Medication Assisted Treatment of Opioid Use Disorder

Question 1

What are characteristics of acute opioid intoxication and overdose

Answer 1

Lowered levels of consciousness, lowered respiratory rate, hypotension, hypothermia, pinpoint pupils, bradycardia, cyanosis (blueish skin)

Question 2

What is used for acute opiod overdose

Answer 2

Naloxone

Question 3

T/F: Opiod withdrawal is unpleseasnt but doesn’t usually lead to death

Answer 3

True

Question 4

For patients using short term opiods (heroin) when does it start, peak, and diminshes

Answer 4

8-12 hours, 36-72 hours, 5 days

Question 5

For patients using long term opiods (methadone) when does it peak, how long does it continue

Answer 5

5-6 days, 14-21 days

Question 6

For early withdrawal (8-24 hours) what are the symptoms of grade 1

Answer 6

lacrimation (tears), rhinorrhea (alot of mucus), diaphoresis (sweating), yawning, restlessness, insomnia

Question 7

For early withdrawal (8-24 hours) what are the symptoms of grade 2

Answer 7

Dilated pupils, goosebumps, nervous ticks, myalgia (muscle aches), arthralgia (joint ache), abdominal pain

Question 8

For fully developed withdrawal (1-3 days) what are the symptoms of grade 3

Answer 8

Tachycardia, hypertension, tachypnea (rapid breathing), fever, anorexia or nausea, extreme restlessness

Question 9

For fully developed withdrawal (1-3 days) what are the symptoms of grade 4

Answer 9

Diarrhea, vomiting, dehydration, hyperglycemia, hypotension, curled up-position

Question 10

What is the alpha 2 adrenergic agonist used

Answer 10

clonidine, lofexidine

Question 11

What is the mu-opioid receptor agonist used

Answer 11

methadone

Question 12

What is the partial mu-opioid receptor agonist used

Answer 12

buprenorphine

Question 13

What is the opiod antagonist

Answer 13

naltrexone

Question 14

What are the symptoms that are resolved when using alpha=2 adrenergic agonist, how is this done

Answer 14

Improve restlessness, GI symptoms, lacrimation, rhinorrhea, and muscle pain/ decreases adrenergic neurotransmission from the locus cerculeus

Question 15

What are the side effects of clonidine

Answer 15

significant hypotension,dry mouth, orthostatic hypotension, dizziness, sedation

Question 16

T/F: Clonidine does not affect cravings

Answer 16

True

Question 17

What are the unique adverse effects of lofexidine

Answer 17

CNS depression and QT prolongation

Question 18

What is the benefits of using methadone

Answer 18

Reduces cravings and doesn’t have fast onset leading to less potential for euphoria and precipitation of withdrawal (leaves 70% of mu receptors open)

Question 19

What heart condition can methadone cause

Answer 19

Life threatening QT prolongation

Question 20

T/F: Methadone cautions should be present with use of all CYP450 inhibitors and inducers

Answer 20

True

Question 21

T/F: Patients taking methadone have a risk of long term chronic diarrhea

Answer 21

False: Patients taking methadone have a long term risk of chronic constipation

Question 22

How long does it take for methadone to have its full effect

Answer 22

Several days

Question 23

What is the MOA of buprenorphine

Answer 23

Partial agonist at the mu-opioid that has a ceiling effect to decrease the potential for respiratory depression

Question 24

How can buprenorphine cause withdrawal when someone has been taking heroin recently

Answer 24

Greater affinity of mu-receptor cause the other opioid to be kicked off causing a withdrawal

Question 25

What is the only dosage form that buprenorphine comes in, how many are taken and how are they taken

Answer 25

Sublingual tablet, dissolution under the tounge with all of the tablets or at least two at a time

Question 26

T/F: Buprenorphine can swallowed with no problems

Answer 26

False: Buprenorphine sublingual tablets cannot be swallowed

Question 27

Where is the buprenorphine

Answer 27

Subdermal

Question 28

What are the common side effects of burprenophine

Answer 28

nausea, vomiting, and constipation

Question 29

What CYP enzyme is buprenoprhine a substrate of

Answer 29

CYP3A4

Question 30

Which medication is an opioid antagonist and has no abuse potential

Answer 30

Naltrexone

Question 31

How long should a patient wait to take Naltrexone if taking a short-acting opioid, long acting opioid, why

Answer 31

7-10 days, 10-14 days, NTX-precipitated opioid withdrawal

Question 32

What are the pharmacological treatment strategies for anti-withdrawal agents

Answer 32

Clonidine, tapering methadone, buprenorphine

Question 33

What is the option for agonist maintenance therapy, partial-agonist maintenance therapy, antagonist maintenance therapy

Answer 33

Methadone, Buprenorphine, Naltrexone

Question 34

What is the complication with methadone taper

Answer 34

While on methadone the patient is a functioning member of society but once off methadone the patient has a high risk of relapse forever

Question 35

T/F: Buprenorphine is more effective than methadone

Answer 35

False: Methadone is more effective than buprenorphine because it does not have the ceiling effect

Question 36

What is the initial dosing for agonist (methadone) maintenance therapy, dose increases, maintenance dosing ranges

Answer 36

10-30 mg daily (Federal law limit is 30 mg), 5-10 mg increments over several days, 80-120 mg

Question 37

What are the three phases of treatment for partial agonist (buprenophine)

Answer 37

Induction, Stabilization, Maintenance

Question 38

When does induction of burpenorphine occur

Answer 38

In early stages of withdrawal (one week)

Question 39

How long is stabilization, maintenance

Answer 39

1-2 months, indefinitely