Part 3 Flashcards
Symptoms of opioid overdose?
unconscious
unresponsive
awake, but unable to talk
vomiting
making choking sounds, or a snore-like gurgling noise
may also have
- stopped breathing or have slow, shallow breathing
- bluish purple skin
- limp body
- pale or clammy fae
- blue or purplish black fingernails and lips
- slow, erratic or no pulse
- constricted pupils
How to administer prenoxad naloxone dose?
- Intramusuclar injection
- Check for symptoms and response (follow DRSABCD first aid guide)
- Place the patient in a recovery position
- Call for an ambulance
- Twist outer plastic box to break open
- Unscrew clear plastic top from syringe
- Peel backing paper from needle packet and remove needle
- Screw needle onto the syringe
- Twist needle sheath and remove from syringe
- Hold the syringe like a pen
- Inject 0.4 mL into the outer thigh muscle or upper arm muscle
- Repeat this dose in 2-3 minutes until a clinical effect in noted or ambulance arrives
- Person should improve 1 minute
What are the options for OST services?
- Methadone (oral-liquid)
- Buprenorphine (oral-sublingual)
- Buprenorphine/naloxone (oral-sublingual) –> suboxone
- Buprenorphine (long acting/depot injection)
> buprenorphine allows a wide range of dosing regimes from daily to once every two or three days –> less frequent administration
What to do prior to dosing for suboxone?
- Advise client not to eat immediately before dosing as may interfere with absorption, offer sip of water to moisten mouth. Ensure hands are clean and dry as film may stick to wet hands and make it difficult to put in their mouth.
- Collect films needed to make up dose and check against prescription. Films should not be cut-up to maniuplate dose. Clarify with prescriber in such an event
- Open all packages (bend along dotted line and tear at perforation) and offer the packages to client, who removes film from packages one at a time to place in their mouth or remove all films from packages and palce into an appropriate container (medication cup) and offer to client to place in their mouth one at a time. Alternatively, open one packaging at a time.
How to observe correct placement of films of suboxone?
- Client should hold the film by its edges and place sublingually one at a time
- If multiple films are needed, first two are placed under the tongue and rest are placed onto the inside of the heeks
- Advise client not to attempt to move the films once they have been placed in the mouth nor to chew or swallow the films until they have fully dissolved (generally 2 to 5 minnutes)
- If films accidentally stick ontop of the tongue or to the teeth, reassure the client that buprenorphine will still be absorbed and to keep the motuh closed as the films will dissolve.
> discourage client from overlapping films when placing in the mouth as this impairs adherence to the mucosa and prolongs time required for supervision
What is the supervision time for suboxone?
Films adhere to mucous membranes within seconds and are difficult to remove within 30 to 60 seconds, so under normal cirumstances, post-dose supervision does not exceed one minute.
What happens if missed doses for clozapine:
A) <2days
B) <2 days and <3 days
C) >3 days and <4 weeks
D) >4 weeks
A)
- No change to dose or monitoring requirements
B)
- Start again at 12.5mg and titrate up
- No additional monitoring requirements
C)
- Start again at 12.5mg and titrate up
- For monthly patients: weekly monitoring for 6/52 (6 weeks)
- For weekly patients: weekly monitoring for 6/52 (6 weeks) or as long as needed to reach 18 weeks
D)
- Need to re-register with clozapine registry and recommence clozapine as for new patient
What does caffeine do to clozapine levels?
CYP1A2 inducer
- Increases clozapine levels
> Thus when reducing caffeine intake, will decrease clozapine levels
> any change in caffeine intake should be in discussion with doctor
> taper down caffeine gradually
> monitoring of signs and symptoms
What does smoking do to clozapine levels?
Smoking is a CYP1A2 inhibitor
> Reduces clozapine levels
> Ceasing smoking will increase clozapine levels
> 80% of people with schizophrenia smoke and heavily
> Cardiovascular disease is major cause of morbidity and mortality in these people
> Doctor has to be aware of cessation attempt and prepared to regularly monitor and reduce clozapine dose
Patients taking clozapine gets a cold, what to do…?
- Blood test results? Neutropenia
> concerns are towards low white cell counts and risk of infection due to weakened immnune system
> concern towards myocarditis and risk of aspiration
> if satisfied its a cold, give symptomatic relief such as decongestant nasal spray, paracetamol
How long can supply clozapine for?
- Refer to clozapine coordinator
- Cannot supply more than 28 days at a time
- Need to arrange for extra blood tests as tests needs to be every 4 weeks
- Check community pharmacies that could supply in other areas
- Check other legislative requirements
Can supply another brand for clozapine?
i.e. clozaril and clopine
Check what he had before
Has to be on one system for monitoring
Cannot be swapped even though generically equivalent
Could miss one dose but need to get correct brand
Refer to clozapine coordinator
How to mange sialorrhea for clozapine?
Especially during first 4 weeks, can be ongoing
Not sailva increase, but swallowing decrease
Most profound during sleep
What to monitor for in clozapine
Cholesterol levels –> dyslipidemia
Blood glucose levels
Weight, BMI, waist circumference
Regular ECG and CK/troponin monitoring
Constipation
Fever
Tachycardia
Seizures
How often does someone need a blood test prior to each prescription for clozapine?
Every 28 days, prior to each prescription
