Drugs of dependence opioids Flashcards
List some types of prescription opiods
codeine, oxycodone, morphine, dextropropoxyphene, heroin
Physically addictive –> physical withdrawal and tolerance
Use of one opioid stops w/drawal of aother
What are some pharm effects of opioids?
Analgesia, sedation/drowsiness, resp depression, dec GI motility/secretions
strong sense of euphoria, nause/vom, cough suppression
Release of histamine - itching.flushin
peripheral vasodilation –> dizziness
How many hospital presentation due to prescription opioids were there in 2016-2017?
27,435 (or 75 a day)
How many emergency department presentation due to prescription opioids were there in 2016-2017?
4,232
List some preventative strategies implemented to aid prescription opioid misuse/addiction
Schedule changes
Drug monitoring (QScript)
Reformulation of drugs with diversion risk = prevent intravenous use of oral drugs
changes to prescribing practice
Inc training of healthcare proff
Good prescribing practices
New regulations for monitored and diversion risk meds
What changes were made to PBS opioid listing to reduce misuse?
Reduce pack size to 10 or 1 bottle
1st line = codeine, oxycodone, tramadol
2nd line = hydromorphone, morphine
No inc quant or repeats
Discuss the QLD MATOD program goals and expectations
Reduce harm due to unsanctioned use of opioids
Improve control over drug use, eventual abstinence
reduce overdose risk
reduce transmission of blood-borne viruses
Psychological stability
What is the role of the pharmacist in reduce opioid misuse?
Identify overdose/intoxication, identify withdrawal
provide support and education
Regular contact with prescriber to report = intoxication, non-attendance for dosing, nay other problems
Supervise compliance
Understand naloxone provisions
Educate those who are supplied naloxone
What are some treatments for opioid withdrawal/ovedose?
Opioid agonists = methadone (full), buprenorphine (partial)
Opioid antagonist = naltrexone
Compare methadone and buprenorphine
Methadone is full agonist, buprenorphine is partial agonists
Methadone is oral liquid, buprenorphine is sublingual (film/tablet)
Both have long half life
Methadone duration 20-36 hrs, buprenorphine duration 24-72 hrs
Discuss the general dosing advice for methadone
Daily doses, can be split doses (multiple a day)
Take away doses
What should be done with missed methadone or buprenorphine doses?
1 or 2 missed –> dose as normal
3 doses missed –> consult prescriber and review dose
4-5 doses missed –> consult prescriber and reduce dose
6+ missed —> refer to prescriber
Discuss the general dosing advice for buprenorphine
Always starts as daily dosing until stabilised
Ceiling effect of drug = reduced freq dosing regimen
double dose = dose every 2 days
triple dose - dose every 3 days
max dose = 32mg
Discuss the buprenorphine/naloxone combination product (Suboxone film)
Easier supervised dosing, reduces time for effective supervision
Film adheres in seconds and difficult to remove, reduced potential for diversion/misuse
no dose adjustment when changing from tablet to film
Discuss the use of nalterxone
Antagonist of mu opioid receptor –> orally to block opioid drugs
maintenance treatment to support relapse prevention
“insurance” –> protection against sudden temptation, but patient req motivation for abstinence
