SUD agents

Question 1

Suboxone (Buprenorphine/Naloxone) class

Answer 1

opioid analgesic, opioid partial agonist

Question 2

Buprenorphine MOA

Answer 2

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

Question 3

Naloxone MOA

Answer 3

pure opioid antagonist that competes with and displaces opioids at opioid receptor sites

Question 4

Suboxone (Buprenorphine/Naloxone) dosing for opioid use disorder (INDUCTION)

Answer 4

Sublingual film:
Day 1: 2/0.5mg or 4/1mg may titrate dose based on control of acute withdrawal symptoms in 2/0.5 or 4/1 mg increments about every 2 hrs up to a total dose of 8/2mg
Day 2: up to 16/4 mg as a single dose

Question 5

Suboxone (Buprenorphine/Naloxone) dosing for opioid use disorder (MAINTENANCE)

Answer 5

16/4 mg QD

Question 6

Suboxone (Buprenorphine/Naloxone) ADE

Answer 6

• dental (tooth decay, dental caries, dental abscesses/infection, tooth erosion, fillings falling out, total tooth loss)
• constipation
• respiratory depression
• withdrawal sx
• sweating
• abdominal pain
• constipation
• nausea
• headache
• withdrawal syndrome

Question 7

Suboxone (Buprenorphine/Naloxone) hepatic impairment dosing

Answer 7

Mild: no adjustment needed
Moderate: use with caution as maintenance treatment, avoid use for induction
Severe: avoid use

Question 8

Suboxone (Buprenorphine/Naloxone) altered kidney function dosing

Answer 8

no adjustment needed

Question 9

Vivitrol (Naltrexone) class

Answer 9

antidote: opioid antagonist

Question 10

Vivitrol (Naltrexone) MOA

Answer 10

pure opioid antagonist

Question 11

Vivitrol (Naltrexone) AUD dosing

Answer 11

PO: 50mg QD, may increase to 100mg QD after one week based on response

IM: 380 mg once every 4 weeks

Question 12

Vivitrol (Naltrexone) OUD dosing

Answer 12

PO: 25mg QD for 1-3 days, then 50mg QD thereafter

IM: 380mg once every 4 weeks

Question 13

Vivitrol (Naltrexone) altered kidney function dosing

Answer 13

caution in moderate to severe impairment

Question 14

Vivitrol (Naltrexone) hepatic impairment dosing

Answer 14

use not recommended in acute hepatitis or hepatic failure

Question 15

Vivitrol (Naltrexone) ADE

Answer 15

• accidental opioid overdose (pts hypersensitive to opioids after treatment)
• hepatotoxicity
• injection site reactions
• withdrawal symptoms
• syncope
• abd pain, change in appetite, diarrhea, N/V
• anxiety, depression, dizziness, drowsiness sleep disorder, suicidal ideation
• xerostomia
• back/muscle pain

Question 16

Transitioning from buprenorphine to naltrexone

Answer 16

1.) taper buprenorphine gradually and DC
2.) wait 7-14 days before initiating naltrexone
- Naloxone challenge may be used to demonstrate an absence of physical dependence

Question 17

Transitioning from methadone to naltrexone

Answer 17

1.) taper methadone gradually and DC
2.) wait 7-14 days before initiating naltrexone
- Naloxone challenge may be used to demonstrate an absence of physical dependence

Question 18

Transitioning from naltrexone to methadone or buprenorphine

Answer 18

begin methadone or buprenorphine when patient is due for next dose of naltrexone