Opioid Addiction Flashcards
categorization of opioids
natural
semi-synthetic
synthetic
opioid MOA
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
opioid routes of administration
oral IN IV smoking subcutaneous intramuscular trans mucosal transdermal intravenous
opioid w/d sx
Dysphoria Anxiety Cravings Insomnia Nausea Abdominal Cramps Muscle and Joint Aches Muscle twitches Chills/sweats Yawning Runny nose Eyes tearing
opioid w/d signs
Restlessness Tachycardia Mydriasis Vomiting and Diarrhea Myoclonic jerks Low grade temperature Diaphoresis Piloerection Yawning Rhinorrhea Lacrimation
opioids (examples)
heroin (diacetylmorphine) morphine codeine hydrocodone oxycodone oxymorphone hydromorphone methadone fentanyl
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.
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%] estimated decrease in 2018 compared with 2017.
What percentage of opioid-related ODs tested + for fentanyl?
89%
features of the Baker-Polito 2017 plan
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
Most sensitive urine drug test for opioid detection
liquid chromatography-mass spectrometry
physical and imaging evidence of IV drug use
track marks
non-healing ulcer used as injection site
osteomyelitis of ulna
LE petechia (S. aureus endocarditis)
IV drug use co-morbidities
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
IV drug use and HIV statistics
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
Variables effecting opioid w/d experience
Short vs. long-acting (intense/brief w/d vs. less intense/prolonged w/d)
duration of use
dose
individual
medical management of opioid w/d via substitution of agonist w/ taper
methadone
buprenorphine
medical management of opioid w/d via sx attenuation
clonidine (alpha-2-adrenergic agonist, suppresses NE release)
medical management of opioid w/d via antagonist precipitation of w/d
naltrexone
medical management of opioid w/d via sx modulation
- Benzodiazepines
- NSAIDs
- anti-diarrheals
- Antispasmodics
- Stimulation device NSS-2 Bridge
methadone
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
buprenorphine
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
naltrexone
Schedule VI
Office based
Delivery: oral or monthly IM
Higher tx dropout rates
PMP (prescription drug monitoring database) requirements in MA
MD’s are required to access MassPAT before EVERY schedule II and III prescription and before the first benzodiazepine prescription.
Controlled substances scheduling system
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)
signs of opioid OD
stupor --> coma respiratory depression --> arrest bradycardia miosis pale skin --> dusky lips and fingers
opioid OD tx
naloxone:
- opioid antagonist
- intravenous IV, intranasal IN, intramuscular IM
supportive:
- ventilation
- fluids
Supervised Injection Facilities (SIF) are currently being piloted in Massachusetts, T or F?
NO.
US Attorney for Massachusetts issued statement against their implementation in 2018.
Effects of opioids within brain
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
Why is methadone therapeutically useful for w/d?
Methadone takes much longer than other opiate medications to peak and reach its endpoint –> provides relief from cravings and w/d
clonidine
alpha-2 agonist used to tx opioid w/d
suppresses NE release
mediates hyper autonomic signs
