OUD-Treatment

Question 1

IS the withdrawal management strategy good?

Answer 1

NO not effective

Question 2

What is the relapse rate of withdrawal management?

Answer 2

50-65%

Question 3

What is first line for OUD?

Answer 3

Suboxone

Question 4

What is second line for OUD?

Answer 4

Methadone

Question 5

Is Suboxone an agonist or antagonist?

Answer 5

PARTIAL agonist

Question 6

Why is naloxone in Suboxone?

Answer 6

can’t abuse or divert medication

Question 7

Can we use buphrenorphine patches?

Answer 7

Only for pain

Question 8

Benefit of buprenorphine injection?

Answer 8

monthly

Question 9

MOA of buprenorphine

Answer 9

displaces opioids and slowly dissociates for a long duration

Question 10

Due to partial agonist of Suboxone, what can we say about dose?

Answer 10

there is a point where no more opioid effect past a certain dose

Question 11

Where can naloxone be absorbed from?

Answer 11

nasal or injection ONLY

Question 12

S/e of Suboxone?

Answer 12

headaches, pain, withdrawal, constipation, nausea, insomnia, sweating

Question 13

Interactions with Suboxone?

Answer 13

opioids- duh
alcohol and benzos increase risk of respiratory depression

Question 14

Why is suboxone better than methadone?

Answer 14

less risk of overdose, side effects, diversion, and interactions

Question 15

Which one is more efficacious, Suboxone or methadone?

Answer 15

equal

Question 16

How do you administer Suboxone?

Answer 16

dissolve under tongue

Question 17

For oral dissolving tablets what counselling is required?

Answer 17

no eating or drinking during 10 minutes it takes to dissolve

Question 18

If a patient accidentally swallows Suboxone, are they ok?

Answer 18

NO effect

Question 19

Explain how Suboxone can cause withdrawal?

Answer 19

if on high dose of opioids, it displaces them and only partially activates receptor

Question 20

When does Suboxone caused withdrawal usually occur?

Answer 20

30-60 minutes after dose

Question 21

How can we minimize risk of Suboxone withdrawal?

Answer 21

delay 1st dose until moderate withdrawal, start low, microdose

Question 22

At what COWS score is moderate withdrawal?

Answer 22

> 12

Question 23

Why is the COWS method not preferred?

Answer 23

Hard to get buy in cause withdrawal is brutal

Question 24

How does microdosing work, and at what dose do you stop full agonist therapy?

Answer 24

give small amounts and slowly increase until bup dose of 12

Question 25

Is it okay to split/crush Suboxone tabs?

Answer 25

yes just don’t swallow

Question 26

When do we go to methadone for OUD?

Answer 26

if responding poorly to Suboxone

Question 27

What patient facts may indicate methadone may be better?

Answer 27

mod-severe OUD
heroin
long history
people who may not get follow up

Question 28

What option if pregnant?

Answer 28

methadone BUT growing evidence for Suboxone

Question 29

What was the worrisome agent in Suboxone in pregnant people?

Answer 29

naloxone

Question 30

Onset and 1/2 of methadone?

Answer 30

30-60 min
24-36 hours= accumulate

Question 31

What metabolizes methadone?

Answer 31

3A4 and 2D6

Question 32

What s/e of methadone?

Answer 32

QT, agitation, weight gain, sweat, constipation, nausea, drowsy

Question 33

What dose of methadone is seen as optimal?

Answer 33

> 80 mg/day

Question 34

What dose is needed to prevent withdrawal?

Answer 34

> 120mg /day

Question 35

If adjusting methadone dose how long should we wait?

Answer 35

NO SOONER than 5 days

Question 36

What do we do if multiple missed methadone doses?

Answer 36

maybe change dose as there may have been a drop in tolerance

Question 37

What flavour of Methadose is not recommended due to potentially causing withdrawal?

Answer 37

cherry flavor

Question 38

When is Slow release oral morphine indicated? And how is it dispensed?

Answer 38

when naloxone and methadone doesn’t work, once a day witness

Question 39

When would it be a good idea to use injectable OAT?

Answer 39

cravings despite other therapy,

Question 40

What are our options for injectable OAT?

Answer 40

diacetlamide and hydromorphone