MAT Flashcards
overall goal of starting buprinorphine
To transition from opioid drug usage
Should be established before starting your patient on Buprinorphine
How will the pay? Type of Insurance, Out-of-pocket
Validate acces to pharmacy
Validate Access to urine drug testing
Office induction
Patient brings filled prescription into the office.
Home induction
Administer at home
Typically when should induction occur:
Earlier in the week
What day to avoid inductions
Friday
How to avoid precipitated withdrawal
Start low (2-4 mg)
Mild to moderate withdrawals at time of induction
Patient should avoid ____ product because it interferes with medication
Nicotine
Avoid for 30 minutes at least
How often do patients typicaly take Buprenorphine
Daily
It can be taken at night
How long should you wait to induce Buprenorphine after a patient’s last dosage of short acting opioiod
12 - 16 hours
How long should you wait to induce Buprenorphine after a patient’s last dosage of sustained release opioid
24 hours
How long should you wait to induce Buprenorphine after a patient’s last dosage of methadone
36 hours
Example of short acting opioids
Heroin
oxycodone
hydrocodone
Where should COW score be at before you induce Buprenorphine for SA opioids
> 8
How low should methadone be before introducing Buprenoprhine
30 mg
Consider dosing down to 15 mg
Process of induction when you are working with methadone user
Last day of methadone use (15 - 30 mg)
Next day - don’t take
Following day - introduce Buprenorphine ( 2 - 4 mg)
Make sure they are in mild to moderate withdrawal via COW scale before giving Buprenorphine
How long should you monitor after first dosage of Buprenorphine is given in office
At least two hours
How should you respond if opioid withdrawal re-appears
re-dose every 2-4 hours
Typical dose range
8 - 16 mgs
Interval of dose titration per day after induction
2 - 6 mgs/daily
You can increase rapidly if patient has a lot of cravings
When should we expect relieve of opioid withdrawal
30 - 45 minutes
Expected first dosage of induction
2 - 4 mg
When do we see a steady state of stabilization
Looking for the days
5 days
WHAT IS THE REASON WE GO UP ON DOSE
THE AUTHOR REPEATED THIS SO THIS IS IMPORTANT
ONLY FOR CRAVINGS
Do not fall victim to withdrawal sx. The drug always wins. Let them know their body is learning to stabalize
What if Opioid withdrawal occurs right after dosage of med
Precipitated withdrawal occurring
Two options if patient is going through precipitated withdrawals
What do we do
Increase the med
Stop the induction and treat symptoms
Increasing the med allows for more partial agonist effect of buprenorphine
What is the preferred method of response to precipitated withdrawal and why
Increase the med.
We DO NOT WANT TO LOSE THE PATIENT
Dose range where stabilization typically occurs:
8 - 16 mgs
Rarely is there a reason to go over ____ mg/daily
Looking for a dose here
16 mg
Typically insurance companies do not approve a dosage above 24 mgs
Drugs typically not found in a drug screen
You have to specifically ask for this to be found in a UDS
Buprenorphine
Fentanyl
Oxycodone
Methadone
