Lecture 9 - Opioid & Stimulate Use Disorder Flashcards
Withdrawal Symptoms of Opioid use
restlessness
Musculoskeletal pain
Insomnia
N/V/D
gooseflesh
Autonomic dysfunction
Maintenance OUD txm
Buprenorphine = partial agonist, generate limited effect
Methadone = full agonist, generate effect
Naltrexone = antagonist, blocks effect
OD txm Opioid
Naloxone
Methadone info
1st line for OUD
Maintains tolerance, reduces cravings
Req enrollment in registered clinic (Opioid Txm Program)
Methadone dosing
starting: 10-30mg (opioid tolerant), monitor 2-4hrs
Dose titration (wk 1-2) 5mg every 5+ days, avoid sedation
Dose titration (wk3-4), 5mg every 3-5 day
Dose stabilization (wk 5+), maintince dose achieved unless changes in health, meds, etc
Monitor QTc prolongation and many DDI
Methadone advantages n Disadvantages
Advantage: no lag, treat co-morbid pain, long 1/2 life, txm retention
Disadvantage: OTP structure, adverse effects (no ceiling), DDI, Age-related changes
Considerations for Methadone treatment
considered 1st line in OUD
Analgesia 7 Euphoria last 6-8hrs, can lead to “dose stacking” and possible OD, dont give take home doses early on in txm
Craving prevention & AE’s last 24+hrs so given Q24, TID = pain
Target dose = lowest dose limiting craving w/o euphoria (high)
Buprenorphine info
also 1st line
partial agonist
DATA wavered clinician (X-DEA)
Buprenorphine Dosing
Requires induction therapy…
Must display clear signs of withdrawal
admin 2-4mg buprenorphine, wait 2 hrs
admin 2-4mg but if continued withdrawal symptoms
Day 1 FDA max dose rec = 8mg bup
Day 2 FDA max dose rec = 16mg
How long do you need to take oral before doing subQ bup
8-24mg SL bup for 7 days
How long do you need to take oral before doing transdermal implant bup
< 8mg SL bup for 3 months
Buprenorphine Advantages n Disadvantages
Advantages: ceiling effect, can be used for pain, txm retention, long acting products
Disadvantages: dosed multiple times per day, req induction, precipitated withdrawal
Naltrexone oral tab info
generally not preferred txm option
limited benefit over placebo
Naltrexone ER IM info
can provide improved adherence, Q monthly
must be opioid free 7-10 days prior to infection
Admin in butt
Naltrexone Advantages n Disadvantages
Advantages: long acting product, lack of induced tolerance, lack of misuse
Disadvantages: blocks opioid analgesics, doesn’t treat pain, opioid free req, reduced opioid tolerance n risk of OD, may inc depression
Best options for pregnancy
safest to start therapy, not detox
methadone easier to star, but may lead to worse neonatal abstinence syndrome
Bup req mild withdrawal to start, milder NAS; avoid naloxone combo
Dont D/c if someone ie stable n preg
Key point in Intoxication to Opioid OD
** Responds to stimuli (verbal, sternal)**
Risk factors for Opioid OD
mixing substances
using alone
Not taking turns
using without narcan nearby
bypassing “tester shots”
liver/respiratory disease
use after abstinence
Opioid withdrawal onset
Short acting = 6-12hrs after last dose
Long acting = 30 hours after last dose
Peak symptoms = 72hrs after dose
Clonidine
used to help reduce intensity of withdrawal symptoms and control autonomic arousal
0.1-0.3mg Q6-8hrs, max 1.2mg daily
How long does the High last of stimulants
crack/coke = 30mins to few hours
meth = 4-16, makes you extra horny
How long can withdrawal last from stimulants
crack/cocaine = up to 3 weeks
meth = up to 12 weeks
to reduce cocaine/meth cravings give….
agent with longest 1/2 life (XR forms)
Avoid Ir forms due to inc misuse potential/drug peaks
safety = neg on top before starting stim to dec risk of cardio toxic effects
Topiramate info
GABA/Glutamate Modulator
Should lead to dec cravings
Wk 1 = 25mg QD
Wk 2 = 50mg QD
Wk 3 = 75mg QD
Wk 4 = 100mg QD
inc by 50mg weekly to target dose 200-300mg QD
ADE: N/V/D, confusion, anxiety, dec appetite, trouble conc
Safe Inhalation Practices
Avoid sharing pipes and mouthpieces
wash hands
inhaler slowly, exhale immediately
Keep pipe clean
Handle pipe with care
