module 5 opiates and heroin

Question 1

factors associated with risk of overdose or addiction

Answer 1

long acting or ER formula: overdose  
combo of opioid and benzo: overdose
long term use: overdose, addiction
age > 65: overdose
sleep disordered breathing: overdose 
renal or hepatic impairment: overdose
depression: overdose, addiction
substance use disorder: overdose, addiction
hx of overdose: overdose
adolescence: addiction

Question 2

dx criteria for opioid use disorder

Answer 2

inc. amount or longer than intended use
unable to cut down or control use
excessive time spent to obtain, use, recover
strong desire to use
interference of important obligations
continued use despite problems 
use of opioid in hazardous situation: drive
need for inc. dose for effects
withdrawal s/s with dose decrease

Question 3

naloxone use

Answer 3

opiate or heroin overdose

Question 4

naloxone AE

Answer 4

ventricular arrhythmia 
cardiac arrest
HTN/hypoTN
coma
encephalopathy
seizure
pulmonary edema
opioid withdrawal s/s

Question 5

naloxone administration

Answer 5

intranasal
- Q2-3 min until response or EMT arrival
subQ
IV
IM
- large first pass 
- short half life

Question 6

opioids activate

Answer 6

my opioid receptors located on synaptic nerve terminals

- over time tolerance to euphoric effects occurs

Question 7

opioid withdrawal

Answer 7

enhanced GABA release from inhibitory interneurones results in inhibition of dopamine neurons, dysphoria.

Question 8

naltrexone MOA

Answer 8

partial mu opioid antagonist

- prevents high

Question 9

medical detox 3 steps

Answer 9

1. evaluation: screen and assess
2. stabilization: assisting pt through intoxication and withdrawal, meds may be used,
3. fostering readiness and entry into tx

Question 10

methadone MOA

Answer 10

mu-opioid agonist

Question 11

methadone uses

Answer 11

opioid detox

long-term relapse prevention

Question 12

methadone AE

Answer 12

risk of addiction, misuse/abuse
respiratory depression
QT prolongation, torsades
neonatal opioid withdrawal

Question 13

methadone and preg

Answer 13

risk of fetal harm, but benefits outweigh the risk

Question 14

methadone interactions

Answer 14

CYP450

benzos and other CNS depressants

Question 15

methadone administartion

Answer 15

oral, daily

Question 16

buprenorephine MOA

Answer 16

partial mu receptor agonist

- prevents lower affinity drugs like morphine from binding

Question 17

buprenorephine AE

Answer 17

BB: use with other CNS depressants

• sedation
• respiratory depression
• coma
• death

Question 18

buprenorephine precaution

Answer 18

preg: prolong use in 3rd trimester -> neonatal withdrawal

Question 19

buprenorpherine administration

Answer 19

start 12-48hrs after last opioid: precipitate withdrawal

- prevents high and alleviates cravings

Question 20

buprenorphine/naloxone MOA

Answer 20

sublingual: naloxone inactivated, get full buprenorphine effect
injected: naloxone activated, prevents euphoria effect

Question 21

buprenorphine/naloxone use

Answer 21

detox opioid/heroin

maintenance tx

Question 22

buprenorphine/naloxone AE

Answer 22

precipitate or worsen withdrawal if receptor still occupied

Question 23

cannabis use disorder

Answer 23

significant impairment in function in two or more areas within a 12 month period

Question 24

cannabis behavior effect

Answer 24

anxiety
euphoria
impaired judgement
impaired motor coordination
social withdrawal

Question 25

cannabis physiologic effects

Answer 25

CNS depressant w/out respiratory depression

Question 26

cannabis drug interactions

Answer 26

CYP2C9

CYP3A4

Question 27

cannabis withdrawal s/s

Answer 27

mild
anxiety
depression
irritability
anorexia
nausea
insomnia