Opioid use disorder Flashcards
Maintenance treatment
Buprenorphine
Methadone
Naltrexone
Overdose treatment
Naloxone
Short term effects of opioid use
Analgesia
Euphoria
Sedation
Respiratory depression
Death
Long term effects of opioid use
Tolerance
Dependence
Addiction
Reduced analgesia or hyperalgesia
Low testosterone
Constipation
Sedation
Respiratory depression
Death
Endocarditis (d/t IV use)
Cellulitis (d/t IV/SQ use)
Osteomyelitis (d/t IV/SQ use)
Withdrawal sx of opioid use
Restlessness
MS pain
Insomnia
N/V/D
Gooseflesh
Autonomic dysfunction
Dopamine D2 receptors are ___in addiction
lower
Methadone MOA
Full agonist at the mu opioid receptor (MOR)
Long acting
Maintains tolerance, reduces cravings
Opioid treatment programs (OTP)
Methadone requires enrollment in registered clinic
Methadone clinical action
Reduce/eliminate withdrawal symptoms
Blunt/block effects of other opioids
Reduce/eliminate cravings
Methadone dosing
10-30 mg starting dose
monitor 2-4 hours
titrate (weeks 1-2) 5 mg every 5+ days
(weeks 3-4) 5 mg every 3-5 days
(week 5+) dose stabilization
Methadone advantages
No lag to start time
Treats co-morbid pain
Long half-life (~24-55 hours)
Treatment retention
Methadone disadvantages
OTP structure
Adverse effects (no ceiling)
Changes to CYP2D6
Drug-drug interactions
Age-related changes
Methadone considerations
1st line treatment
Analgesia & euphoria last 6-8 hours; can lead to “dose stacking” and possibly overdose
Once daily
Buprenorphine MOA
Partial agonist at the mu opioid receptor (MOR)
Buprenorphine clinical action
Reduce/eliminate withdrawal symptoms
Blunt/block effects of other opioids
Reduce/eliminate cravings
Buprenorphine dosing
Requires induction (SL formulation)
2-4 mg, wait 2 hours
maximum of 8 mg day 1, 16 mg day 2
Buprenorphine subcutaneous injection
Must take 8-24mg SL buprenorphine x7 days
Buprenorphine transdermal implant
Must take <8mg SL buprenorphine x3 months
Buprenorphine education points
products not equivalent
take dose at regular intervals
do not swallow SL tabs or film
Sublingual tablets counseling
Place tablets under tongue and allow the tablet to fully dissolve which can take several minutes.
If your dose requires multiple tablets, all tablets can be placed under the tongue at one time. If this is uncomfortable, only place two tablets under the tongue at a time.
Sl film education
Drink water prior to placing the film to help the film dissolve easily.
Place film under the tongue, to the left or right of the center of the tongue, and allow to completely dissolve
If you are prescribed 2 films at a time, place the second film on the opposite side of the tongue. Do not allow the films to touch.
If you are prescribed more than 2 films at a time, wait until previous films have dissolved and repeat the process.
buccal film counseling
Wet the inside of your cheek with your tongue or rinse with water prior to placing film.
Hold the film by the edges with two fingers and place on inside of cheek until fully dissolved that can take up to 30 minutes.
If you are prescribed two films, place the second film inside the opposite cheek.
Do not adjust the film placement or touch the film, do not chew or swallow the film.
Do not drink or eat until the film has completely dissolved.
Buprenorphine advanatges
Ceiling effect
Treats co-morbid pain
Treatment retention
Long-acting products
Buprenorphine disadvanatges
Dosed multiple times per day?
Requires induction
Precipitated withdrawal?
