Opioid Use Disorder

Question 1

in what age is the peak for OUD

Answer 1

18-29 (0.82%)

Question 2

what % of those who have OUD experiences ACEs

Answer 2

80%

Question 3

what temperaments are more likely to be susceptible to OUD

Answer 3

those wiht impulsivity and novelty seeking

Question 4

when does OUD usually start

Answer 4

late teens, early 20s

Question 5

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

Answer 5

pupillary dilation

Question 6

how does opioid intoxication present

Answer 6

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

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

Question 7

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

Answer 7

decreased mucous membrane secretion–> dry mouth and nose

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

Question 8

what infections can be associated with OUD

Answer 8

bacterial endocardities

hepatitis

HIV

TB (esp heroin of if have HIV)

Question 9

what is the yearly mortality rate for OUD

Answer 9

1.5-2% per year

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

Question 10

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

Answer 10

50%

Question 11

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

Answer 11

low birth weight seen but not assoc with serious complications

Question 12

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

Answer 12

less likely

Question 13

how do you distinguish opioid withdrawal from other withdrawal syndromes

Answer 13

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

Question 14

what are the most common medical comorbidities with OUD

Answer 14

viral/bacterial infections

Question 15

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

Answer 15

ASPD

Question 16

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

Answer 16

80-90%

Question 17

what other body changes may be seen in OUD

Answer 17

cortisol secretion aptterns

body temp regulation changes

*can last up to 6 months after opioid detox

Question 18

how do you manage opioid overdose

Answer 18

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

Question 19

what is the clinical goal of maintenance therapy for OUD

Answer 19

24 hours with no cravings

Question 20

how does buprenorphine interact with dynorphin

Answer 20

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

Question 21

how much more safe is buprenorphine than methadone

Answer 21

6x safer

Question 22

can you use buprenorphine in renal impairment

Answer 22

yes as eliminated in feces

Question 23

what CYP enzyme metabolizes buprenorphine

Answer 23

3A4

Question 24

above what QTc should you NOT start methadone

Answer 24

600

reconsider if repeated QTc above 500

Question 25

what % of those with OUD achieve long term abstinence

Answer 25

20-30%

Question 26

how many symptoms of opiate withdrawal are listed in the DSM

Answer 26

9

Question 27

how many symptoms do you need to dx opiate withdrawal per the DSM

Answer 27

3+

Question 28

list the 9 symptoms of opiate withdrawal in the DSM

Answer 28

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

Question 29

for short acting opioids, when does withdrawal start, peak and end?

Answer 29

i.e heroin

starts within 6-12 hours

peaks within 1-3 days

subsides over 5-7 days

Question 30

for long acting opioids, when does withdrawal start, peak and end?

Answer 30

may take 2-4 days

Question 31

how long might less acute symptoms of opioid withdrawal last

Answer 31

i.e anxiety, dysphoria, irritability, insomnia

can last weeks to months

Question 32

which symptoms are associated with more severe opioid withdrawal

Answer 32

piloerection, fever

Question 33

what is the goal of acute opioid withdrawal management

Answer 33

manage the cravings

Question 34

how do you manage opioid withdrawal

Answer 34

morphine or hydromorphone liquid

non-opioids:
clonidine
gravol
ibuprofen
tylenol
*may not want to use these as may want to monitor withdrawal symptoms

Question 35

when do you use COWS

Answer 35

to determine readiness to start suboxone