Flashcards in 13 - Opioid-Related Disorders Deck (23):
for chronic opioid noncancer pain, keep opioid dose below _____
90 mg MED (morphine equivalents daily)
When tapering opioids, what is a good taper rate to use?
lower dose by 5-10% every 2-4 weeks and regularly monitor
What is the most effective tx for opioid use disorder?
maintenance therapy with a long acting agonist like methadone or partial agonist buprenorphine
Why should you avoid detoxification for those in pregnancy?
risk of spontaneous abortion
What can clonidine help with?
it decreases neuronal output of NE which can blunt the noradrenergic symptoms of withdrawal such as chills and flushing
s/e of clonidine
______ is used off-label for out-patient detox
What is naloxone?
Why is buprenorphine combined with naloxone? (Suboxone)
-naloxone is an opioid antagonist with no action taken orally
-it is combined with buprenorphine to prevent abuse
-if taken intranasally or injected it will induce opioid withdrawal symptoms in opioid-tolerant individuals
Typically increase the dose of suboxone over ____ days
Typically taper the dose of suboxone over ___ weeks
Why is methadone seldom used in the acute setting?
increased risk of sedation and respiratory depression
How can we manage nausea, diarrhea and muscle aches associated with opioid withdrawal?
-antiemetics (ginger over gravol bc of abuse potential)
-NSAIDs or espom salts
What are the current maintenance therapies for opioid use disorder?
1st line = suboxone
2nd line = methadone
3rd line = slow-release morphine (off-label use)
MOA of buprenorphine
partial agonist at the mu opioid receptor and an antagonist at other receptors (ex. kappa)
MOA of methadone
mu opioid receptor agonist
Min length of treatment?
12 months, potentially lifelong
Why is suboxone better than methadone?
safer during initiation and less likely to cause DIs, erectile dysfunction, or cognitive/psychomotor impairment
Naltrexone is usually just used for ______ treatment
What are the symptoms of opioid toxicity/overdose?
respiratory depression (shallow breathing, respiratory rate < 12 breaths per minute), constricted pupils, pale/cold skin, blue fingernails and being unresponsive to shaking or pain
How do you treat opioid toxicity/overdose?
-While awaiting EMS, give CPR and naloxone (NAPRA schedule 2) which is an opioid antagonist
-Repeat dose every 3-5 minutes if still unresponsive or overdose symptoms come back
-Naloxone comes as IM or IN
How do we treat opioid use disorder in pregnant patients?
Buprenorphine (w/o naloxone) may be as safe and effective as methadone. Can get through SAP in Canada but if not available can just give Suboxone as withdrawal carries a great risk of harm to fetus than naloxone exposure
Methadone is ok to use