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445- Pain and Mental Health > Opioid Use Disorder > Flashcards

Opioid Use Disorder Flashcards

1
Q

define opioid use disorder

A

problematic pattern of opioid use that leads to clinically significant impairment or distress
has to have at least 2 of the designated criteria, occurring within a 12mth period

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2
Q

list 3 characteristics of OUD

A

taking opioids in larger amounts/ longer time
significant amount of time spent trying to get them
cravings
persistent desire or unsuccessful efforts to get them
not doing major role obligations due to use
giving up social, occupational, or rec activities
continued despite persistent/ recurrent social/ interpersonal problems caused by opioids
continued despite knowing that it is a physical/ psyc problem
use in situations where it is physically hazardous
tolerance
withdrawal

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3
Q

define tolerance

A

needing increased amounts to achieve desired effect
diminished effect with continued use of same amount of opioid

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4
Q

define withdrawal

A

characteristic opioid withdrawal sx or
using the same or a closely related substance to relieve/ avoid sx

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5
Q

why is opioid withdrawal dangerous

A

tolerance may be lost rapidly (days) and when pt relapses and uses same amount as before, they can OD

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6
Q

describe some reinforcing effects of opioids

A

pain relief (analgesia), euphoria, warmth, numbness, relief of anxiety (anxiolytic)

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7
Q

describe some AEs of opioids

A

constipation, dry mouth, hypogonadism, weight gain, CNS/ respiratory depression

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8
Q

list 3 sx of withdrawal

A

Rapid HR
Sweating
Restlessness
Dilated pupils
Aches (bone/ joints)
Runny eyes and nose
Upset stomach
Tremor
Yawning
Irritability
Anxiety
Goosebumps

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9
Q

list 3 sx of OD

A

cyanosis, dizziness and confusion, can’t be woken up, choking/ gurgling/ snoring sounds, slow/ weak/ no breathing, drowsiness or difficulty staying awake

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10
Q

what to do if you suspect an OD

A

call 911, admin naloxone, stay with person until help arrives

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11
Q

how does naloxone work to prevent OD

A

rapidly reverses CNS and respiratory depression secondary to opioids by competitively booting opioids out of receptors + binding to them instead as an antagonist

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12
Q

naloxone IM onset

A

2-3min

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13
Q

currently, nasal naloxone spray kits are covered for pts with

A

NIHB coverage

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14
Q

when should a second dose of naloxone be administered?

A

if the person has not responded within 2-3 minutes

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15
Q

what tx is the lowest intensity for OUD

A

withdrawal management

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16
Q

what is the gold standard for OUD tx

A

agonist therapies

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17
Q

what are the 2 agonist therapies for OUD

A

buprenorphine/ naloxone or methadone

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18
Q

when should harm reduction be offered in OUD

A

at all stages of the treatment intensiyt spectrum

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19
Q

what is the main downside to withdrawal management for OUD

A

risk of relapse after losing tolerance, resulting in increased mortality

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20
Q

list the 3 advantages of OAT over withdrawal management

A

↑ treatment retention, substance abstinence than illicit opioids, ↓ risk of morbidity/ mortality

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21
Q

buprenorphine MOA

A

Partial mu opioid receptor agonist with high binding affinity, antagonist at kappa receptor
very strong binding affinity

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22
Q

what are the 4 advantages of buprenorphine’s strong binding affinity

A

Good at blocking effect of other opioids = ↓ euphoria from illicit substances, important to consider when managing acute pain (↓ pain control)
Slow dissociation = long relief of withdrawal sx (can miss up to 5 consecutive days before reinitiation required)
Ceiling effect for respiratory depression
standard doses are well below legal threshold for those that are opioid naive

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23
Q

what is the major con of buprenorphine/ naloxone

A

will have precipitated withdrawal if used too soon after last full agonist dose

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24
Q

which is the preferred tx option now? suboxone or methadone

A

suboxone

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25
Q

how is suboxone administered

A

dissolved sublingually, then swallowed

26
Q

suboxone…
1. is absorbed SL
2. is made in noncrushable tablets
3. is an orally absorbed substance
4. has naloxone, which is responsible for the withdrawal effect

A

3

27
Q

why is naloxone present in suboxone

A

to prevent diversion by injection
is not absorbed PO if the tablet is taken appropriately, but will be absorbed if crushed and injected = unpleasant effects

28
Q

how is suboxone induction done? what are the 2 options?

A

pt must be in mod withdrawal (COWs scale) during clinical induction, or can do a microinduction to avoid waiting until mod withdrawal
may get to max tolerated dose in 24-72hrs

29
Q

how soon can suboxone be tolerated to max tolerated dose

A

24-72hrs

30
Q

can patients use illicit opioids during microinduction with suboxone?

A

yes

31
Q

what are 2 other formulations of buprenorphine

A

probuphine and sublocade

32
Q

what is probuphine

A

a buprenorphine subdermal implant

33
Q

who is probuphine indicated for

A

for pts with OUD that are clinically stabilized on no more than 8mg of SL buprenorphine for the last 90 days

34
Q

what is sublocade

A

a buprenorphine ER injection

35
Q

sublocade is indicated for pts who

A

have been stabilized on an eq of 8-24mg SL per day for min 7 d

36
Q

what are some cons for sublocade

A

very aggressive dosing
may have a visible depot after injection

37
Q

methadone MOA

A

full mu opioid agonist with slow onset of action

38
Q

methadone peaks at

A

2-4hrs

39
Q

methadone does not
1. have a long half life
2. have a slow onset
3. have a max dose
4. have the most evidence for use in pregnancy

A

3

40
Q

why must methadone doses be titrated slowly?

A

because of the long half life- to avoid risk of accumulation

41
Q

T or F: methadone for OUD is also effective for acute pain in dependent pts

A

F- will also need short acting agent in addition

42
Q

which OAT has the most evidence in pregnancy?
1. methadone
2. buprenorphine
3. buprenorphine/ naloxone
4. none of the above

A

1

43
Q

studies show that methadone has efficacy for 5 things

A

decreased drug use
decreased transmission of HIV and Hep C
decreased criminal activity
decreased OD and premature mortality
increased tx retention

44
Q

methadone dose is typically increased by __ q___d

A

by 10mg q3d

45
Q

how is methadone formulated for OAT
1. tablets SL
2. tablets PO
3. liquids PO
4. injection

A
  1. dispensed in juice and diluted to 100mL to minimize risk of diversion + improve taste
    tablets not usually used for OAT
46
Q

list the 6 cons for methadone OAT

A

delayed sedation
slow to achieve therapeutic dose due to longer titration time
more potential for interactions
high risk for OD
risk for serious SEs
loss of tolerance occurs quickly

47
Q

which one can be titrated to max dose the fastest? which has a higher risk of OD?
1. methadone
2. buprenorphine/ naloxone

A

2, 1

48
Q

methadone can cause ____ or _____ with other agents

A

respiratory depression or QT interval prolongation

49
Q

what are some more serious SEs of methadone

A

CNS depression, constipation, sweating, hypogonadism, weight gain, dental concerns

50
Q

how soon does loss of tolerance to methadone happen?

A

3 days
if last dose was >3 days, must decrease dose

51
Q

what is a monitoring parameter specific to methadone

A

ECG

52
Q

when should ECG monitoring with methadone be done

A

baseline, then within 30 d of initiation, then if dose ≥ 100mg + thereafter at every dose that meets/ exceeds multiples of 20 mg

if pt experiences unexplained syncope, seizures, or other sx suggesting cardiac involvement

if pt is initiated on a med that causes QTc prolongation

53
Q

purpose of urine drug screening with OAT

A

Confirms reports of substance use
Identify presence of concerning substances
Monitor for tx efficacy and adherence

54
Q

what are some specialist led tx options for OUD?

A

slow release oral morphine (SROM)
injectable opioid agonist treatment (IOAT)

55
Q

SROM is the preferred option for

A

those who have not stabilized on or have have CI to preferred tx options

56
Q

data suggests that SROM is better than MMT for (3 things)

A

pt satisfaction
decreasing cravings
decreasing sx of persistent mild depression

57
Q

what is the only formulation studied for SROM

A

kadian (24hr morphine product)

58
Q

how is kadian usually used for OAT

A

Typically once daily as OAT as witnessed PO
Requires diligent measures to avoid diversion + mitigate risk of OD
Capsules are opened into med cup, ingestion of beads witnessed (sometimes mixed with pizza)
Can not crush or chew pellets

59
Q

how is IOAT done?

A

Pts self administer prefilled syringes of hydromorphone IV/IM up to TID in supervised setting

60
Q

which of the following is false
1. opioids can be used safely in pts with hx of OUD but should be carefully monitoring
2. OAT does not treat acute pain
3. nonopioid pharmacotherapy should not be included
4. undertreated acute pain is a RF for returning/ ongoing opioid use

A

3- nonopioid should be included

445- Pain and Mental Health (21 decks)

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