Medication Assisted Treatment of Opioid Use Disorder Flashcards
What are characteristics of acute opioid intoxication and overdose
Lowered levels of consciousness, lowered respiratory rate, hypotension, hypothermia, pinpoint pupils, bradycardia, cyanosis (blueish skin)
What is used for acute opiod overdose
Naloxone
T/F: Opiod withdrawal is unpleseasnt but doesn’t usually lead to death
True
For patients using short term opiods (heroin) when does it start, peak, and diminshes
8-12 hours, 36-72 hours, 5 days
For patients using long term opiods (methadone) when does it peak, how long does it continue
5-6 days, 14-21 days
For early withdrawal (8-24 hours) what are the symptoms of grade 1
lacrimation (tears), rhinorrhea (alot of mucus), diaphoresis (sweating), yawning, restlessness, insomnia
For early withdrawal (8-24 hours) what are the symptoms of grade 2
Dilated pupils, goosebumps, nervous ticks, myalgia (muscle aches), arthralgia (joint ache), abdominal pain
For fully developed withdrawal (1-3 days) what are the symptoms of grade 3
Tachycardia, hypertension, tachypnea (rapid breathing), fever, anorexia or nausea, extreme restlessness
For fully developed withdrawal (1-3 days) what are the symptoms of grade 4
Diarrhea, vomiting, dehydration, hyperglycemia, hypotension, curled up-position
What is the alpha 2 adrenergic agonist used
clonidine, lofexidine
What is the mu-opioid receptor agonist used
methadone
What is the partial mu-opioid receptor agonist used
buprenorphine
What is the opiod antagonist
naltrexone
What are the symptoms that are resolved when using alpha=2 adrenergic agonist, how is this done
Improve restlessness, GI symptoms, lacrimation, rhinorrhea, and muscle pain/ decreases adrenergic neurotransmission from the locus cerculeus
What are the side effects of clonidine
significant hypotension,dry mouth, orthostatic hypotension, dizziness, sedation
T/F: Clonidine does not affect cravings
True
What are the unique adverse effects of lofexidine
CNS depression and QT prolongation
What is the benefits of using methadone
Reduces cravings and doesn’t have fast onset leading to less potential for euphoria and precipitation of withdrawal (leaves 70% of mu receptors open)
What heart condition can methadone cause
Life threatening QT prolongation
T/F: Methadone cautions should be present with use of all CYP450 inhibitors and inducers
True
T/F: Patients taking methadone have a risk of long term chronic diarrhea
False: Patients taking methadone have a long term risk of chronic constipation
How long does it take for methadone to have its full effect
Several days
What is the MOA of buprenorphine
Partial agonist at the mu-opioid that has a ceiling effect to decrease the potential for respiratory depression
How can buprenorphine cause withdrawal when someone has been taking heroin recently
Greater affinity of mu-receptor cause the other opioid to be kicked off causing a withdrawal
What is the only dosage form that buprenorphine comes in, how many are taken and how are they taken
Sublingual tablet, dissolution under the tounge with all of the tablets or at least two at a time
T/F: Buprenorphine can swallowed with no problems
False: Buprenorphine sublingual tablets cannot be swallowed
Where is the buprenorphine
Subdermal
What are the common side effects of burprenophine
nausea, vomiting, and constipation
What CYP enzyme is buprenoprhine a substrate of
CYP3A4
Which medication is an opioid antagonist and has no abuse potential
Naltrexone
How long should a patient wait to take Naltrexone if taking a short-acting opioid, long acting opioid, why
7-10 days, 10-14 days, NTX-precipitated opioid withdrawal
What are the pharmacological treatment strategies for anti-withdrawal agents
Clonidine, tapering methadone, buprenorphine
What is the option for agonist maintenance therapy, partial-agonist maintenance therapy, antagonist maintenance therapy
Methadone, Buprenorphine, Naltrexone
What is the complication with methadone taper
While on methadone the patient is a functioning member of society but once off methadone the patient has a high risk of relapse forever
T/F: Buprenorphine is more effective than methadone
False: Methadone is more effective than buprenorphine because it does not have the ceiling effect
What is the initial dosing for agonist (methadone) maintenance therapy, dose increases, maintenance dosing ranges
10-30 mg daily (Federal law limit is 30 mg), 5-10 mg increments over several days, 80-120 mg
What are the three phases of treatment for partial agonist (buprenophine)
Induction, Stabilization, Maintenance
When does induction of burpenorphine occur
In early stages of withdrawal (one week)
How long is stabilization, maintenance
1-2 months, indefinitely
