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Psychiatry > Management of Opiate Misuse > Flashcards

Management of Opiate Misuse Flashcards

1
Q

What is problematic drug use?

A

Problematic use of opiates (including illicit and prescribed methadone use) and/or illicit use of BZD and implies route and prolonged use as opposed to recreational and occasional drug use

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2
Q

What is opium?

A

Mixture of alkaloids (esp codeine and morphine)

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3
Q

What is morphine?

A

Morphine extracted though often codeine contaminants remain

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4
Q

What is diamorphine?

A

Addition of 2 acetyl rings to produce diacetylmorphine

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5
Q

How can heroin be taken?

A 
IV
Smoking
Suppository
Insufflation 
Ingestion
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6
Q

How is heroin metabolised?

A

Diacetylmorphine -> 6-monoacetyl-morphine -> morphine

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7
Q

What are the effects of heroin?

A 
Euphoria
Analgesia
Resp depression 
Constipation 
Reduced conscious level 
Hypotension and bradycardia
Pupillary constriction 
Tolerance with repeated use
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8
Q

Withdrawal symptoms from opiates?

A 
Dysphoria and cravings 
Agitation 
Tachycardia and hypertension 
Piloerection 
Diarrhoea, nausea and vomiting
Dilated pupils
Joint pains
Yawning
Runny nose (rhinorrhoea), watery eyes (lacrimation)
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9
Q

How quickly will withdrawal symptoms appear in opiate withdrawal?

A

6-8 hours

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10
Q

What are the complications of IV opiate use?

A

Infections:
Local: cellulitis, abscess, thrombophlebitis, necrotising fasciitis)
Distsant: infective endocarditis
Systemic: hep B, HIV, hep C
Thrombotic/ embolic: DVT, PTE, ischaemic limb

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11
Q

Social consequences of heroin use?

A 
Unemployment
Neglect of family/ children 
Alternative interests
Criminality
Risk of violence
Prostitution
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12
Q

Psychiatric complications of heroin use?

A

Depression
Anxiety
DOES NOT CAUSE PSYCHOSIS OR DELIRIUM

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13
Q

What is opiate substitution therapy (OST)?

A

Replacement of short acting opiate with long acting opiate

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14
Q

What medications are used for OST?

A

Buprenorphine

Methadone

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15
Q

Describe the pharmacology of methadone

A

Long acting full opioid agonist
Used with high doses of heroin are used
Liquid form

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16
Q

Describe the pharmacology of buprenorphine

A

Long acting partial opioid agonist
High affinity for opioid receptors; will displace opioids from receptors but causes withdrawal
Tablet (depot in future)

17
Q

How many drug addicts who detoxity will relapse within 1 year?

A

70-80%

18
Q

What psychosocial interventions are recommended by NICE for substance misuse?

A

Contingency management; rewarding positive behaviours to reduce illicit drug use/ promote engagement with methadone maintenance treatment
Behavioural couples therapy

19
Q

Is CBT and psychodynamic therapy recommended for drug misuse?

A

No but IS appropriate for comorbid anxiety and depression

20
Q

What is heroin based treatment?

A

Combined methadone and heroin/methadone injected in clinic under medical supervision

21
Q

Does heroin based treatment work?

A

Yes; results in greater improvements in most other outcomes such as crime and psychosocial functioning

22
Q

What are the pros of prescribing buprenorphine in comparison with methadone?

A

Safter (less risk of overdosing as partial agonist)
Less sedative
Blocks effect of using heroin on top
Longer effect (taken every other day)
Quicker titration (2-3 days instead of weeks/ months for methadone)
Easier to detox from
Less stigma

23
Q

Cons of Buprenorphine when in comparison with methadone?

A

Not indicated for those on high doses of opioids
Misuse (injected/ snorted)
Risk of induced withdrawal
Less sedative

24
Q

Is there a max dose of methadone?

A

No

25
Q

How should you titrate methadone?

A

10mg a day

30mg a week

26
Q

What is the starting dose of methadone?

A

10-30mgs

27
Q

What is usually an effective dose of methadone?

A

60-120 mg

28
Q

What is the 3 day rule?

A

If medication not collected for 3 days; pharmacist should contact prescriber

29
Q

What is the right dose for maintenance?

A

When the patient stops using and is not experiencing any craving or withdrawal

30
Q

Starting dose for Buprenorphine?

A

4-8mg

31
Q

Second day dosing for Buprenorphine?

A

16mg

32
Q

What is the usual effective dose for Buprenorphine?

A

12-16mg

33
Q

Max dose for Buprenorphine?

A

42 mgs
24 mmgs for suboxone
18 mgs for espranor

34
Q

When do you take Buprenorphine?

A

Morning

Psychiatry (35 decks)

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