Opioids Unless otherwise indicated, the answers are from DSM-IV-TR and APA Practice Guidelines, AJP...
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Transcript of Opioids Unless otherwise indicated, the answers are from DSM-IV-TR and APA Practice Guidelines, AJP...
![Page 1: Opioids Unless otherwise indicated, the answers are from DSM-IV-TR and APA Practice Guidelines, AJP Supplement, August, 2006. As of 3Aug06.](https://reader035.fdocuments.in/reader035/viewer/2022070401/56649f205503460f94c38a8b/html5/thumbnails/1.jpg)
Opioids
Unless otherwise indicated, the answers are from DSM-IV-TR and APA Practice
Guidelines, AJP Supplement, August, 2006.As of 3Aug06
![Page 2: Opioids Unless otherwise indicated, the answers are from DSM-IV-TR and APA Practice Guidelines, AJP Supplement, August, 2006. As of 3Aug06.](https://reader035.fdocuments.in/reader035/viewer/2022070401/56649f205503460f94c38a8b/html5/thumbnails/2.jpg)
Treatment of intoxication
Q. Treatment of acute intoxication? Divide into mild to moderate treatment and severe intoxication and its treatment.
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Treatment of intoxication
Ans. Mild to moderate intoxication has no specific treatment. Severe overdose, e.g., R down, stupor, or coma requires 24 hour setting and naloxone to reverse.
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Naloxone dosing
Q. For severe intoxication, what dosing would you order?
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Naloxone dosing
Ans. Depends on how opioid dependent the pt is and how severe the respiratory depression. If R is very depressed, use 2.0 mg IV. If not that severe, use from 0.05-0.4 mg IV, using less for those pts who are opioid dependent. If pt doesn’t respond in 2 minutes, e.g., R improve And pupil size become normal, repeat. Still not adequate response, repeat q 5 minutes two times.
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Naloxone failure
Q. After you have had complete failure of the four doses in the previous slide, what to do?
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Naloxone failure
Ans. You have only part of the dx as another overdose, e.g., barbiturates overdosage, or head trauma may also be present.
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Opioid withdrawal treatment
Q. What meds to use for management of opioid withdrawal?
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Opioid withdrawal treatment
Ans. Methadone or buprenorphine.
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Methadone dosing
Q. What is the dosing of methadone in opioid withdrawal?
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Methadone dosing
Ans. Depending on the objective signs of withdrawal, 10 mg every 2 – 4 hours until withdrawal signs are stabilized, usually means the pt will be on 10 – 40 mg/d.
Once stabilized, taper at 5 mg/d.
As you get below 20 mg/d pt may complain of withdrawal: Manage with clonidine.
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Buprenorphine dosing
Q. What is the dosing of buprenorphine for opioid withdrawal?
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Buprenorphine dosing
Ans. Stabilization of signs usually occur at a dosage of 8 mg/d in hospitals or 8-32 mg/d in clinics. Tapering over 10-14 days reducing at rate of 2 mg/d.
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Clonidine use
Q. What is clonidine useful for as to opioid withdrawal?
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Clonidine use
Ans. Clonidine:-- reduces nausea, vomiting, diarrhea,
abdominal cramps, and sweating associated with methadone tapering.
-- not helpful with muscle aches, insomnia, or opioid craving
-- remember, with a few pts, hypotensive crisis. To have an order: “Take BP and if < 90/60, skip next dose.”
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Ultra-rapid detox
Q. What is ultra-rapid detoxification and what is its status?
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Ultra-rapid detox
Ans. Naltrexone detox while under general anesthesia. Not recommended.
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Psychosocial approaches
Q. List the six psychosocial approaches that may be helpful in treating opioid dependence whether the pt is on meds or not.
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Psychosocial approaches
Ans.
1] CBT
2] behavioral therapies
3] psychodynamic therapies
4] drug counseling
5] group and family therapies
6] self-help groups
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Opioid dependence - FDA
Q. Meds FDA approved for opioid dependence?
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Opioid dependence - meds
Ans. FDA approved:
1] methadone
2] buprenorphine
3] LAAM
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Methadone maintenance
Q. Methadone maintenance typical dosing?
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Methadone maintenance
Ans. 40 – 60 mg/d
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Buprenorphine maintenance
Q. Buprenorphine maintenance typical dosing?
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Buprenorphine maintenance
Ans. 8-32 mg every two to three days.
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Naltrexone maintenance
Q. While not specifically approved for opioid maintenance treatment, what is the typical dosing of those using naltrexone for maintenance?
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Naltrexone maintenance
Ans. 100 mg on Mondays, 100 mgs on Wednesdays, and 150 mg on Fridays.
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Naltrexone wait time
Q. What is the wait time before beginning the use of naltrexone maintenance?
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Naltrexone wait time
Ans. Five days for short-acting opioids and seven days for long-acting opioids.