Opioids

Question 1

Naloxone: Dosing/ADEs

Answer 1

Dose: 0.4-2mg IM/IV q2-3min till breathing or 0.2mg intranasal
Onset: 2-5min
-recurrant/profound toxicity may require infusion

*Avoid using with TRAMADOL intoxication (seizure risk)

Question 2

Time Course Opioid Withdrawal

Answer 2

Short-Acting: Onset (8-12h), Duration (7-10d)

Long-Acting: Onset (1-3d), weeks

Question 3

Methadone: Dosing

Answer 3

Brand: Dolophine
Dosing: 20-30mg (NTE 40mg on day 1)
Maintenance: 80-120mg/day (indefinitely)
Onset: 24-36hr (within)

Question 4

Methadone: ADEs (6)

Answer 4

QTc Prolongation
**change to buprenorphine

Respiratory depression, constipation, N/V, dizziness, hypotension

Question 5

Methadone: Interactions (5)

Answer 5

• MAOIs (Serotonin syndrome)
• CNS Depressants
• CYP3A4 inducers/inhibitors
• QTc prolonging
• Electrolyte-fluctuating medications

Question 6

Buprenorphine/Naloxone: Dosing + Other

Answer 6

Brand: Suboxone (sublingual)
Dosing:
4mg (NTE 8mg) Day 1 –> 16mg/day max Day 3
Poor absorption –> sublingual film*

Other:
$$$
Requires special MDs + PharmDs

Question 7

Buprenorphine/Naloxone: ADEs + Interactions

Answer 7

ADEs: Headache, insomnia, N/V
Interactions: CYP3A4 + CNS depressants (i.e. benzodiazepines)
**TOXICITY MUCH LESS RISKY vs. METHADONE

Combination with naloxone –> reduce abuse potential