Opioid Dependence Flashcards
what are the three different types of opiates?
natural
semi synthetic
fully synthetic
name two natural opiates
morphine
codeine
name two semi synthetic opiates
hydrocodone
hydromorphone
name two fully synthetic opiates
methadone
tramadol
what rating scale is used to asses symptoms of an opioid withdrawal?
COWS
clinical opiate withdrawal scale
what is ORT?
opioid replacement therapy
what is the main management for opioid dependence?
ORT
what are the four phases of ORT?
induction
optimisation
maintenance
reduction
what is involved in the induction phase of ORT?
identifying need for treatment
starting
what is involved in the optimisation phase of ORT?
finding the right dose for the patient that eliminates opioid use
what is involved in the maintenance phase of ORT?
keep the dose stable til they feel ready to reduce
what is involved in the reduction phase of ORT?
reducing dose of ORT when the patient is ready and stable on maintenance
how long can the maintenance phase of ORT last?
months - years if stable
what are the two main ORT drugs used?
methadone
buprenorphine
what type of drug is methadone?
Mu receptor agonist
when does methadone reach peak plasma concentration?
4 hours
when does methadone reach a steady state?
5 days
how is methadone metabolised?
hepatic
via CY3P4 pathway
how is methadone administered?
liquid preparation
what dose of methadone are patients started on?
30ml
increase by 10ml until reaching 60ml then optimise from there
what type of drug is buprenorphine?
Mu receptor partial agonist
when does buprenorphine reach peak plasma levels?
1.5-2.5 hours
how long does buprenorphine have an effect for?
depends on the dose
what are the effective doses of buprenorphine?
12-24 mg
how is buprenorphine administered?
sublingual tablets
