OUD-Treatment Flashcards
IS the withdrawal management strategy good?
NO not effective
What is the relapse rate of withdrawal management?
50-65%
What is first line for OUD?
Suboxone
What is second line for OUD?
Methadone
Is Suboxone an agonist or antagonist?
PARTIAL agonist
Why is naloxone in Suboxone?
can’t abuse or divert medication
Can we use buphrenorphine patches?
Only for pain
Benefit of buprenorphine injection?
monthly
MOA of buprenorphine
displaces opioids and slowly dissociates for a long duration
Due to partial agonist of Suboxone, what can we say about dose?
there is a point where no more opioid effect past a certain dose
Where can naloxone be absorbed from?
nasal or injection ONLY
S/e of Suboxone?
headaches, pain, withdrawal, constipation, nausea, insomnia, sweating
Interactions with Suboxone?
opioids- duh
alcohol and benzos increase risk of respiratory depression
Why is suboxone better than methadone?
less risk of overdose, side effects, diversion, and interactions
Which one is more efficacious, Suboxone or methadone?
equal
How do you administer Suboxone?
dissolve under tongue
For oral dissolving tablets what counselling is required?
no eating or drinking during 10 minutes it takes to dissolve
If a patient accidentally swallows Suboxone, are they ok?
NO effect
Explain how Suboxone can cause withdrawal?
if on high dose of opioids, it displaces them and only partially activates receptor
When does Suboxone caused withdrawal usually occur?
30-60 minutes after dose
How can we minimize risk of Suboxone withdrawal?
delay 1st dose until moderate withdrawal, start low, microdose
At what COWS score is moderate withdrawal?
> 12
Why is the COWS method not preferred?
Hard to get buy in cause withdrawal is brutal
How does microdosing work, and at what dose do you stop full agonist therapy?
give small amounts and slowly increase until bup dose of 12
Is it okay to split/crush Suboxone tabs?
yes just don’t swallow
When do we go to methadone for OUD?
if responding poorly to Suboxone
What patient facts may indicate methadone may be better?
mod-severe OUD
heroin
long history
people who may not get follow up
What option if pregnant?
methadone BUT growing evidence for Suboxone
What was the worrisome agent in Suboxone in pregnant people?
naloxone
Onset and 1/2 of methadone?
30-60 min
24-36 hours= accumulate
What metabolizes methadone?
3A4 and 2D6
What s/e of methadone?
QT, agitation, weight gain, sweat, constipation, nausea, drowsy
What dose of methadone is seen as optimal?
> 80 mg/day
What dose is needed to prevent withdrawal?
> 120mg /day
If adjusting methadone dose how long should we wait?
NO SOONER than 5 days
What do we do if multiple missed methadone doses?
maybe change dose as there may have been a drop in tolerance
What flavour of Methadose is not recommended due to potentially causing withdrawal?
cherry flavor
When is Slow release oral morphine indicated? And how is it dispensed?
when naloxone and methadone doesn’t work, once a day witness
When would it be a good idea to use injectable OAT?
cravings despite other therapy,
What are our options for injectable OAT?
diacetlamide and hydromorphone
