Substance Abuse Opioid Withdrawal + 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

CYP3A4

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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

CYP3A4

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

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

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