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Substance Use Disorders > Introduction to Opioids, OUD, and Withdrawal > Flashcards

Introduction to Opioids, OUD, and Withdrawal Flashcards

1
Q

Opioids may be used to…

A

Reduce pain
Manage opioid dependence
Produce temporary euphoria/relaxation

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2
Q

The 3 main opioid receptor subtypes include…

A

Mu, delta, and kappa

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3
Q

Mu receptors are responsible for…

A

Most of the opioid analgesic effect
Also causes respiratory depression, reduced GI motility, euphoria, sedation, and physical dependence

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4
Q

Delta receptors are responsible for…

A

Analgesia, euphoria, physical dependence

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5
Q

Kappa receptors are responsible for…

A

Analgesia, sedation
Questionable effect on mood
Does NOT contribute to physical dependence

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6
Q

Opioid use disorder is…

A

A long-lasting chronic brain disease, involving recurrent use of opioids causing significant clinical + functional impairment due to cumulative impact of opioids on the brain

Is often relapsing and requires long-term chronic disease management

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7
Q

OUD without treatment or engagement in recovery activities…

A

Is an addiction, progressive, and can result in disability or premature death

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8
Q

DSM-5 discusses components of OUD such as…

A

Problems with USE - using large amounts, more time spent with use, repeated attempts to control use

Problems with LIFESTYLE - physical/psych/social/interpersonal problems related to use, activities given up, neglected major roles, hazardous use

Problems with PHYSIOLOGY - craving, tolerance, withdrawal

Severity needs to be individualized

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9
Q

Manifestations of OUD can involve…

A

Misuse of prescribed opioid medications
Use of diverted opioid medications
Use of illicitly obtained opioids

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10
Q

It is important to note that OUD does NOT end when…

A

The drug is removed from the body, or when acute post-drug taking illness dissipates

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11
Q

OUD is similar to other chronic disease such as T2DM and HTN in that…

A

It cannot be cured, but can be treated and managed

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12
Q

The leading cause of death among people using opioids is…

A

Opioid toxicity and trauma

OUD is associated with increased morbidity + mortality

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13
Q

The cycle of OUD involves the 3 stages of addiction, which include…

A

Binge/intoxication - individual consumes intoxicating substance, experiencing rewarding/pleasurable effects

Withdrawal/negative affect - individual experiences negative emotional state in absence of substance

Preoccupation/anticipation - individual seeks substance again after period of abstinence

3 stages are linked to + feed on each other, involving different brain regions, circuits, NT’s - result in specific kinds of changes in the brain

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14
Q

The intensity and frequency of the OUD cycle can vary…

A

Frequency - course of weeks/months, or several times in a day
Intensity - variation in how people progress, and intensity

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15
Q

The addiction cycle tends to intensify over time, leading to…

A

Greater physical and psychological harm

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16
Q

When an opioid attaches to the Mu receptor, it triggers a structure in the brain called…

Related to euphoric feeling and opioid tolerance

A

The mesolimbic (midbrain) reward system in the ventral tegmental area (VTA)

17
Q

The VTA system is responsible for the release of ____ in the ____, resulting in pleasure.

A

Release of dopamine in the nucleus accumbens (NAc)

18
Q

Feedback to the prefrontal cortex to the VTA regulates…

A

The drive to obtain pleasure (risk vs. reward)

19
Q

Overtime, with the repeated opioid use, the feedback pathway between the prefrontal cortex to VTA becomes dysregulated, which…

A

Impairs decision making

20
Q

Development of opioid tolerance results from…

A

The opioid receptors in the VTA become less sensitive to opioid stimulation - dopamine production is reduced and the experience of pleasure/opioid is diminished

Higher and higher doses are required to achieve the same pleasure reward

21
Q

Neurons in the locus coeruleus (LC) function by…

A

Producing NE and distribute it to other parts of the brain where it stimulates wakefulness, breathing blood pressure, alertness (fight/flight)

22
Q

When opioids bind to Mu receptors in the LC, they…

A

Suppress release of NE, causing drowsiness, hypotension, and slowed respiration (resulting in opioid intoxication)

Which can result in death; hence why harm reduction is extremely critical

23
Q

The MOA of naloxone is to…

A

Bind the same sites as the opioids in the brain more tightly - displaces opioid and acts as an antagonist at the receptor

24
Q

Naloxone helps to ____ within ____, when…

A

Restore breathing within 2-5 minutes, when it has been dangerously slowed/stopped due to opioid usage

25
Q

Naloxone formulations are available in…

A

IM (can be given through clothing into muscle of upper arm or upper leg)
IN

26
Q

In those with opioid dependence, naloxone can cause…

A

Opioid withdrawal

Benefit outweighs risk of toxicity

27
Q

Effects of naloxone wear off after ____, which may cause…

A

30-90 minutes; overdose may return (especially if pt. has been taking long acting opioid

Repeated dosing q2-3 minutes may be required

28
Q

Notable physical signs + symptoms of opioid withdrawal may involve…

A

N/V/D/C
Muscle aches, abdominal cramps and tenderness, chills
Tachycardia, HTN
Sweating, chills, hot flashes, dilated pupils

29
Q

Notable psychological symptoms of opioid withdrawal include…

A

Restlessness
Dysphoria
Insomnia, anxiety
Irritability
Fatigue
Drug craving

30
Q

For management of aches/pains/myalgias in opioid withdrawal, we can give…

A

NSAID’s, acetaminophen scheduled

31
Q

For management of bowel function in opioid withdrawal (constipation, diarrhea), we can give…

A

Laxatives (senokot) or loperamide

32
Q

For nausea/vomiting in opioid withdrawal, we can give…

A

Antiemetics - dimenhydrinate, haloperidol

33
Q

For anxiety, irritability, cramping, and rhinorrhea in opioid withdrawal, we can give…

A

Hydroxyzine

BZD’s should NOT be used for withdrawal symptoms due to increased risk of CNS depression + opioid toxicity

34
Q

For insomnia in opioid withdrawal, we can try…

A

Non-drug and sleep hygiene measures
Trazodone
Hydroxyzine

35
Q

For other physical symptoms such as sweating, increased HR, we can try..,.

A

Clonidine
Oxybutynin for sweating

Substance Use Disorders (6 decks)

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