Opiods

Question 1

Methadone

Answer 1

• Long acting, full opioid agonist
• Binds to and occupies mu-opioid receptors
• Prevents euphoria from other mu agonists
• Alleviates withdrawal symptoms
• Administered in licensed OTP
• Federal law: initial dose 10-30mg, not to exceed 40mg in 1 day
• Suppresses cravings (60-120mg+)
• Can prolong QTc w/ risk of Torsades de Pointes
• Respiratory depression can be a side effect at any dose
• Increases overdose risk significantly if mixed w/ sedative hypnotics and EtOH

Question 2

Buprenorphine

Answer 2

• Partial agonist-antagonist
• Sublingual
• Higher affinity for the mu opioid receptor compared to full agonists
• Slow to dissociate
• Will displace full agonists from the receptor w/ decreased opioid effect—> precipitated withdrawal
• Relieves cravings w/o producing euphoria or dangerous side effects of other opioids
• Naloxone to deter IV use, not active sublingually

Question 3

Receptors down-regulated in opioid addicts

Answer 3

• Dopamine D2 receptors

Question 4

Medication Therapy for Opiod Addiction

Answer 4

Opioid Agonists

• Full: Methadone (Methadose or Dolophine)
• Partial: Buprenorphine/Naloxone, Buprenorphine (Suboxone or Subutex)

Opioid Antagonis

• Naltrexone (Revia or Vivitrol)

Question 5

Goals of Opioid Addiction Therapy

Answer 5

Maximal function

• Stabilization and normalization of the brain
• Establishment of durable hedonic tone
• Engagement in care and recovery
• Prevention of disease transmission
• Restoration of health
• Prevention of death
• Achieve appropriate dosage
• NOT to see how fast a pt can taper off meds

Question 6

Naloxone/Narcan

Answer 6

• Pure antagonist at the mu receptor
• Opioid overdose reversal medication

Question 7

Signs and Symptoms of Neonatal Abstinence Syndrome (NAS)

Answer 7

• Signs of opioid withdrawal in an infant from maternal use typically start after 24-96hrs after birth depending upon the specific opioid exposure
• CNS signs

*tremors

*irritability, high-pitched crying

*sleep disturbances

*tight muscles tone, hyperactive reflexes

*myoclonic jerks (sometimes misinterpreted as seizures), seizures-rare

• Autonomic signs

*sweating, fever, yawning and sneezing

*rapid breathing, nasal congestion

• GI signs

*poor feeding, vomiting and loose stools or diarrhea

Question 8

Opioid Addiction Treatment during Pregnacy

Answer 8

• Buprenorphine; Subutex is preferred as Neonatal Abstinence Syndrome (NAS) is far less
• When not pregnant you can use Suboxone which has Naloxone in it so you cant use it IV
• Methadone used to be the drug of choice for treatment during pregnancy