Opioid Use Disorder Flashcards
What is the DSM5 Criteria?
used to determine if the patient is experiencing opioid use disorder
What are the categories of the DSM5?
-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
What are the goals of treatment for opioid use disorder?
-appropriately manage acute symptoms
-successfully initiate maintenance treatment
-sustain/prolong abstinence
-alleviate stigma
What are the symptoms of opioid intoxication?
-euphoria followed by depressed mood
-impaired judgement
-slurred speech
-psychomotor agitation or retardation
-drowsiness
-impaired memory and attention
-rarely, but hallucinations
What are the symptoms of opioid overdose?
-pinpoint pupils
-blue fingers or mouth (cyanosis)
-paraphernalia near pt (needles, empty pill bottles)
-no pulse or heart beat
-unresponsive to stimuli
-clammy skin
What is the use of NALOXONE?
to treat overdose
What is the MOA or Naloxone?
pure opioid antagonist to reverse the effects of opioid agonist
What is the dosing of Narcan?
4mg/via nostril every 2-3 minutes until EMS arrives
What are the symptoms of opioid withdrawal?
-insomnia
-cramping
-N/V/D
-restless leg
-chills and sweating
-musculoskeletal pain
-yawning
-runny nose
What can be used to assess a patient in opioid withdrawal?
COWS
How long does opioid withdrawal last?
4-10 days
What drugs can be used to manage insomnia in opioid withdrawal?
trazodone or diphenhydramine
What drugs can be used to manage muscle pain or cramps in opioid withdrawal?
methocarbamol, dicyclomine, acetaminophen, NSAIDs
What drugs can be used to manage N/V/D in opioid withdrawal?
anti-emetics, loperamide
What drugs can be used to manage autonomic dysfunction in opioid withdrawal?
clonidine
What drugs can be used to manage anxiety in opioid withdrawal?
hydroxyzine and haloperinol
What is the use of alpha-2 agonists in opioid withdrawal?
alpha-2 agonist, useful with autonomic symptoms (tachycardia, hypertension), anxiety, and sleep, pt may still need other medications for other symptoms
What drugs are alpha-2 agonists?
clonidine and lofexidine
What is the dosing of clonidine?
scheduled 0.1-0.2 mg every 8-12 hours, but also can be given PRN
What us the dosing of lofexidine?
0.54mg QID, max dose= 2.88 mg/day monitor blood pressure
What is the advantage of using buprenorphine in opioid withdrawal?
preferred treatment
-MOA= partial opioid agonist
-manages core withdrawal symptoms
-better symptom management and less side effects than clonidine and methadone
Describe the use of methadone in opioid use disorder
-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
Describe the use of Buprenorphine/Naloxone in opioid use disorder
-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
