Opiate Abuse, MacIntyre

Question 1

how many people die everyday from opioid OD

Answer 1

44

Question 2

which drug is on the rise in OD

Answer 2

heroin

Question 3

leading cause injury death in 2013

Answer 3

drug OD

Question 4

deadly combo of drugs

Answer 4

benzos and opioid painkillers

Question 5

routes of opium

Answer 5

PO, IV, skin pop, snort, smoke

Question 6

most popular Rx opioids

Answer 6

OxyContin:oxycodone
Vicodin: hydrocodone/acetaminophen
Percocet: oxycodone acetaminophen

Question 7

Sx of Rx opioids

Answer 7

euphoria, sedation
constricted pupils
slurred speech
impaired coordination
dec BP HR and rspiratory depression

Question 8

other names for heroin

Answer 8

horse, dope, H, junk, smack

Question 9

how is heroin used

Answer 9

IV IM snorted skin popping

Question 10

Sx heroin

Answer 10

euphoria, sedation, constricted pupils, impaired coordination, can cause dec BP HR, respiratory depression

Question 11

IV use heroin inc risk for

Answer 11

HIV
HCV
HBV
cellulitis
sepsis
bacterial
endocarditis

Question 12

Street heroin cut with

Answer 12

sometimes fentanyl, barbs, household powders… etc

Question 13

intoxication Sx of heroin

Answer 13

pupillary constriciton
flushing
sedation
slurred speech
bradycardia
hypotension
resp depression
hypothermia
constipation

Question 14

withdrawal Sx of heroin

Answer 14

pupillary dilation
piloerection
nausea
vomiting
diarrhea
lacrimation
rhinorrhea
joint/muscle pain
abdominal cramps
yawning

Question 15

withdrawal heroin peaks

Answer 15

3-4 days

can continue for weeks to months

Question 16

if patient has co morbid respiratory conditions

Answer 16

avoid opiate use, at least reduce dose

Question 17

naloxone

Answer 17

reverse opiate OD

shown in like epi pen format or intranasal

Question 18

first step Tx for opioid abuse

Answer 18

detox

Question 19

types of detox

Answer 19

cold turkey
methadone and wean
buprenorphine
supportive meds for withdrawal Sx
clonidine for mild withdrawal or as adjunct

Question 20

after detox

Answer 20

need to transition to maintenance Tx else at high risk of relapse

Question 21

synthetic opioid

Answer 21

methadone

Question 22

pros methadone

Answer 22

safety
safe in pregnancy
intoxicating effects less euphoric
can take at home

Question 23

cons to methadone

Answer 23

cant leave clinic vicinity for a day
prolong QT
multiple DDI
use restricted

Question 24

What is LAAM

Answer 24

levo alpha acetylmethadol

similar to methadone but less dosing

Question 25

buprenorphine

Answer 25

high affinity for opioid R mu and kappa

Question 26

Side effects buprenorphine

Answer 26

nausea and vomiting

Question 27

buprenorphine abuse

Answer 27

IV

can be fatal

Question 28

what is suboxone

Answer 28

buprenorphine/naloxone

Question 29

MOA buprenorphine

Answer 29

partial agonist, quick onset, prevents binding to other opiates

Question 30

how is subloxone laken

Answer 30

sublingually

Question 31

what happens with crushed or injected suboxone

Answer 31

patient goes into withdrawal

Question 32

naltrexone

Answer 32

synthetic opiate antagonist

Question 33

warnings with naltrexone

Answer 33

hepatotoxic

Question 34

when giving naltrexone must require patient to carry

Answer 34

alert card notifying medical personnel that they are on opiate antagonist and higher doses may be needed to overcome blockade