EXAM 4 Opioid Use Disorder Dr. Thomason Flashcards

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1
Q

Which diseases are associated with OUD and should be checked on patients?

A

HIV and Hepatitis C

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2
Q

What should be checked on a patient’s visit?

!!!

A

-prescription drug monitoring (check PDMP if they are taking something else like benzos or other opioids)

-physical exam (withdrawal, intoxication, injection when measuring BP)

-labs:
CBC (infection from injection use)
metabolic profile (check electrolytes, LFT (hepatitis risk), thyroid (hypothyroid causes anxiety and depression and may lead to self-eating
HIV test
urine drug test (the substance they are using may be contaminated with something else)

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3
Q

How does buprenorphine reduce cravings and block the effects of illicit drugs?

A

it is a partial agonist -> stops withdrawal and cravings
-give it only if the patient has withdrawal, if they are still using buprenorphine will put them into withdrawal!
-has to be abstinent for 7-10

-it has a high affinity to mu-receptors -> kicks off other opioids and prevents them from binding

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4
Q

How does Naltrexone work?

A

opioid antagonist

Vivitrol (injectable) preferred

-it can push patients into withdrawal if they are still using

-patients must stay abstinent for 7-10 days from opioids because it causes precipitated withdrawal (precipitated = induced by meds)

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5
Q

Why do people tend to use more Methadone over time?

A

because the effect doesn’t last as long as it binds to the receptor -> causing ACCUMULATION

-long half-life: 15-150hr

-effective dose range: 60-120 mg/day
max starting dose: 30 mg

-only available through opioid treatment program

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6
Q

What is the starting dose of methadone?

A

20-30 mg

max dose is 30 mg

total max dose is 40 mg

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7
Q

Adverse effects of Methadone

A

-Qtc prolongation!!! need ECG

most common:
-constipation, dry mouth
-sedation, dizziness
-diaphoresis (sweating) at night time
-sexual dysfunction (long-term decreases testosterone)

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8
Q

How much should the dose of Methadone be increased?

A

by 5-10 mg

steady-state occurs after 4-6 half-lives or 1 week

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9
Q

Disadvantages of Methadone use

A

-need close monitoring
-risk for mortality in the first 2 weeks
-Qtc prolongation
-multiple DDIs

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10
Q

What is the highest effective dose of Buprenorphine?

A

24 mg/day

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11
Q

How is Buprenorphine initiated?

A

called induction: start when they are in withdrawal

low dose: <2mg (microdosing) while they are still on opioids

high dose: 16-24 mg

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12
Q

Which tool is used to assess for withdrawal symptoms?

A

COWS
Clinical Opioid Withdrawal Scale

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13
Q

What is recommended if a patient on buprenorphine needs an opioid for pain treatment (ex after surgery)?

A

instead of giving a high dose of the opiod to overcome the blockade of buprenorphine
->use buprenorphine as the pain med (increase the dose)

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14
Q

Contraindication of Buprenorphine

A

-liver failure
-concurrent use of benzo, alcohol or opioids

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15
Q

How is XR Naltrexone given

A

380 mg IM every 4 weeks

-have to be abstinent from opioids

-can also be used for concomitant alcohol disorder

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16
Q

Who might use Naltrexone

A

professionals (physicians, pharmacists, pilots) with OUD who are not allowed to work with opioids or be on an opioid

17
Q

How long do patients have to be abstinent to use Naltrexone?

A

if they are on a short-acting opioid like heroin, fentanyl, oxycodone, or hydrocodone: 5-7 days

long-acting: 7-10 days

before Naltrexone or naloxone use they take a urine drug test to see if it’s still in the system

patients often cant handle the craving and wait until they are off the opioid

18
Q

Precautions with Naltrexone

A

-bleeding risk if they have thrombocytopenia or coagulation disorder

-check liver functions -> liver toxic

-don’t use if they are on an opioid -> precipitated withdrawal
-don’t use if they are in a withdrawal

19
Q

What are complications of OUD in pregnancy?

A

-early labor
-fetal growth restriction
-stillbirth
-neonatal abstinence syndrome (NAS) - baby goes into withdrawal
-maternal complications

20
Q

How should pregnant women on opioids be managed during pregnancy?

A

-don’t taper off, it causes withdrawal for the mother and the baby
-reduce the maternal opioid use

Txt:
-methadone

-buprenorphine mono
-buprenorphine-naloxone (recent evidence supports efficacy)

MOTHER-trial showed better outcomes for the baby with buprenorphine VS methadone

21
Q

Dose adjustment during pregnancy with OUD

A

-higher metabolism of the mother -> may need to increase the dose

-breastfeeding is encouraged, opioids is in the milk and may prevent withdrawal of the baby

22
Q

When to use Clonidine or Lofexidine (alpha-2agonists)

A

autonomic hyperactivity
-muscle twitching
-hot flushes or chills
-restlessness