Substance Use Flashcards
Miskle
What is the Clinical Opiate Withdrawal Scale (COWS)? and what are the levels?
A scale used to help clinicians determine the
stage or severity of opiate withdrawal and assess the level of physical
dependence on opioids
5-12: mild withdrawal
13-24: moderate withdrawal
25-36: moderately severe
> 36: severe withdrawal
What are the normal QTc ranges for men and women?
Women: 360-460 ms
Men: 350-450 ms
What drugs were mentioned to cause QTc prolongation?
Methadone: BBW for QT prolongation leading to TdP
Quetiapine
How much does a single dose of 100mg of quetiapine change QT interval?
~ 13.7 ms
Steady state dose of 750 mg/day changes interval by 5.7 ms
What are the opioid use disorder (OUD) diagnostic criteria scores?
Must meet at least two criteria
- If withdrawal and tolerance only, must meet a 3rd criteria
Mild: 2-3
Moderate: 4-5
Severe: > 6
What are some potential options for withdrawal treatment?
Methadone
Buprenorphine
Symptomatic withdrawal management
What are some benefits of methadone?
will resolve opioid withdrawal sx quickly (full agonist)
No concerns of precipitated withdrawal
Patients retained in tx longer on methadone than buprenorphine
What are some cons of methadone?
Laws: 3 day law
QTc prolongation
What are some benefits of buprenorphine?
Partial mu agonist and weak kappa antagonist = safer option
Does Not have to be daily dosed
Patient could be given a rx to go home w
What are some cons of buprenorphine?
Laws
QTc prolongation
Precipitated withdrawal likely, given long t1/2 of methadone if taken
– May need more frequent dosing in order to prevent breakthrough withdrawal sx
What are some benefits of symptomatic withdrawal management?
No concerns w the law
What are some cons of symptomatic withdrawal management?
Might help w withdrawal sx, does not work as well as the other options
What are the laws w Methadone?
Can continue methadone while admitted to the hospital
Methadone must NOT be “prescribed” upon discharge
Patient can return to the hospital (ex: ED) for a total of 72 hours to be re-dosed each day
Any provider w a DEA # can initiate methadone for > 72 hours if the patient is admitted for any reason other than opioid use disorder
What are the laws w buprenorphine?
Can continue buprenorphine while admitted to the hospital
Can be “prescribed” upon discharge
Any provider can initiate buprenorphine
72 hour rule only for methadone
What was the DEA announcement on the 72 hour rule?
An exception to the registration requirement, known as the “three day rule” (Title 21, Code of Federal Regulations, Part 1306.07(b)), allows a practitioner who is not separately registered as a narcotic treatment program, to administer (but not prescribe) narcotic drugs to a patient for the purpose of relieving acute withdrawal symptoms while arranging for the patient’s referral for treatment, under the following conditions:
Not more than one day’s medication may be administered or given to a patient at one time – no longer applicable!
Updated rule went into effect 3/2022, not more than a three day supply of such med may be dispensed to the person
This treatment may not be carried out for more than 72 hours and;
This 72-hour period cannot be renewed or extended
