Management of opioid misuse Flashcards
define problem drug use
problematic use of opiates +/or the illicit use of BZDs
implies routine and prolonged use as opposed to recreational and occasional use
effects of heroin
euphoria analgesia respiratory depression constipation reduced conscious level hypotension + bradycardia pupillary constriction - miosis tolerance
why is heroin addictive
rapid onset of action
short half life
available
withdrawal symptoms
dysphoria cravings agitation tachycardia + hypertension piloerection dilated pupils diarrhoea, N+V joint pains yawning rhinorrhoea + lacrimation
when do withdrawal symptoms usually occur
within 6-8 hours
methods of administrating drugs
IV smoking suppository insufflation ingestion
complications of IV drug use
infection: cellulitis, infective endocarditis abscess DVT, PE thrombophlebitis necrotising fasciitis ischaemic limb viral hepatitis B+C HIV
heroin causes psychosis, true or false
false
what are the aims of treatment
reducing harm
promoting recovery
maintaining abstinence
what test is used in drug testing
urine sample
in terms of goal setting what does SMART stand for
specific measurable achievable realistic time limited
what are the prescribing options for pharmacological management of problem drug use
Opioid replacement therapy ORT
Opioid detox
Opioid antagonists
examples of opioid replacement therapy
methadone
buprenorphine
examples of opioid detox and which is most commonly used
methadone - most common
buprenorphine
lofexidine
examples of opioid antagonists
naltrexone
naloxone
what is ORT
replacement of a short acting opioid with a long acting one that is safer, well tolerated and stops withdrawal symptoms
ORT administration
daily visits to pharmacy
taken under supervision
what is opioid detox
aims to achieve complete abstinence from all opioids
indication for opioid antagonists
used in acute opioid intoxication
methadone is a full/partial agonist and is short/long lasting
full agonist
long lasting
administration of methadone
PO tablet
liquid
does methadone have a maximum dose
no
what is the mechanism of action of buprenorphine
partial agonist and antagonist
buprenorphine is short/long lasting
long lasting with very high affinity
administration of buprenorphine
subllingual
depot injection
methadone/buprenorphine is used in high dose heroin addiction
methadone
which drug is safer and less sedative, methadone or buprenorphine
buprenorphine
max dose of buprenorphine
32mg/day
what is ECG monitoring for
look for prolonged QT interval
if medication is not collected for __ consecutive days, medication cannot be given
3
