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CDM 4 Exam 2 > Opioid use disorder > Flashcards

Opioid use disorder Flashcards

1
Q

Maintenance treatment

A

Buprenorphine
Methadone
Naltrexone

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2
Q

Overdose treatment

A

Naloxone

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3
Q

Short term effects of opioid use

A

Analgesia
Euphoria
Sedation
Respiratory depression
Death

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4
Q

Long term effects of opioid use

A

Tolerance
Dependence
Addiction
Reduced analgesia or hyperalgesia
Low testosterone
Constipation
Sedation
Respiratory depression
Death
Endocarditis (d/t IV use)
Cellulitis (d/t IV/SQ use)
Osteomyelitis (d/t IV/SQ use)

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5
Q

Withdrawal sx of opioid use

A

Restlessness
MS pain
Insomnia
N/V/D
Gooseflesh
Autonomic dysfunction

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6
Q

Dopamine D2 receptors are ___in addiction

A

lower

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7
Q

Methadone MOA

A

Full agonist at the mu opioid receptor (MOR)
Long acting

Maintains tolerance, reduces cravings

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8
Q

Opioid treatment programs (OTP)

A

Methadone requires enrollment in registered clinic

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9
Q

Methadone clinical action

A

Reduce/eliminate withdrawal symptoms
Blunt/block effects of other opioids
Reduce/eliminate cravings

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10
Q

Methadone dosing

A

10-30 mg starting dose
monitor 2-4 hours
titrate (weeks 1-2) 5 mg every 5+ days
(weeks 3-4) 5 mg every 3-5 days
(week 5+) dose stabilization

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11
Q

Methadone advantages

A

No lag to start time
Treats co-morbid pain
Long half-life (~24-55 hours)
Treatment retention

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12
Q

Methadone disadvantages

A

OTP structure
Adverse effects (no ceiling)
Changes to CYP2D6
Drug-drug interactions
Age-related changes

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13
Q

Methadone considerations

A

1st line treatment
Analgesia & euphoria last 6-8 hours; can lead to “dose stacking” and possibly overdose
Once daily

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14
Q

Buprenorphine MOA

A

Partial agonist at the mu opioid receptor (MOR)

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15
Q

Buprenorphine clinical action

A

Reduce/eliminate withdrawal symptoms
Blunt/block effects of other opioids
Reduce/eliminate cravings

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16
Q

Buprenorphine dosing

A

Requires induction (SL formulation)
2-4 mg, wait 2 hours
maximum of 8 mg day 1, 16 mg day 2

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17
Q

Buprenorphine subcutaneous injection

A

Must take 8-24mg SL buprenorphine x7 days

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18
Q

Buprenorphine transdermal implant

A

Must take <8mg SL buprenorphine x3 months

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19
Q

Buprenorphine education points

A

products not equivalent
take dose at regular intervals
do not swallow SL tabs or film

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20
Q

Sublingual tablets counseling

A

Place tablets under tongue and allow the tablet to fully dissolve which can take several minutes.
If your dose requires multiple tablets, all tablets can be placed under the tongue at one time. If this is uncomfortable, only place two tablets under the tongue at a time.

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21
Q

Sl film education

A

Drink water prior to placing the film to help the film dissolve easily.
Place film under the tongue, to the left or right of the center of the tongue, and allow to completely dissolve
If you are prescribed 2 films at a time, place the second film on the opposite side of the tongue. Do not allow the films to touch.
If you are prescribed more than 2 films at a time, wait until previous films have dissolved and repeat the process.

22
Q

buccal film counseling

A

Wet the inside of your cheek with your tongue or rinse with water prior to placing film.
Hold the film by the edges with two fingers and place on inside of cheek until fully dissolved that can take up to 30 minutes.
If you are prescribed two films, place the second film inside the opposite cheek.
Do not adjust the film placement or touch the film, do not chew or swallow the film.
Do not drink or eat until the film has completely dissolved.

23
Q

Buprenorphine advanatges

A

Ceiling effect
Treats co-morbid pain
Treatment retention
Long-acting products

24
Q

Buprenorphine disadvanatges

A

Dosed multiple times per day?
Requires induction
Precipitated withdrawal?

25
Q

Naltrexone MOA

A

Antagonist at the mu opioid receptor (MOR)

26
Q

Naltrexone prescribing restrictions

A

None - enroll in REMS

27
Q

Naltrexone clinical action

A

Blunt/block effects of other opioids
Reduce/eliminate cravings

28
Q

Naltrexone treatment for OUD

A

oral not usually preferred
ER IM once monthly
must be opioid-free 7-10 days
administer in gluteus

29
Q

Naltrexone advantage

A

Long-acting product
Lack of induced tolerance
Lack of misuse

30
Q

Naltrexone disadvantage

A

Blocks opioid analgesics
Does not treat pain
Opioid free requirement
Reduced opioid tolerance
Risk of overdose
May increase depression

31
Q

Pregnancy

A

Safest to start pharmacotherapy, not detox

Do NOT discontinue if someone is stable and becomes pregnant

Buprenorphine requires mild withdrawal to start; milder NAS; avoid combo w/ naloxone

32
Q

Intoxication

A

Euphoria
Miosis (pinpoint pupils)
Constipation
Drowsiness (“nodding”)
Itching/red eyes
Slurred speech
Impaired attention/memory
Droopy muscles
Responds to stimuli (verbal, sternal)

33
Q

Overdose

A

Loss of consciousness
Unresponsive to stimuli
Awake, but unable to talk
Slow, shallow, or halted breathing
Blue-ish tint to skin (for light skin)
Ash/gray tint to skin (for dark skin)
Choking/snoring/gurgling (death rattle)
Limp body
Pale/clammy face
Fingernails/tips are blue, purple, or black
Slow, erratic, or absent heartbeat

34
Q

Risk factors for OD

A

Mixing substances (esp. other CNS depressants)
Using alone
Not taking turns
Using without Narcan close by/visible
Bypassing “tester shots”
Liver/respiratory disease
Use after abstinence

35
Q

Harm reduction steps

A

Education re: separating substances
Education re: not using alone
Education re: taking turns
Narcan distribution/education
Education re: test shots

36
Q

General opioid counseling

A

Take medication only prescribed for you, only take prescribed doses
Do not mix opioids with alcohol or sleeping pills
Always store all medications in a locked and secure place
Dispose of unused medications appropriately
Do not use opioids/medications in seclusion. Never buy opioids/medications from unknown source
Do not restart opioid at same dose if there is a period of abstinence. Overdose is possible due to lower tolerance

37
Q

Opioid overdose reversal

A

Naloxone (IM, Inject, nasal, intranasal

38
Q

Naloxone counseling

A

Overdose recognition, response, prevention
Importance of seeking emergency medical care
Proper device use and counseling of family members and caregivers
Proper storage, shelf life. Periodically check expiration date
Potential adverse medication effects associated with naloxone
Availability of substance use disorder treatment program

39
Q

Responding to an overdose

A

Check for symptoms of opioid overdose
Call 911 and administer naloxone
Stay until help arrives

40
Q

Opioid withdrawal onset

A

symptoms begin at 6 hours, peak at 72 hours

41
Q

Clinical presentation of overdose

A

Strong cravings
N/V/D
Stomach cramps
Sweating/chills
Goosebumps
Shakes/tremors
Agitation/anxiety
Muscle aches
Runny nose/eyes
Yawning
Insomnia
Dilated pupils

42
Q

Comfort Medications

A

May be required for naltrexone given the need to be opioid free for 7-10 days (i.e. withdrawal)

43
Q

Standard comfort medication

A

Clonidine 0.1-0.3mg every 6-8 hours; maximum 1.2mg daily

44
Q

comfort meds: anxiety

A

Benzodiazepines (clonazepam); Antihistamines (hydroxyzine),

45
Q

comfort meds: pain

A

acetaminophen or NSAIDs

46
Q

comfort meds: nausea

A

hydration
ondansetron

47
Q

comfort meds: diarrhea

A

loperamide

48
Q

comfort meds: insomnia

A

trazadone, doxepin, quetiapine, z-drugs

49
Q

comfort meds: stomach pain

A

Dicyclomine

50
Q

risk factor for infection

A

Sharing/reusing needles
Not cleaning injection site
Not covering broken skin
Non-sterile diluent
Reusing cotton/cotton shots

CDM 4 Exam 2 (13 decks)

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