Buprenorphine

Question 1

What type of drug is Buprenorphine

Answer 1

Partial agonist of Mu receptor

Question 2

What is the half life of Buprenorphine

Answer 2

24 - 36 hour

long

Question 3

What type of affinity does buprenorphine have to mu receptors

Answer 3

High

It will displace other Opioids - precipitated withdrawals

If you take this with Methadone or Heroine, you will not get full euphoria effect.

Question 4

How is Buprenorphine metabolized

Answer 4

Liver

Question 5

How is Buprenorphine taken

Answer 5

Sublingual due to low first pass

Question 6

How does Buprenorphine work

Answer 6

High affinity displaces other opioids.

Slow dissociation allows for decrease withdrawal , decreased cravings and decreased effects of other opiods.

Question 7

Types of Buprenorphine formularies used for analgesic

Answer 7

Patch

IV

Question 8

Rationale to prescribe Buprenorphine/Naloxane

Answer 8

Reduce IV drug use

Question 9

Major features of Naltroxene

Answer 9

High affinity for Mu receptors

Long acting: oral ( 24 hours), Injection (5 - 10 days)

Full antagonist

Need to be off of Opioids for several days prior to injection to prevent precipitated withdrawals.

Question 10

How does naltrexone work:

Answer 10

it decreases craving of opioids (Behavioral component).

Question 11

Usual dosage for Buprenorphine

Answer 11

4 - 32 mg (oral tab)

Question 12

Usual dosage for Naltrexone

Answer 12

380 mg Depot Injection

Question 13

Best option for anyone trying to avoid Opioids

Answer 13

Naltrexone

Question 14

Relative, where do we see a good therapeutic dosage response for buprenorphine

Answer 14

8 - 12 mgs

Question 15

Relative, what is the typical max dosage of mono buprenorphine?

Answer 15

16 mgs

Question 16

Special consideration for Buprenorphine

Answer 16

Risk of diversion

Question 17

Special consideration for Naltroxene

Answer 17

Patients must be opioid free before starting

Risk of overdose for patients who stop it

Pain management - non pharmological usage

Question 18

Maintenance vs taper

Answer 18

Tapering seems to cause less retention. Maintenance treatment seems like best option for prevention of Opioid relapse.

Question 19

Common side effects of Buprenorphine

Answer 19

Headaches - manage with OTC meds

Constipation - High fiber diet, hydration and stool softener

Dry mouth - Hydration, good oral mouth

Question 20

Explain Buprenorphine role in causing clarity in patients and brightening affect

Answer 20

It is a kappa agonist which leads to this expression

Kappa antagonist would do the opposite of such

Question 21

Can you overdose on Buprenorphine

Answer 21

Technically no. Although the med at higher doses can decrease respiration, it has not known to cause increase in carbon dioxide retention of the body.

Usually the cases is multiple drug interaction

Question 22

Which is better: Buprenorphine or the injection of naltrexone

Answer 22

Both seemingly even in effectiveness. The caveat being, we have to get individuals pass the initial stage of detox to start them on an naltrexone injection.

Question 23

What cytochrome is Buprenorphine metabolized by?

Answer 23

CYP3A4

Question 24

What does CYP3A4 inducers do to Buprenorphine

Answer 24

It causes it to leave the blood stream a lot quicker

Consequence: withdrawal and cravings

Question 25

What does CYP3A4 inhibitors do to Buprenorphine

Answer 25

It causes higher levels of the medication Consequence: Sedation and nausea

Question 26

Medication to watch out for when administering Buprenorphine

Answer 26

Anything that may cause sedations such as benzos Think about alcoholism

Question 27

What happens to receptors if Buprenorphine is used alone

Answer 27

It stays on that receptor

Question 28

What happens if an opioid agonist follows buprenorphine

Answer 28

Buprenorphine will stay on that receptor. Agonist would have lesser effects

Question 29

What happens if buprenorphine follows an opioid agonist

Answer 29

Buprenorphine will displace that agonist leading to precipitated withdrawals

Question 30

What happens if buprenorphine is followed by an Opioid antagonist

Answer 30

Not much. Buprenorphine will remain on that receptor. Antagonist will work slower leading to precipitated withdrawals

Question 31

FDA recommendations when treating a patient with Buprenorphine, If they are in fact on a benzo

Answer 31

We should still give them it as it has not shown to cause over doses at therapeutic dose range. Rationale: Overdosing on Opioids is a much more adverse event Response: Educate, potentially taper the Benzo or CNS depressant, Verify the dx of the patient for taking these medications.

Question 32

When to initiate Naltrexone when opioid free:

Answer 32

7 - 10 day wait period

Question 33

Why is long acting injectable considered better option than oral Naltrexone

Answer 33

Better adherence with long acting Lower risk of relapse lower risk of overdose

Question 34

Potential side effects after initiation of naltrexone injection

Answer 34

Subacute withdrawal but usually recovers after a week. Pain at injection site