Thera 2 Opiod withdrawal treatment

Question 1

Grade 1 Signs / Symptoms of opiod withdrawal

Answer 1

-Lacrimation
-Rhinorrhea
-Restlessness
-Insomnia

Question 2

Grade 2 Signs / Symptoms Opiod Withdrawal

Answer 2

-Abdominal pain
-Arthralgia
-Myalgia
-Muscle twitching
-Dilated pupils

Question 3

Grade 3 Opiod Withdrawals

Answer 3

-Tachycardia
-Tacpnea
-Hypertension
-Fever
-Nausea
-Anorexia
-Severe restlessness

Question 4

Grade 4 Opiod Withdrawals

Answer 4

-Dehydration
-Diarrhea
-Vomiting
-Hyperglycemia
-Hypotension
-Curled position because intense abdominal pain

Question 5

Non agonist outpatient withdrawal protocol
Clonidine dose is

Answer 5

0.1mg QID

Question 6

If the patient is suffering from Stomach cramps or GI spasm Give:

Answer 6

Dicyclomine
Dose:
20mg TID PRN x 7D

Question 7

If the patient is suffering from Diarrhea give:

Answer 7

Loperamide (Imodium) –> Mu peripheral agonist
Dose:
2mg BID PRN x 7D

Question 8

If the patient is suffering from restless leg give:

Answer 8

Ropinirole
Dose:
0.25mg QHS PRN x7D

Question 9

If the patient is suffering from Muscle ache / HA give:

Answer 9

Ibuprofen
Dose:
800mg TID PRN x7D

Question 10

If the patient is suffering from anxiety / insomnia give

Answer 10

Gabapentin
Dose:
600mg TID and HS PRN x 7D

Question 11

Opiod dependence disorder treatment:
Naltrexone

Answer 11

PO = Revia
Longterm injection= Vivitrol
-Pt should be 7-10 days opiod free
-Dose PO is 25mg/day for 3-4 days and then increase the dose
-Long term injection - last for 3-4 months good for pt that is poor adherent
-If LFT are normal and pt is HEPC+ can give it
-If LFT are high = avoid

Question 12

Opiod use dependence
Methadone
For maitainence

Answer 12

-Dose is 5-150mg
-Can prolong the QTC and cause death
-But doses >50mg have a positive benefit of pt to not use illicit drugs
-Methadone is metabolize by CYP 3A4 so avoid 3A4 inhibitors (RACEGAVD)
-Also if the pt is ultra rapid metabolizer of CYP 3A4 the dose of methadone will not have any clinical benefit

Question 13

Opiod use dependence
Methadone
For initiation for dependence treatment

Answer 13

Dose typically star 10mg-40mg / day
-Dose can be titrated up based on the patient cravings
-Is only dispense in a methadone clinic and pt need to drink it infront of the nurse
-Avoid CYP 3A4 inhibitors

Question 14

Opiod use dependence
Buprenorphine sq injection Sublocade

Answer 14

Partial Mu agonist
-It helps with the withdrawal symptoms
-Does not cause euphoria
-Start sublocade when the pt is stable with min 7days of taking buprenorphine
the first 2 doses montly is 300mg
Then the thirs dose and following doses is 100mg

Question 15

Opiod use dependence
Buprenorphine sq injection Brixadi

Answer 15

Long acting injection
Can be monthly or weekly
is a partial mu agonist
It reduces the withdrawal symptoms
Prevent the pt from getting buprenorphine from the street