Opioid Use Disorder

Question 1

What is the DSM5 Criteria?

Answer 1

used to determine if the patient is experiencing opioid use disorder

Question 2

What are the categories of the DSM5?

Answer 2

-Impaired control= cravings and desire
-Social impairment= failure to fulfill obligations, once enjoyable activities are given up
-Risky use= physical hazards to themselves or others
-Tolerance/Withdrawal= increased doses needed, negative symptoms experienced in the absence of substance

Question 3

What are the goals of treatment for opioid use disorder?

Answer 3

-appropriately manage acute symptoms
-successfully initiate maintenance treatment
-sustain/prolong abstinence
-alleviate stigma

Question 4

What are the symptoms of opioid intoxication?

Answer 4

-euphoria followed by depressed mood
-impaired judgement
-slurred speech
-psychomotor agitation or retardation
-drowsiness
-impaired memory and attention
-rarely, but hallucinations

Question 5

What are the symptoms of opioid overdose?

Answer 5

-pinpoint pupils
-blue fingers or mouth (cyanosis)
-paraphernalia near pt (needles, empty pill bottles)
-no pulse or heart beat
-unresponsive to stimuli
-clammy skin

Question 6

What is the use of NALOXONE?

Answer 6

to treat overdose

Question 7

What is the MOA or Naloxone?

Answer 7

pure opioid antagonist to reverse the effects of opioid agonist

Question 8

What is the dosing of Narcan?

Answer 8

4mg/via nostril every 2-3 minutes until EMS arrives

Question 9

What are the symptoms of opioid withdrawal?

Answer 9

-insomnia
-cramping
-N/V/D
-restless leg
-chills and sweating
-musculoskeletal pain
-yawning
-runny nose

Question 10

What can be used to assess a patient in opioid withdrawal?

Answer 10

COWS

Question 11

How long does opioid withdrawal last?

Answer 11

4-10 days

Question 12

What drugs can be used to manage insomnia in opioid withdrawal?

Answer 12

trazodone or diphenhydramine

Question 13

What drugs can be used to manage muscle pain or cramps in opioid withdrawal?

Answer 13

methocarbamol, dicyclomine, acetaminophen, NSAIDs

Question 14

What drugs can be used to manage N/V/D in opioid withdrawal?

Answer 14

anti-emetics, loperamide

Question 15

What drugs can be used to manage autonomic dysfunction in opioid withdrawal?

Answer 15

clonidine

Question 16

What drugs can be used to manage anxiety in opioid withdrawal?

Answer 16

hydroxyzine and haloperinol

Question 17

What is the use of alpha-2 agonists in opioid withdrawal?

Answer 17

alpha-2 agonist, useful with autonomic symptoms (tachycardia, hypertension), anxiety, and sleep, pt may still need other medications for other symptoms

Question 18

What drugs are alpha-2 agonists?

Answer 18

clonidine and lofexidine

Question 19

What is the dosing of clonidine?

Answer 19

scheduled 0.1-0.2 mg every 8-12 hours, but also can be given PRN

Question 20

What us the dosing of lofexidine?

Answer 20

0.54mg QID, max dose= 2.88 mg/day monitor blood pressure

Question 21

What is the advantage of using buprenorphine in opioid withdrawal?

Answer 21

preferred treatment
-MOA= partial opioid agonist
-manages core withdrawal symptoms
-better symptom management and less side effects than clonidine and methadone

Question 22

Describe the use of methadone in opioid use disorder

Answer 22

-MOA: full opioid agonist
-give initial dose and may add additional doses over the next couple hours until symptoms are controlled then may give maintenance dose until tapering
-goals= reduce cravings and minimize withdrawal
-methadone clinics= pt must go in every day for dose
-monitor= EKG and liver function

Question 23

Describe the use of Buprenorphine/Naloxone in opioid use disorder

Answer 23

-MOA= partial mu opioid receptor agonist, weak kappa opioid receptor antagonist (abuse deterrent)
-patients must be experiencing withdrawal symptoms before 1st dose, max dose= 24mg/day (no added benefit over this dose)
-goals= reduce cravings and prevent withdrawal