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Therapeutics II Exam 3 > Opioid Addiction > Flashcards

Opioid Addiction Flashcards

1
Q

Is physical dependence/tolerance to opioids necessary/sufficient for diagnosis of opioid use disorder?

A

no

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2
Q

Criteria for Substance Use Disorder

A
  • taking larger amounts or longer than intended
  • attempt to quit or control use
  • much time spent using or recovering
  • cravings
  • inability to meet responsibilities at home, school, employment
  • interpersonal/relationship problems
  • give up or cut back pleasurable activities to use
  • place oneself in danger d/t use
  • use resulting in physical or psychological illness/harm
  • tolerance to effect of substance
  • withdrawal sx when using or using less
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3
Q

Mild/Mod/Severe?

A

Mild 2-3
Mod 4-5
Severe 6+

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4
Q

What are 3 specific findings of opioid withdrawal?

A

Piloerection
Mydriasis
Yawning

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5
Q

What are other sx of opioid withdrawal?

A
  • GI: cramps, diarrhea, N/V
  • Flu-like: lacrimation, rhinorrhea, diaphoresis, shivering, piloerection, sneezing, myalgia, arthralgia, muscle cramps
  • Sympathic/CNS arousal: mydriasis, HTN, tachycardia, anxiety, irritabiltiy, insomnia, agitation, restlessness, tremor, low grade fever
  • Other: yawning, opioid craving
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6
Q

What does COWs stand for?

A

Chronic Opioid Withdrawal Scale

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7
Q

What is COWs used for?

A
  • Severity tool
  • NOT diagnostic tool

*Must have diagnosis of opioid withdrawal before using tool

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8
Q

Can methadone be administered in inpatient setting?

A

Yes, IF pt is admitted for a condition other than opioid use withdrawal

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9
Q

Inpatient Goal of mgmt of acute opioid withdrawal?

A
  • focus on acute medical problem requiring hospitilization
  • decrease leaving against medical advice
  • facilitate open discussion about addiction
  • improve pt/provider relationship
  • help facilitate referral to substance us disorder tx after hospitlization
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10
Q

What are NOT the goal of inpatient mgmt of acute opioid withdrawal?

A

To cure addiction or eliminate cravings

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11
Q

Full agonist?

A

Morphine
Oxycodone
Methadone

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12
Q

Partial agonist?

A

Buprenorphine

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13
Q

Antagonist?

A

Naloxone

Naltrexone

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14
Q

Methadone (class, onset, duration, dosing)

A

Full opioid agonist
Full SYNTHETIC opioid

Onset: 30-60min
Duration: highly variable; tx pain before addiction
Dosing: 20-40mg

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15
Q

Buprenorphine

A
  • PARTIAL AGONIST
  • Mono therapy = safe in pregnancy
  • Good SL and IV bioavailability
  • HIGH AFFINITY for opioid receptor
  • “ceiling effect”
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16
Q

What is the ceiling effect of Buprenorphine?

A

Effect of buprenorphine plateau and will ONLY provide withdrawal relief and pain relief

It will NOT provide euphoria, respiratory depression or death

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17
Q

What do you want to make sure before admin buprenorphine?

A

Pt is in withdrawal or has not been using opioids

*want to avoid going from full agonist –> partial agonist

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18
Q

What is suboxone?

A
  • Buprenorphine + Naloxone
  • Naloxone has good IV bioavailability
  • burprenorphine doing affect
19
Q

What is the purpose of combining nalaoxone w/ buprenorphine?

A
  • Nalaxone is there so if a pt decides to melt, crush, mix suboxone, they will get the naloxone component when they inject it via IV
  • reduces street value and misuse potential
20
Q

What is naloxone?

A
  • Full antagonist w/ strong affinity to receptor
  • Reverses opioid OD by displacing opioid agonist (heroin) from receptor
  • will induce withdrawal sx if opioid remain on receptor when given
  • BLOCKS opioid receptor
21
Q

What is naltrexone?

A
  • Pure opioid antagonist

- comes PO and IM (Vivitrol)

22
Q

Can pt be admin Vivitrol if they’re still taking opioids?

A

No. Must be opioid free for minimum 7-10days before tx

23
Q

What are some “comfort meds” when treating opioid withdrawal?

A
  • Clonidine (hyperadrenergic state)
  • NSAIDs (muscle cramps/pain)
  • Benzos (insomnia)
  • Dicyclomine (abd cramps)
  • Bismuth subsalicylate or other anti-diarrheals
24
Q

Goals of maintenance therapy?

A
  1. alleviate withdrawal
  2. eliminate drug craving & opioid use
  3. opioid blockade
  4. normalize brain reward pathways & behavior

Need higher dose of methadone or buprenorphine to achieve 2->4

25
Q

How does an opioid agonist like methadone and buprenorphine, tx opioid use disorder?

A

It keeps pt in normal phase (no euphora, no withdrawal) long enough till their BEHAVIOR changes and their dopaminergic system rewires itself to have normal life again.

Then slowly start removing the methadone or buprenorphine slowly over time

26
Q

Methadone Maintenance involves…?

A
  • pt have to go to methadone clinic EVERYDAY
  • daily nursing assessment
  • weekly individual and/or group counseling
  • random supervised drug testing
  • psychiatric services
  • medical services
  • methadone dosing
27
Q

Benefit of Methadone

A
  • increase overall survival
  • increase tx retention
  • increase employment
  • decrease illicit opioid use
  • decrease criminal activity
  • improved birth outcomes
28
Q

Methadone Maintenance Limitation

A
  • Highly regulated
  • Limited access
  • Inconvenient and highly punitive
  • Mixes stable & unstable pt
  • Lack of privacy
  • No ability to “graduate” from program
  • Stigma
29
Q

Strategies to Address Overdose

A
  • prescription monitoring program
  • prescription drug take back events
  • safe opioid prescribing education
  • opioid agonist tx
  • supervised injection facilities
  • OD education and naloxone distribution
30
Q

Opiates on tox screen

A

POSITIVE

comes from poppy seeds

31
Q

Opium, morphine, codeine, thebaine, diacetylmorphine, mitragyna speciose leaves, slavia divinorum…are examples of what?

A

Opiates

32
Q

Semi-synthetic opioids on tox screen

A

MIGHT be POSITIVE

Created from natural opiates or morphine esters & adjust in the lab

33
Q

Examples of Semi-synthetic opioids

A

Hydromorphone
Hydrocodone
Oxycodone
Oxymorphone

34
Q

Synthetic opioids on tox screen

A

NEGATIVE
created in the lab
*need specific test for specific substance; order individually

35
Q

Examples of synthetic opioids

A

Fentanyl
Tramadol
Methadone
Buprenorphine

36
Q

Which opioid is the DRIVER of OD deaths in MA?

A

FENTANYL

specifically illicitly made fentanyl mixed w/ heroin

37
Q

Is fentanyl more potent than heroin?

A

YES 50-100x more potent

38
Q

MOA fentanyl

A

Rapid onset of potent full mu agonist activity
Transdermal for chronic pain
IV or lozenge/lollipop

39
Q

What schedule is fentanyl?

A

schedule II

40
Q

What schedule is buprenorphine?

A

schedule III

41
Q

What is acetyl fentanyl?

A
  • illicitly produced fentanyl anolog
  • more potent than heroin, but less potent than fentanyl
  • assoc w/ relatively isolated OD outbreaks
42
Q

Why is there a surge in OD?

A
  • high rate rx opioid use compounded by diversion
  • transition to heroin
  • change in heroin & drug supply to include fentanyl
  • polypharmacy (benzo + opioid)
43
Q

Which tx option of opioid withdrawal is safe in pregnancy?

a. methadone
b. buprenorphine
c. naloxone
d. naltrexone

A

b. buprenorphine

44
Q

Which of the following will be negative on tox screen?

a. methadone
b. morphine
c. codeine
d. thebaine

A

A. Methadone

Therapeutics II Exam 3 (2 decks)

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