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Emma H&N II > Opioid Addiction > Flashcards

Opioid Addiction Flashcards

1
Q

categorization of opioids

A

natural
semi-synthetic
synthetic

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2
Q

opioid MOA

A

agonists of mu opioid receptors (MOP-r)

  • extensive distribution thru CNS
  • analgesic/reward effects
  • G-protein receptor coupled
  • regulates release of DA. NE. GABA, glutamate, substance P
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3
Q

opioid routes of administration

A 
oral
IN
IV
smoking
subcutaneous
intramuscular
trans mucosal
transdermal
intravenous
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4
Q

opioid w/d sx

A 
Dysphoria
Anxiety 
Cravings
Insomnia
Nausea
Abdominal Cramps
Muscle and Joint Aches
Muscle twitches
Chills/sweats
Yawning
Runny nose
Eyes tearing
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5
Q

opioid w/d signs

A 
Restlessness
Tachycardia
Mydriasis
Vomiting and Diarrhea
Myoclonic jerks
Low grade temperature
Diaphoresis
Piloerection
Yawning
Rhinorrhea
Lacrimation
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6
Q

opioids (examples)

A 
heroin (diacetylmorphine)
morphine
codeine
hydrocodone
oxycodone
oxymorphone
hydromorphone
methadone
fentanyl
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7
Q

In opioid related deaths, there was an estimated _________ in the number of opioid-related overdose deaths in 2017 compared with 2016, followed by another __ estimated decrease in 2018 compared with 2017.

A

In opioid related deaths, there was an estimated [2% DECREASE] in the number of opioid-related overdose deaths in 2017 compared with 2016, followed by another [4% DECREASE] estimated decrease in 2018 compared with 2017.

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8
Q

What percentage of 2018 opioid-related ODs tested + for fentanyl?

A

89%

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9
Q

features of the Baker-Polito 2017 plan

A

Inc access to acute/chronic tx

  • expand residential facilities
  • add recovery coaches
  • ER req for OD pts

Improve education and prevention

  • schedule II electronic rx mandate
  • COMMISION TO REVIEW APPROPRIATE RX PRACTICES/EXPLORE OPTIONS LIKE BLISTER PACKS

Petition the federal gov to provide specific mechanisms on

  • naloxone OTC
  • pt limits for buprenorphine prescribers
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10
Q

Most sensitive urine drug test for opioid detection

A

liquid chromatography-mass spectrometry

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11
Q

physical and imaging evidence of IV drug use

A

track marks
non-healing ulcer used as injection site
osteomyelitis of ulna
LE petechia (S. aureus endocarditis)

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12
Q

IV drug use co-morbidities

A 
Abscess 
Cellulitis
Thrombophlebitis
Deep Vein Thrombosis
Venous ulcer
Necrotizing fasciitis                                        	
Pyomyositis
Septic emboli
Bacterial endocarditis, Staph aureus
Osteomyelitis
Septic arthritis
Brain abscess
Pulmonary abscess, granulomas
Fungal infections
Hepatitis B and C
HIV
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13
Q

IV drug use and HIV statistics

A

2017: for all HIV infections reported, IV drug users represented 14% of total

Over past 5-10 years, IV drug users represented 4-8% of total reported newly diagnosed HIV infections

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14
Q

Variables effecting opioid w/d experience

A

Short vs. long-acting (intense/brief w/d vs. less intense/prolonged w/d)

duration of use

dose

individual

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15
Q

medical management of opioid w/d via substitution of agonist w/ taper

A

methadone

buprenorphine

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16
Q

medical management of opioid w/d via sx attenuation

A

clonidine (alpha-2-adrenergic agonist, suppresses NE release)

17
Q

medical management of opioid w/d via antagonist precipitation of w/d

A

naltrexone

18
Q

medical management of opioid w/d via sx modulation

A
  • Benzodiazepines
  • NSAIDs
  • anti-diarrheals
  • Antispasmodics
  • Stimulation device NSS-2 Bridge
19
Q

methadone

A

Schedule II full agonist opioid

Opioid Treatment Program (OTP) federally licensed clinics; does not show up on PMP

Drug delivery system: Daily oral outpatient dosing (liquid preparation) and monitoring

On-site behavioral health therapy

20
Q

buprenorphine

A

Schedule III partial agonist opioid; allows for 30 day prescription with refills x5
Office based
MD (NP/PA) prescribers c DEA waiver

delivery:
transmucosal
buccal film
subdermal implant
subQ injection
21
Q

naltrexone

A

Schedule VI
Office based
Delivery: oral or monthly IM
Higher tx dropout rates

22
Q

PMP (prescription drug monitoring database) requirements in MA

A

MD’s are required to access MassPAT before EVERY schedule II and III prescription and before the first benzodiazepine prescription.

23
Q

Controlled substances scheduling system

A

Schedule I – high potential for abuse; no accepted medical use (eg, heroin)

Schedule II – high potential for abuse; currently accepted medical use (eg, morphine, methadone)

Schedule III-V
Lesser potential for abuse (buprenorphine)

Schedule VI
All other prescription drugs (naltrexone)

24
Q

signs of opioid OD

A 
stupor --> coma
respiratory depression --> arrest
bradycardia
miosis
pale skin --> dusky lips and fingers
25
Q

opioid OD tx

A

naloxone:
- opioid antagonist
- intravenous IV, intranasal IN, intramuscular IM

supportive:

  • ventilation
  • fluids
26
Q

Supervised Injection Facilities (SIF) are currently being piloted in Massachusetts, T or F?

A

NO.

US Attorney for Massachusetts issued statement against their implementation in 2018.

27
Q

Effects of opioids within brain

A

The Mesolimbic Pathway: projections VTA of the midbrain to NA.

VTA neurons synthesize Dopamine (DA).

Drug (opioid)-Receptor (MOR) interaction causes inhibition of GABAergic neurons and activates DA release from neurons extending into NA –> pleasurable feeling

28
Q

Why is methadone therapeutically useful for w/d?

A

Methadone takes much longer than other opiate medications to peak and reach its endpoint –> provides relief from cravings and w/d

29
Q

clonidine

A

alpha-2 agonist used to tx opioid w/d
suppresses NE release
mediates hyper autonomic signs

Emma H&N II (49 decks)

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