Opioid Use Disorder Flashcards by Linda Chen

define opioid use disorder

problematic pattern of opioid use that leads to clinically significant impairment or distress
has to have at least 2 of the designated criteria, occurring within a 12mth period

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list 3 characteristics of OUD

taking opioids in larger amounts/ longer time
significant amount of time spent trying to get them
cravings
persistent desire or unsuccessful efforts to get them
not doing major role obligations due to use
giving up social, occupational, or rec activities
continued despite persistent/ recurrent social/ interpersonal problems caused by opioids
continued despite knowing that it is a physical/ psyc problem
use in situations where it is physically hazardous
tolerance
withdrawal

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define tolerance

needing increased amounts to achieve desired effect
diminished effect with continued use of same amount of opioid

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define withdrawal

characteristic opioid withdrawal sx or
using the same or a closely related substance to relieve/ avoid sx

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why is opioid withdrawal dangerous

tolerance may be lost rapidly (days) and when pt relapses and uses same amount as before, they can OD

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describe some reinforcing effects of opioids

pain relief (analgesia), euphoria, warmth, numbness, relief of anxiety (anxiolytic)

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describe some AEs of opioids

constipation, dry mouth, hypogonadism, weight gain, CNS/ respiratory depression

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list 3 sx of withdrawal

Rapid HR
Sweating
Restlessness
Dilated pupils
Aches (bone/ joints)
Runny eyes and nose
Upset stomach
Tremor
Yawning
Irritability
Anxiety
Goosebumps

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list 3 sx of OD

cyanosis, dizziness and confusion, can’t be woken up, choking/ gurgling/ snoring sounds, slow/ weak/ no breathing, drowsiness or difficulty staying awake

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what to do if you suspect an OD

call 911, admin naloxone, stay with person until help arrives

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how does naloxone work to prevent OD

rapidly reverses CNS and respiratory depression secondary to opioids by competitively booting opioids out of receptors + binding to them instead as an antagonist

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naloxone IM onset

2-3min

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currently, nasal naloxone spray kits are covered for pts with

NIHB coverage

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when should a second dose of naloxone be administered?

if the person has not responded within 2-3 minutes

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what tx is the lowest intensity for OUD

withdrawal management

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what is the gold standard for OUD tx

agonist therapies

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what are the 2 agonist therapies for OUD

buprenorphine/ naloxone or methadone

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when should harm reduction be offered in OUD

at all stages of the treatment intensiyt spectrum

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what is the main downside to withdrawal management for OUD

risk of relapse after losing tolerance, resulting in increased mortality

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list the 3 advantages of OAT over withdrawal management

↑ treatment retention, substance abstinence than illicit opioids, ↓ risk of morbidity/ mortality

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buprenorphine MOA

Partial mu opioid receptor agonist with high binding affinity, antagonist at kappa receptor
very strong binding affinity

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what are the 4 advantages of buprenorphine’s strong binding affinity

Good at blocking effect of other opioids = ↓ euphoria from illicit substances, important to consider when managing acute pain (↓ pain control)
Slow dissociation = long relief of withdrawal sx (can miss up to 5 consecutive days before reinitiation required)
Ceiling effect for respiratory depression
standard doses are well below legal threshold for those that are opioid naive

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what is the major con of buprenorphine/ naloxone

will have precipitated withdrawal if used too soon after last full agonist dose

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which is the preferred tx option now? suboxone or methadone

suboxone

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how is suboxone administered

dissolved sublingually, then swallowed

suboxone... 1. is absorbed SL 2. is made in noncrushable tablets 3. is an orally absorbed substance 4. has naloxone, which is responsible for the withdrawal effect

why is naloxone present in suboxone

to prevent diversion by injection is not absorbed PO if the tablet is taken appropriately, but will be absorbed if crushed and injected = unpleasant effects

how is suboxone induction done? what are the 2 options?

pt must be in mod withdrawal (COWs scale) during clinical induction, or can do a microinduction to avoid waiting until mod withdrawal may get to max tolerated dose in 24-72hrs

how soon can suboxone be tolerated to max tolerated dose

24-72hrs

can patients use illicit opioids during microinduction with suboxone?

yes

what are 2 other formulations of buprenorphine

probuphine and sublocade

what is probuphine

a buprenorphine subdermal implant

who is probuphine indicated for

for pts with OUD that are clinically stabilized on no more than 8mg of SL buprenorphine for the last 90 days

what is sublocade

a buprenorphine ER injection

sublocade is indicated for pts who

have been stabilized on an eq of 8-24mg SL per day for min 7 d

what are some cons for sublocade

very aggressive dosing may have a visible depot after injection

methadone MOA

full mu opioid agonist with slow onset of action

methadone peaks at

2-4hrs

methadone does not 1. have a long half life 2. have a slow onset 3. have a max dose 4. have the most evidence for use in pregnancy

why must methadone doses be titrated slowly?

because of the long half life- to avoid risk of accumulation

T or F: methadone for OUD is also effective for acute pain in dependent pts

F- will also need short acting agent in addition

which OAT has the most evidence in pregnancy? 1. methadone 2. buprenorphine 3. buprenorphine/ naloxone 4. none of the above

studies show that methadone has efficacy for 5 things

decreased drug use decreased transmission of HIV and Hep C decreased criminal activity decreased OD and premature mortality increased tx retention

methadone dose is typically increased by __ q___d

by 10mg q3d

how is methadone formulated for OAT 1. tablets SL 2. tablets PO 3. liquids PO 4. injection

3. dispensed in juice and diluted to 100mL to minimize risk of diversion + improve taste tablets not usually used for OAT

list the 6 cons for methadone OAT

delayed sedation slow to achieve therapeutic dose due to longer titration time more potential for interactions high risk for OD risk for serious SEs loss of tolerance occurs quickly

which one can be titrated to max dose the fastest? which has a higher risk of OD? 1. methadone 2. buprenorphine/ naloxone

2, 1

methadone can cause ____ or _____ with other agents

respiratory depression or QT interval prolongation

what are some more serious SEs of methadone

CNS depression, constipation, sweating, hypogonadism, weight gain, dental concerns

how soon does loss of tolerance to methadone happen?

3 days if last dose was >3 days, must decrease dose

what is a monitoring parameter specific to methadone

ECG

when should ECG monitoring with methadone be done

baseline, then within 30 d of initiation, then if dose ≥ 100mg + thereafter at every dose that meets/ exceeds multiples of 20 mg if pt experiences unexplained syncope, seizures, or other sx suggesting cardiac involvement if pt is initiated on a med that causes QTc prolongation

purpose of urine drug screening with OAT

Confirms reports of substance use Identify presence of concerning substances Monitor for tx efficacy and adherence

what are some specialist led tx options for OUD?

slow release oral morphine (SROM) injectable opioid agonist treatment (IOAT)

SROM is the preferred option for

those who have not stabilized on or have have CI to preferred tx options

data suggests that SROM is better than MMT for (3 things)

pt satisfaction decreasing cravings decreasing sx of persistent mild depression

what is the only formulation studied for SROM

kadian (24hr morphine product)

how is kadian usually used for OAT

Typically once daily as OAT as witnessed PO Requires diligent measures to avoid diversion + mitigate risk of OD Capsules are opened into med cup, ingestion of beads witnessed (sometimes mixed with pizza) Can not crush or chew pellets

how is IOAT done?

Pts self administer prefilled syringes of hydromorphone IV/IM up to TID in supervised setting

which of the following is false 1. opioids can be used safely in pts with hx of OUD but should be carefully monitoring 2. OAT does not treat acute pain 3. nonopioid pharmacotherapy should not be included 4. undertreated acute pain is a RF for returning/ ongoing opioid use

3- nonopioid should be included

Opioid Use Disorder Flashcards

(60 cards)