Opiods and MAT Flashcards
When need to check MassPat
required to check EVERY time a schedule II or III narcotic or a benzodiazepine are prescribed
Whether risk of opioid overdose is higher or lower with extended-release opioids
Risk of OD higher with extended release opioids, immediate release should be used when beginning treatment, there is no evidence that extended release are more effective
Delta:
Diffusely found in the brain and spinal cord
◦ Weaker analgesic effect but also fewer side effects such as respiratory depression
◦ Can have some mood related effects including dysphoria, delusions, hallucinations
kappa
Dorsal horn of spinal cord and brain stem ◦ Analgesia, miosis, sedation
Mu
main target
◦Located at supraspinal and spinal sites and the gut
◦ Analgesia and respiratory depression
◦ Mioisis (oculomotor nerve), euphoria, reduced g.i. motility
Schedule I
heroin & marijuana
shedule II
Oxycodone – mu, kappa, delta receptors
Hydrocodone- mu
Fentanyl- mu receptor
Methadone – mu receptor
Adderall
Schedule III
Codeine (Scheduled III or V depending on dose) - mu selective
schedule IV
Tramadol – mu receptors
How to calculate MMEs
1). determine total daily amount of each opioid the patient takes
2). Convert each to MMEs-multiply the dose for each opioid by the conversion factor (see table)
3). Add them together
Recommendations for tapering opioids
◦ Consider tapering if:
◦ No meaningful improvement in pain and function
◦ Doses > 50 MME/day
◦ Signs of substance use disorder
◦ Overdose/serious adverse effects
◦ How to taper
◦ Goal: minimize withdrawal symptoms
◦ If on opioids >1 year – decrease by 10% per month
◦ If <1 year could consider decrease by 10% per week
◦ Monitor patient’s response and adjust accordingly
◦ Optimize non-opioid pain management and psychosocial support
◦ Discuss risk for overdose if abrupt return to higher dosages
◦ Monitor for signs of depression, anxiety and opioid use disorder
What naltrexone does
Opiod antagonist meaning it binds to opioid receptors but doesn’t activate them. This prevents other opioids from producing a high
Reduces cravings and helps prevent relapse after detox
Can precipitate withdrawal if taken too soon after opioid use so person must be opioid free for 7-10 days before starting it
Which drugs used to treat substance abuse disorder have the greatest risk for overdose
Methadone due to long/ variable half life
Which medication is an opioid antagonist
naltrexone
When start naltrexone how long should patient be opioid free before you initiate treatment
recommends that patients be
opioid-free followed by a wait-period
of 7-10 days before treatment can be
initiated, to avoid precipitated withdrawal
Buprenorphine bioavailability percent after the significant first pass metabolism what that results in the oral bioavailability of that drug (percentage)
Oral bioavailability<5%
