Opioid Use Disorder Flashcards

1
Q

in what age is the peak for OUD

A

18-29 (0.82%)

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2
Q

what % of those who have OUD experiences ACEs

A

80%

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3
Q

what temperaments are more likely to be susceptible to OUD

A

those wiht impulsivity and novelty seeking

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4
Q

when does OUD usually start

A

late teens, early 20s

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5
Q

what would you expect someones pupils to look like if they are experiencing severe opioid overdose with anoxia

A

pupillary dilation

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6
Q

how does opioid intoxication present

A

behavioural–> initial euphoria then apathy, dysphoria, psychomotor agitation/retardation, impaired judgment

pupillary constriction, drowsiness/coma, slurred speech, impairment in attention/memory

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7
Q

what direct opioid effects are there on the body (i.e effects of opioid use)

A

decreased mucous membrane secretion–> dry mouth and nose

decrease GI activity, gut motility–> constipation (severe)

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8
Q

what infections can be associated with OUD

A

bacterial endocardities

hepatitis

HIV

TB (esp heroin of if have HIV)

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9
Q

what is the yearly mortality rate for OUD

A

1.5-2% per year

–> OD, accidents, injuries, HIV, general medical complications
–> in some places, violence&raquo_space;> OD, HIV

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10
Q

what % of infants born to mothers with OUD will be born with physiological dependence

A

50%

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11
Q

are there other pregnancy complications for neonates born to moms with OUD

A

low birth weight seen but not assoc with serious complications

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12
Q

compared to other drugs, are opioids more or less likely to produce symptoms of mental disturbance

A

less likely

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13
Q

how do you distinguish opioid withdrawal from other withdrawal syndromes

A

sedative/hypnotic withdrawal does not have rhinorrhea, pupil dilation, lacrimation

hallucinogen, stimulant withdrawal DOES have dilated pupils but no N/V, diarrhea, abdo cramps, rhinorrhea, lacrimation

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14
Q

what are the most common medical comorbidities with OUD

A

viral/bacterial infections

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15
Q

what personality disorder is more common in those with OUD than in the general population

A

ASPD

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16
Q

among IV drug users, what % are positive for hep A/B/C either current or past

17
Q

what other body changes may be seen in OUD

A

cortisol secretion aptterns

body temp regulation changes

*can last up to 6 months after opioid detox

18
Q

how do you manage opioid overdose

A

naloxone IM or subQ

2mg as single dose and can repeat every 2-3 min until ER assistance becomes available

at 10min, consider other causes of reduced LOC

19
Q

what is the clinical goal of maintenance therapy for OUD

A

24 hours with no cravings

20
Q

how does buprenorphine interact with dynorphin

A

dynorphin is the endogenous neurotransmitter at the Kappa receptor, and is upregulated during negative affect stage of addiction

buprenorphine is a Kappa receptor antagonist–> unclear significance however maybe it blocks dynorphin from acting on the receptor and prevents negative emotions once allostatic set point changes

21
Q

how much more safe is buprenorphine than methadone

22
Q

can you use buprenorphine in renal impairment

A

yes as eliminated in feces

23
Q

what CYP enzyme metabolizes buprenorphine

24
Q

above what QTc should you NOT start methadone

A

600

reconsider if repeated QTc above 500

25
what % of those with OUD achieve long term abstinence
20-30%
26
how many symptoms of opiate withdrawal are listed in the DSM
9
27
how many symptoms do you need to dx opiate withdrawal per the DSM
3+
28
list the 9 symptoms of opiate withdrawal in the DSM
1. dysphoric mood 2. insomnia 3. yawning 4. N/V 5. diarrhea 6. lacrimation or rhinorrhea 7. pupillary dilation, piloerection, sweating 8. fever 9. muscle aches
29
for short acting opioids, when does withdrawal start, peak and end?
i.e heroin starts within 6-12 hours peaks within 1-3 days subsides over 5-7 days
30
for long acting opioids, when does withdrawal start, peak and end?
may take 2-4 days
31
how long might less acute symptoms of opioid withdrawal last
i.e anxiety, dysphoria, irritability, insomnia can last weeks to months
32
which symptoms are associated with more severe opioid withdrawal
piloerection, fever
33
what is the goal of acute opioid withdrawal management
manage the cravings
34
how do you manage opioid withdrawal
morphine or hydromorphone liquid non-opioids: clonidine gravol ibuprofen tylenol *may not want to use these as may want to monitor withdrawal symptoms
35
when do you use COWS
to determine readiness to start suboxone