Question 18

avoid methadone with this class of antidepressants due to increased risk of CNS excitation or depression

Answer 18

MAOIs
isocarboxazid, tranylcpromine, phenelzine

Question 19

methadone is a serotingeric drug so interacts with others - increased risk of serotonin syndrome

Answer 19

e.g. anti depressants, triptans, drugs for ADHD etc

Question 20

methadone is affected by drugs like phenytoin , carbamazepine, phenobarbital, St Johns wart etc aka enzyme…

Answer 20

inducers
they decrease the exposure to methadone

Question 21

what is lofexidine and when is it indicated

Answer 21

alpha2-adrenergic agonist
Management of symptoms of opioid withdrawal.

Question 22

what time to take lofexidine and why

Answer 22

take part of the dose at bedtime to offset insomnia associated with opioid withdrawal.

Question 23

Methadone is used in opioid dependence. What are 2 other indications?

Answer 23

Severe pain
Cough in palliative care (linctus)

Question 24

True or false. methadone oral solution is used in the treatment of cough in palliative care

Answer 24

false - linctus, not oral solution

Question 25

What drug is used as adjunct to prevent relapse in formerly opioid dependent patients

Answer 25

naltrexone

Question 26

MOA naltrexone and how does it work to prevent relapse in formerly opioid dependent pt

Answer 26

opioid receptor antagonist

naltrexone blocks the effect of opioids and prevents opioid intoxication and physiologic dependence on opioid users

Question 27

what drug is used in opioid overdose

Answer 27

naloxone

Question 28

MOA naloxone

Answer 28

It is an opioid antagonist. This means that it attaches to opioid receptors and reverses and blocks the effects of other opioids.

Question 29

lofexidine how to withdraw

Answer 29

Treatment should be withdrawn gradually over 2–4 days (or longer) to reduce the risk of rebound hypertension and associated symptoms.