MAT

Question 1

overall goal of starting buprinorphine

Answer 1

To transition from opioid drug usage

Question 2

Should be established before starting your patient on Buprinorphine

Answer 2

How will the pay? Type of Insurance, Out-of-pocket

Validate acces to pharmacy

Validate Access to urine drug testing

Question 3

Office induction

Answer 3

Patient brings filled prescription into the office.

Question 4

Home induction

Answer 4

Administer at home

Question 5

Typically when should induction occur:

Answer 5

Earlier in the week

Question 6

What day to avoid inductions

Answer 6

Friday

Question 7

How to avoid precipitated withdrawal

Answer 7

Start low (2-4 mg)

Mild to moderate withdrawals at time of induction

Question 8

Patient should avoid ____ product because it interferes with medication

Answer 8

Nicotine

Avoid for 30 minutes at least

Question 9

How often do patients typicaly take Buprenorphine

Answer 9

Daily

It can be taken at night

Question 10

How long should you wait to induce Buprenorphine after a patient’s last dosage of short acting opioiod

Answer 10

12 - 16 hours

Question 11

How long should you wait to induce Buprenorphine after a patient’s last dosage of sustained release opioid

Answer 11

24 hours

Question 12

How long should you wait to induce Buprenorphine after a patient’s last dosage of methadone

Answer 12

36 hours

Question 13

Example of short acting opioids

Answer 13

Heroin

oxycodone

hydrocodone

Question 14

Where should COW score be at before you induce Buprenorphine for SA opioids

Answer 14

> 8

Question 15

How low should methadone be before introducing Buprenoprhine

Answer 15

30 mg

Consider dosing down to 15 mg

Question 16

Process of induction when you are working with methadone user

Answer 16

Last day of methadone use (15 - 30 mg)

Next day - don’t take

Following day - introduce Buprenorphine ( 2 - 4 mg)

Make sure they are in mild to moderate withdrawal via COW scale before giving Buprenorphine

Question 17

How long should you monitor after first dosage of Buprenorphine is given in office

Answer 17

At least two hours

Question 18

How should you respond if opioid withdrawal re-appears

Answer 18

re-dose every 2-4 hours

Question 19

Typical dose range

Answer 19

8 - 16 mgs

Question 20

Interval of dose titration per day after induction

Answer 20

2 - 6 mgs/daily

You can increase rapidly if patient has a lot of cravings

Question 21

When should we expect relieve of opioid withdrawal

Answer 21

30 - 45 minutes

Question 22

Expected first dosage of induction

Answer 22

2 - 4 mg

Question 23

When do we see a steady state of stabilization

Looking for the days

Answer 23

5 days

Question 24

WHAT IS THE REASON WE GO UP ON DOSE

THE AUTHOR REPEATED THIS SO THIS IS IMPORTANT

Answer 24

ONLY FOR CRAVINGS

Do not fall victim to withdrawal sx. The drug always wins. Let them know their body is learning to stabalize

Question 25

What if Opioid withdrawal occurs right after dosage of med

Answer 25

Precipitated withdrawal occurring

Question 26

Two options if patient is going through precipitated withdrawals | What do we do

Answer 26

Increase the med Stop the induction and treat symptoms ## Footnote Increasing the med allows for more partial agonist effect of buprenorphine

Question 27

What is the preferred method of response to precipitated withdrawal and why

Answer 27

Increase the med. We *DO NOT WANT TO LOSE THE PATIENT*

Question 28

Dose range where stabilization typically occurs:

Answer 28

8 - 16 mgs

Question 29

Rarely is there a reason to go over ____ mg/daily | Looking for a dose here

Answer 29

16 mg ## Footnote Typically insurance companies do not approve a dosage above 24 mgs

Question 30

Drugs typically not found in a drug screen | You have to specifically ask for this to be found in a UDS

Answer 30

Buprenorphine Fentanyl Oxycodone Methadone