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Therapeutics (Fall 2024) > OUD (Background, Overdose, Withdrawal Management) > Flashcards

OUD (Background, Overdose, Withdrawal Management) Flashcards

1
Q

What are the differences between opioids and opiates?

A

Opiates are the naturally derived from poppy,

Opioids inlcude both the definition of natural and synthetic

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2
Q

What is an opioid?

A

Class of drugs that can provided illicitly or prescribed and acts as depressants

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3
Q

What may opioids be used for?

A

Reduce pain
Manage opioid dependence
Produce temporary uophoria/relaxation

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4
Q

What are the main opioid receptors?

A

Mu
Delta
Kappa

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5
Q

What is the Mu receptor responsible for?

A

responsible for most of the opioid analgesic effect

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6
Q

What are the effects of the Mu receptor? (5)

A

respiratory depression, reduced GI motility, euphoria, physical dependence, sedation

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7
Q

What are the effects of the delta recepotr?

A

analgesia, euphoria, physical dependence`

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8
Q

What are the effects of the kappa receptor

A

analgesia, sedation, ? mood, does NOT contribute to physical dependence

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9
Q

What is the OUD definition?

A

primary chronic disease of brain reward, motivation,
memory, and related circuitry with a “dysfunction in
these circuits” being reflected in “an individual
pathologically pursing reward and/or relief of
withdrawal symptoms by substance use and other
behaviors”

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10
Q

What was OUD formerly classified as?

A

opioid “dependence”,
“addiction”, “misuse”, “abuse”

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11
Q

What is OUD?

A

Long-lasting chronic brain disease

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12
Q

What can OUD involve?

A

misuse of prescribed opioid medications, use of
diverted opioid medications, use of illicitly obtained opioids

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13
Q

OUD is a ___ condition

A

relapsing

Occurs in cycles of drug use, reduce use/ abstinence, relapse

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14
Q

What does OUD treatemtn require?

A

Long-term chonric disease management

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15
Q

OUD ____ end when the drug is removed from the
body or when acute post-drug taking illness dissipates

A

DOES NOT

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16
Q

What is OUD similar to?

A

T2DM and HTN in which it cannot be cured but can be treated and managed

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17
Q

OUD is associated with ___ morbidity and mortality

A

Increased

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18
Q

What has OUD been associated with increasing the rates of?

A

HIV, Hepatitis, and STDs

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19
Q

what is the apparent opioid toxicity related deaths in Canada in 2023?

A

Just over 8000

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20
Q

What is the Opioid related poisoning emergency visits in Canada in 2023?

A

28345

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21
Q

What are the opioid related poisoning hospitalization in canada?

A

6312

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22
Q

What are the opioid related emergency medical service response to suspected opioid related overdoses?

A

41938

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23
Q

What is the cycle of OUD?

A
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24
Q

What are the 3 stages of addiction of OUD?

A

Binge/Intoxication
Withdrawal/negative affect
preoccupation/anticipation

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25
Q

What is the binge/intoxication stage description?

A

individual consumes an
intoxicating substance and experiences its
rewarding or pleasurable effects

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26
Q

What is the Withdrawal/negative affect description?

A

individual experiences a negative emotional state in the
absence of the substance

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27
Q

What is the preoccupation/anticipation description?

A

Individual seeks substance again after a period of abstinence

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28
Q

How often does someone go through the three stage cycle?

A

over the course of
weeks or months or progress through it several times in a day.

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29
Q

How many regions of the brain do the stages of OUD go through?

A

many different brain regions, circuits, NTs, and result in changes in the brain

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30
Q

The addiction cycle tends to ___ over time ___

A

Intensify, leading to greater
physical and psychological harm.

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31
Q

When an opioid attaches to the mu receptor it triggers a ___ in the brain called the ___

A

structure, mesolimbic midbrain,

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32
Q

The Mesolimbic midbrain is triggered my mu receptors.

The midbrain is a reward system in the ___

A

ventral tegmental area (VTA)

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33
Q

The Ventral segmental area is responsible for the release of ___ in the nucleus accumbens in the ___

A

Dopamine, basal ganglia

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34
Q

Release of dopamine in the nucleus accumbens =

A

pleasure

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35
Q

Over time with repeated opioid use and the feedback to the prefrontal cortex to the vta this feedback path becomes

A

dysregultated

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36
Q

When taken ___ opioids trigger the brain’s reward
system driving a compulsion to take the drug again and
again

A

repeatedly

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37
Q

opioid receptors in the ___ become ___ sensitive to opioid stimulation

A

VTA, less

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38
Q

Dopamine production is ___ and the experience of pleasure/opioid effect is ___

A

decreased, diminished

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39
Q

Where is dopamine production?

A

VTA or ventral tegmental area

40
Q

In addition to the changes in the VTA feedback pathway, OID results in changes in the

A

Locus coeruleus

41
Q

Neurons in the LC produce

A

Noradrenaline

42
Q

What does noraderenaline do?

A

Distribute it to other parts of the brain where it stimulates wakefulness, breathing, blood, pressure, alertness, etc

43
Q

When opioids bind the mu receptors in the LC they suppress the release of noradrenaline leading to

A

drowsiness, slowed respiration, low blood
pressure → opioid intoxication

44
Q

What is naloxone?

A

Binds the same sites as opioids in the brain more tightly
– Displaces opioid
– Antagonist at receptor

45
Q

What are the effects of naloxone?

A

Restores breathing within about 2 to 5 min when it has been dangerously slowed or stopped due to opioid use

46
Q

What are the routes of administration of naloxine?

A

IM or IN

47
Q

Of the 2 formulations which is most expensive?

A

Intranasal

48
Q

What can cause opioid withdrawal in those with opioid dependence

A

Benefit > Risk

49
Q

How long after administration of naloxone do the effects last?

A

30-90 minutes there overdose may return

50
Q

In overdose who may experience the wear off effects and the overdose may return?

A

Those who take long acting opioids (Methadone)

51
Q

What is naloxine kits?

A

One of the most promising and tangible pharmacist activities to ↓ opioid related risks

52
Q

What does the acronym “SAVE ME” stand for?

A

Stimulate
Airway
Ventilate
Evaluate
Medication
Evaluate

53
Q

What are the physical symptoms of withdrawal?

A

Myalgia, abnormal cramps, nausea, chills, hot flashes, electric feeling, yawning.

54
Q

Is Opioid withdrawal life threatening?

A

No

55
Q

What may be the early symptoms of opioid withdrawal?

A
56
Q

What are the late symptoms of opioid wthdrawal?

A
57
Q

What are the prolonged symptoms of opioid withdrawal?

A
58
Q

How can we manage the Aches/Pains/Myaglia of opioid withdrawal?

A

NSAID (give regularly initially), Acetaminophen

59
Q

How can we manage the bowel function withdrawal symptom?

A

Laxative, loperamide

60
Q

How can we manage the Nausea/Vomiting of opioid withdrawal?

A

Dimenhydrinate, haloperidol,

61
Q

How can we manage anxiety/irritability/cramps/rhinorrhea/insomnia of opioid withdrawal?

A

Hydroxyzine

62
Q

How can we manage the insomnia effects of opioid withdrawal?

A

Non-drug and sleep hygiene measures, trazodone

63
Q

How can we manage the physical withdrawal of opioid withdrawal?

A

Clonidine

64
Q

How can we manage the sweating effect of opioid withdrawal?

A

Oxybutynin

65
Q

Should benzos be used ofr opioid withdrawal symptoms?

A

NO, increase risk of CNS depression/opioid toxicity

66
Q

What are the signs and symptoms of opioid overdose?

A
  • difficulty
  • walking
  • talking
  • staying awake
  • blue lips or nails
  • very small pupils
  • cold and clammy skin
  • dizziness and confusion
  • extreme drowsiness
  • choking, gurgling or snoring sounds
  • slow, weak or no breathing
  • inability to wake up, even when shaken or shouted at
67
Q

What are the factors of overdose

A

Overdose?
Substances, how it was taken, individual

68
Q

What is tolerance?

A

Lower tolerance when you have:
* Taken a break from using
* Recently been in detox/treatment
* Recently been incarcerated
* Recently started using
* Lung, liver & other health issues e.g. asthma, COPD, Hep C
* Had a recent overdose

69
Q

What is important about tolerance?

A

Know your tolerance, use less, pace yourself, do testers, if you have been abstinent, start using much less

70
Q

What is the importance of ROA with regards to drug usage?

A

if you use enough of that drug in a short enough period of time OD is possible

71
Q

What are some of the modes of taking opioids?

A
72
Q

What is polysubstance use?

A

heroin + alcohol
methadone + benzos
alcohol + benzos

Where multiple substances are used including alcohol and prescribed medications together in some cases

73
Q

What is important about drugs and alcohol

A

✓ Be aware that prescribed medication can
increase OD risk
✓ If you do mix, use drugs before alcohol

74
Q

What is fentanyl?

A

Used as a painkiller or anaesthetic.

50-100 times more toxic than morphine

75
Q

Whati s the estaimted lethal dose of pure fentanyl

A

2mg

76
Q

What can illicit fentanyl be sold as?

A

fentanyl, heroin,
or fake oxys OR any street drug may be
intentionally or unintentionally contaminated

77
Q

In most cases fentanyl is taken

A

intentionally or unknowingly

78
Q

How much more potent is carfentanil than fentanyl?

A

100x

79
Q

What makes carfentanil more potent?

A
80
Q

What is 15x more poten than fentanyl?

A
81
Q

What is the main dialogue in t erms of pruchasing illicit substances?

A

Small variations of the drug could be lethal (Molecularly)

82
Q

Why might people use substances alone?

A

– Stigma
– Fear
– Preference

83
Q

Why is it dangerous to take too much of an opioid?

A
  • Lose the urge to breath
  • Breathing slows decreasing
    oxygen to the brain
  • Can lead to permanent brain
    injury or death if untreated
84
Q

How long does naloxone work for?

A

30-90 minutes overdose can return

85
Q

What are some opioids that can lead to re-overdose when the effects of naloxone wear off?

A
86
Q

What does opioid OD look like?

A
  • Small pupils
  • Snoring or gurgling
  • Blue lips, fingernails
  • Cold clammy skin
87
Q

After approximately ___ before your cosnider a second dose of naloxone?

A

20-30 breaths

88
Q

What is the goal of utilizing naloxone?

A

Goal is for someone to be breathing on their
own (at least 1 breath every 5 seconds)

89
Q

Aftercare of naloxone and paramedics?

A

– How long person has been unresponsive
– Known medical conditions
– Drugs used
– How much naloxone given
- Allocation of health care resources

90
Q

What is the COWS scale?

A

Clinical Opiate Withdrawal Scale

91
Q

Example of a PPO for a inpatient bup-nal induction order

A

PPO

92
Q

What is the theory of Low-dose/microdosing Bup/Nal

A

– Repetitive administration of very small buprenorphine doses should not precipitate opioid withdrawal
– Buprenorphine will accumulate at the receptor due to long t1/2
– Over time, an increasing amount of the full agonist will be replaced by buprenorphine at the receptor

93
Q

Is suboxone better tolerated or methadone longterm?

A

Suboxone

94
Q

How would be micodose Bup-nal using the bernese method?

A
95
Q
A

Therapeutics (Fall 2024) (11 decks)

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