Opioid withdrawl Flashcards
RASS scale
Richmond Agitation sedation scale
COWS assessment, general?
What specific things does it look at and rate on a scale of 0-5?
clinical opiate withdrawal scale
tool used to determine the stage or severity of opioid dependence or to determine treatment management of withdrawals.
resting pulse rate
sweating (past half hour)
restlessness
pupil size
bone or joint pain
runny nose or tearing
GI upset (over last 30 mins)
tremor
yawning
anxiety/irritability
goosflesh skin (bumps) – priloerection of skin (3)
COWS score?
Mild 5-12
Moderate 13- 24
Moderately severe 25- 36
severe >36
treatment for withdrawal drugs
Methadone
Suboxone
Buprenorphine
Adjuvant symptom management
3 types of pain receptors
mu
kappa
delta
Mu receptors responisble for?
analgesia and dependence
*euphoria, dependence, analgesia, respiratory depression, miosis, decreased digestive tract motility, constipation, vasodilation
Kappa receptors
provide analgesia, diuresis, and dysphoria
delta receptors
analegsia and reduction in gastric motility
Methadone characteristics and effects
taper? effects last?
long acting medication
full agonist at MU pain Receptors
has an ADDITIVE affect to already present opioids
taper is usually 5-14 days, affects can last 24 hrs or more
side effects of methadone
can effect the QT interval, constipation, mild drowsiness, excess sweating, peripheral edema, erectile dysfunction
suboxone and subutex
aka?
brief
suboxone = buprenorphine + naloxone at 4:1 ratio
subetex= burenorphine
avoid giving suboxone when?
avoid giving if RASS score is -1 or lower
buprenorphine charactersistics
PARTIAL AGONIST of the MU and kappa opioid receptors. works well on all mu receptors except with fentamyl.
avoid giving buprnorphine when? what stage?
patient must be in mild to moderate withdrawal stages – if given too early can precipitate withdrawal
