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PHM 701- Alcohol, Seizures, Substance Abuse, Schizophrenia, Depression > Substance Abuse- Opiate Withdrawal and Maintenance > Flashcards

Substance Abuse- Opiate Withdrawal and Maintenance Flashcards

1
Q

Opiate effects

A

Euphoria
Dysphoria
Apathy
Motor retardation
Sedation
Slurred speech
Attention impairment
Miosis
Constipation

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2
Q

Opiate withdrawal effects

A

Lacrimation
Rhinorrhea
Mydriasis
Piloerection
Diaphoresis
Diarrhea
Yawning
Fever
Insomnia
Muscle ache/pain
“Kicking the habit”

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3
Q

Opiate OD treatment

A

Supportive care, Narcan

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4
Q

Narcan MoA

A

Pure opioid receptor antagonist that competes with and displaces narcotics at opioid receptor sites

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5
Q

Treatments for opiate withdrawal

A

methadone, buprenorphine, clonidine, lofexidine

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6
Q

Methadone MoA

A

binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; produces CNS depression

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7
Q

Goal of methadone in maintenance

A

Suppress signs and symptoms of opiate withdrawal, extinguish opiate craving, block reinforcing effects of illicit opiates

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8
Q

Initial dose of methadone should be no greater than ____on day 1.

A

30-40mg

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9
Q

While taking methadone, complete physical exam and labs within ___days.

A

14

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10
Q

When patients take methadone, they have to go to a clinic and take the dose there. When can they take their dose home and take it independently?

A

2 days a week in the first 90 days, 1 month after 2 years

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11
Q

What factors go into letting a patient take home their methadone dose?

A

Capable of handling and taking unsupervised, abstinence from illegal drugs, regular attendance, absence of behavioral or criminal issues, stable home and social environments, can be safely stored

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12
Q

Methadone is a major substrate of what CYP enzyme?

A

3A4

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13
Q

Buprenorphine MoA

A

high-affinity binding to mu opiate receptors in CNS; displays partial mu agonist and weak kappa antagonist activity

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14
Q

Buprenorphine metabolite

A

norbuprenorphine

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15
Q

Buprenorphine goal

A

provide a transition for an opiate physically dependent state to an opiate-free state, induction, and dose reduction

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16
Q

Buprenorphine: induction

A

Switching patients from opiates to buprenorphine, finding minimum dose at which the patient’s D/C’s or markedly diminishes use of opiates, experiences no withdrawal, minimal or no side effects and no cravings

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17
Q

Buprenorphine: stabilization

A

marked by patient experiencing no withdrawal, minimal or no side effects, no longer uncontrolled cravings, patients are seen weekly

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18
Q

Buprenorphine: maintenance

A

may be indefinite, attention to psychosocial issues, seen/toxed monthly

19
Q

Candidates for buprenorphine

A

Not merely physically dependent, but also addicted
No CIs
Interested
Expected to be reasonably compliant
Willing to follow safety precautions
Willing after review of therapy

20
Q

Unlikely candidates for buprenorphine

A

Comorbid dependence on other CNS depressants
Significant unrelated psych
Active/chronic SI/HI
Multiple treatments/relapses
Poor response to Suboxone
Complex medical history

21
Q

Suboxone contains…

A

…buprenorphine and naloxone

22
Q

Role of naloxone in Suboxone

A

Abuse deterrent

23
Q

Sublocade is what formulation of buprenorphine

A

Injectable

24
Q

Who qualifies for Sublocade?

A

Patients whose dose of buprenorphine is >8mg/day and was previously stable on a transmucosal buprenorphine-containing product

25
Q

How often is Sublocade dosed?

A

Once monthly (technically every 28 days-ish)

26
Q

Sublocade counseling points

A

Rotate injection site each time
Subsequent precipitation following injection results in a solid depot, the patient may have a lump for a few weeks but don’t rub/massage the site

27
Q

True or false: Sublocade is in the REMS program

A

True

28
Q

Sublocade BBW

A

serious harm or death could result if administered IV. Sublocade forms a solid mass upon contact with body fluids. Occlusion, local tissue damage, and thromboembolic events, including life-threatening pulmonary emboli, could result if administered

29
Q

Buprenorphine is a major substrate of what CYP enzyme?

A

3A4

30
Q

Clonidine MoA

A

stimulates alpha-2 adrenoreceptors in the brainstem, thus activating an inhibitory neuron, resulting in reduced sympathetic outflow from the CNS

31
Q

Clonidine side effects

A

drowsiness, dizziness, dry mouth, headache, orthostatic hypotension, fatigue, abdominal pain, xerostomia, bradycardia

32
Q

Lofexidine (Lucemyra) MoA

A

Same as clonidine

33
Q

Lofexidine side effects

A

orthostatic hypotension, bradycardia, hypotension, insomnia, dizziness, drowsiness, xerostomia

34
Q

Naltrexone MoA

A

Markedly attenuates or completely blocks, reversibly, the subjective effects of IV-administered opioids by competitive binding at opioid receptors

35
Q

In order to start naltrexone, you must be opiate free for how long?

A

At least 7-10 days

36
Q

Naltrexone dosing: PO

A

25mg QD

37
Q

Naltrexone dosing: IM

A

380mg q4w/qmonth

38
Q

Naltrexone PO side effects

A

GI upset, withdrawal

39
Q

Naltrexone IM side effects

A

Injection site reactions, withdrawal

40
Q

Naltrexone BBW

A

acute hepatitis and hepatocellular injury

41
Q

Naltrexone XR brand name

A

Vivitrol

42
Q

Criteria for Vivitrol

A

Must meet DSM criteria for opiate dependence, recently received opiate detox and opiate free for at least 7 days

43
Q

Exclusion criteria for Vivitrol

A

acute hepatitis or liver failure
receiving opiate analgesics
current opiate dependence
in acute opiate withdrawal
positive urine screen for opiates
known previous allergic response to naltrexone
failed naltrexone challenge test

PHM 701- Alcohol, Seizures, Substance Abuse, Schizophrenia, Depression (23 decks)

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