Opioid Use Disorder Flashcards
in what age is the peak for OUD
18-29 (0.82%)
what % of those who have OUD experiences ACEs
80%
what temperaments are more likely to be susceptible to OUD
those wiht impulsivity and novelty seeking
when does OUD usually start
late teens, early 20s
what would you expect someones pupils to look like if they are experiencing severe opioid overdose with anoxia
pupillary dilation
how does opioid intoxication present
behavioural–> initial euphoria then apathy, dysphoria, psychomotor agitation/retardation, impaired judgment
pupillary constriction, drowsiness/coma, slurred speech, impairment in attention/memory
what direct opioid effects are there on the body (i.e effects of opioid use)
decreased mucous membrane secretion–> dry mouth and nose
decrease GI activity, gut motility–> constipation (severe)
what infections can be associated with OUD
bacterial endocardities
hepatitis
HIV
TB (esp heroin of if have HIV)
what is the yearly mortality rate for OUD
1.5-2% per year
–> OD, accidents, injuries, HIV, general medical complications
–> in some places, violence»_space;> OD, HIV
what % of infants born to mothers with OUD will be born with physiological dependence
50%
are there other pregnancy complications for neonates born to moms with OUD
low birth weight seen but not assoc with serious complications
compared to other drugs, are opioids more or less likely to produce symptoms of mental disturbance
less likely
how do you distinguish opioid withdrawal from other withdrawal syndromes
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
what are the most common medical comorbidities with OUD
viral/bacterial infections
what personality disorder is more common in those with OUD than in the general population
ASPD
among IV drug users, what % are positive for hep A/B/C either current or past
80-90%
what other body changes may be seen in OUD
cortisol secretion aptterns
body temp regulation changes
*can last up to 6 months after opioid detox
how do you manage opioid overdose
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
what is the clinical goal of maintenance therapy for OUD
24 hours with no cravings
how does buprenorphine interact with dynorphin
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
how much more safe is buprenorphine than methadone
6x safer
can you use buprenorphine in renal impairment
yes as eliminated in feces
what CYP enzyme metabolizes buprenorphine
3A4
above what QTc should you NOT start methadone
600
reconsider if repeated QTc above 500
what % of those with OUD achieve long term abstinence
20-30%
how many symptoms of opiate withdrawal are listed in the DSM
9
how many symptoms do you need to dx opiate withdrawal per the DSM
3+
list the 9 symptoms of opiate withdrawal in the DSM
- dysphoric mood
- insomnia
- yawning
- N/V
- diarrhea
- lacrimation or rhinorrhea
- pupillary dilation, piloerection, sweating
- fever
- muscle aches
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
for long acting opioids, when does withdrawal start, peak and end?
may take 2-4 days
how long might less acute symptoms of opioid withdrawal last
i.e anxiety, dysphoria, irritability, insomnia
can last weeks to months
which symptoms are associated with more severe opioid withdrawal
piloerection, fever
what is the goal of acute opioid withdrawal management
manage the cravings
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
when do you use COWS
to determine readiness to start suboxone
