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Clin Therapeutics II (Spring 2018) > Exam 3: Addiction > Flashcards

Exam 3: Addiction Flashcards

1
Q

Is physical dependence/tolerance to opioids part of a dx for Substance Abuse Disorder?

A

It’s neither necessary nor sufficient for dx of opioid abuse disorder. All PT on chronic opioids will develop tolerance and withdrawal.

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2
Q

How many criteria for dx of Substance Abuse Disorder?

A

11

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3
Q

How many criteria for mild Substance Abuse Disorder?

A

2-3

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4
Q

How many criteria for moderate Substance Abuse Disorder?

A

4-5 criteria

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5
Q

How many criteria for severe Substance Abuse Disorder?

A

6+

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6
Q

3 specific signs/symptoms to help determine Acute Opioid Withdrawal?

A
  1. Dilated pupils (Mydraisis)
  2. Yawning
  3. Piloerection (goosebumps)
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7
Q

What does Clinical Opioid Withdrawal Scale (COWS) score?

A

Scored severity of withdrawal from opioids

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8
Q

What are the 3 opiates?

A
  1. Codeine
  2. Diacetylmorphine (Heroin)
  3. Morphine
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9
Q

What are semi-synthetic opioids created from? (Hint: 2 things)

A
  1. Natural opiates

2. morphine esters

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10
Q

4 examples of semi-synthetic opioids?

A
  1. Hydrocodone
  2. Hyrdomorphone
  3. Oxycodone
  4. Oxymorphone
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11
Q

Which opioid class is not from the poppy plant?

A

Fully Synthetic Opioids

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12
Q

4 examples of fully synthetic opioids

A
  1. Buprenorphine
  2. Fentanyl
  3. Methadone
  4. Tramadol
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13
Q

Will opiates turn urine screen positive?

A

Yes

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14
Q

What plants do opiates come from?

A

Poppy

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15
Q

Will semi-synthetic opioids turn urine screen positive?

A

Maybe! if high enough dose and taken close to the urine test.

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16
Q

Will synthetic opioids turn urine screen positive?

A

Nope! Must test specifically.

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17
Q

3 full receptor agonists

A
  1. Morphine
  2. Oxycodone
  3. Methadone
    (MOM)
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18
Q

Partial receptor agonist? (Hint: only one)

A

Buprenorphine

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19
Q

2 receptor antagonists

A
  1. Naloxone

2. Naltrexone

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20
Q

What is not the goal of inpatient withdrawal treatment?

A

Goals are NOT to cure the addiction or eliminate cravings

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21
Q

What 3 classes of meds can be used for acute opioid withdrawal?

A
  1. Full Agonist therapy (methadone)
  2. Partial agonist therapy (bup/naloxone)
  3. “Comfort meds” (helps with sx)
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22
Q

Methadone onset of action?

A

30-60min

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23
Q

Methadone synthetic? Agonist?

A

Fully synthetic. Full agonist.

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24
Q

How long does Methadone last for treatment of opioid addiction?

A

24-36h

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25
Q

Day 1 Methadone dose for acute withdrawal?

A

10-20mg solution x1

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26
Q

Methadone day 1: How often to reevaluate PT? Scale to use?

A

Reevaluate q2-3h, use COWS score

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27
Q

Methadone day 1: still have withdrawal symptoms. Additional dose? How often? Until what?

A

5-10 mg additional doses every 2-3 hours until withdrawal is relieved

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28
Q

Methadone day 2: What to give in morning?

A

Give total daily dose from day 1 (not greater than 40 mg)

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29
Q

Methadone taper in acute opioid withdrawal?

A

Taper methadone 5-10 mg per day. Give last dose on day of discharge.

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30
Q

What to refer to upon discharge?

A

Referral to long term substance use disorder treatment

31
Q

What dose not to exceed of methadone for acute opioid withdrawal?

A

40mg (against the law)

32
Q

Methadone dose needed for cravings and opioid blockade

A

> 60mg, sometimes higher than 80mg

33
Q

Buprenorphone synthetic and agonist?

A

Fully synthetic. Partial agonist.

34
Q

Buprenorphine receptor affinity? What does it mean for other opioids if Bup is present?

A

High receptor affinity. Other opioids can’t bind to receptor if Buprenorphine is present.

35
Q

Buprenorphine activates how much of the opioid receptor?

A

Partial activation

36
Q

What to ensure before starting Buprenorphine in opioid-use disorder?

A

Ensure the patient is in withdrawal or has NOT been using opioids prior to commencing buprenorphine.
PT MUST BE IN OPIOID WITHDRAWL OR OPIOID NAIVE WITH OPIOID-USE-DISORDER BEFORE GIVING BUPRENORPHINE!

37
Q

Buprenorphine delivery?

A

Sublingual

38
Q

What is Subutex? Who takes it?

A

Buprenorphine monotherapy. For preggers women.

39
Q

What is Suboxone?

A

Buprenorphine + Naloxone

40
Q

What does buprenorphine’s high-affinity for opioid receptors result in? Hint: blockage

A

Opioid blockade

41
Q

Speed of Buprenorphine dissociation from receptor?

A

Slow!

42
Q

What effect does Buprenorphine have on respiratory depression?

A

Ceiling effect

43
Q

Why is Suboxone good for IV diversion?

A

Naloxone is inactive until med is burned/crushed/etc and then activated and renders the opioid useless

44
Q

Starting dose of buprenorphine and naloxone for acute opioid withdrawal?

A

Start with 2-4 mg of buprenorphine combined with naloxone 0.5mg-1mg

45
Q

COWS score for when to use Buprenorphine?

A

> 8

46
Q

How often to reevalute when using buprenorphone for acute opioid toxicity? Which scale to use?

A

90 minutes. COWS scale.

47
Q

Additional Buprenorphone dose for acute opioid withdrawal

A

2-4 mg of buprenorphine

48
Q

What happens to tolerance when detox/acute withdrawal done?

A

No more tolerance

49
Q

Do PTs report euphoria with buprenorphine?

A

Nope

50
Q

Buprenorphine sublingual, IV, and GI bioavailability?

A

Sublingual and IV=Good bioavailability

GI=poor bioavailability

51
Q

Naloxone sublingual, IV, and GI bioavailability?

A

IV=good bioavailability

GI and sublingual=poor bioavailability

52
Q

3 options for maintenance therapy

A
  1. Agonist therapy: Methadone- long acting full agonist
  2. Partial agonist therapy: Buprenorphine/naloxone
  3. Antagonist: Naltrexone (PO vs IM vivitrol)
52
Q

Maintenance: What might eliminating drug cravings and opioid use, opioid blockade, normalize brain reward pathways and behavior require for Methodone and Bup doses?

A

Higher doses of Buprenorphone or Methadone in order to be successful

54
Q

Goals of maintenance therapy?

A
  1. Alleviate withdrawal
  2. Eliminating drug cravings and opioid use
  3. Opioid blockade
  4. Normalize brain reward pathways and behavior
55
Q

Naloxone antagonist? Affinity?

A

Full antagonist receptor blocker. Strong affinity.

56
Q

What does Naloxone do to opioid OD?

A

Reverses opioid OD by displacing agonist from receptor

57
Q

What will Naloxone cause if opioids remain on receptor when given?

A

Withdrawal (similar to Buprenorphine)

58
Q

Naltrexone is a “pure” what?

A

Pure opioid antagonist.

59
Q

Naltrexone antagonist? Affinity?

A

Full “pure” antagonist. Strong receptor affinity.

60
Q

Naltrexone PO duration?

A

24-48h duration

61
Q

Naltrexone IM called?

A

Vivitrol

62
Q

Naltrexone IM (Vivitrol) duration?

A

1 month

63
Q

What must patients be free from for Naltrexone IM (Vivitrol)?

A

Opioid-free for 7-10d before using Naltrexone IM. Difficult to obtain, might be easier while in detox.

64
Q

Entire point of buprenorphine or methadone maintenance is to do what to the PT?

A

Keep PT normal enough so their nerves rewire (i.e. DA reward pathway)

65
Q

Can one “graduate” from a methadone maintenance program?

A

Nope

66
Q

Methadone maintenance daily and weekly requirements?

A

Daily nursing assessment, weekly individual and/or group counseling

67
Q

How to choose Buprenorphine vs Methadone for maintenance?

A

PT pref, access to treatment setting, ease of withdrawal, risk of OD, and past experience

68
Q

Maintenance: Buprenorphine or Methadone more effective?

A

Bup effective at maintenance treatment but less effective than Methadone at adequate doses

69
Q

Does Buprenorphine or Methadone have higher risk of abuse and diversion?

A

Buprenorphine

70
Q

Does Buprenorphone or Methadone have decreased risk of respiratory depression, overdose, and death?

A

Buprenorphine

71
Q

Fentanyl is how many more times potent than heroin?

A

50-100 times more potent than heroin

72
Q

Order from least to most potent: Fentanyl, Heroin, Acetyl Fentanyl

A

Heroin->Acetyl Fentanyl->Fentanyl

73
Q

Common risks for opioid overdoses?

A

Mixing substances/polypharmacy (EtOH + stimulants + opioids), Opioid dose and changes in purity, Previous overdose, Addiction history, Abstinence (release from jail, just finished detox, relapse), chronic medical illness, Social isolation (Using alone)

74
Q

Do towns with Naloxone (Narcan) have higher or lower OD death rates?

A

Lower

Clin Therapeutics II (Spring 2018) (11 decks)

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