SUD I | Opioid-Related Disorders Cheat Sheet
by Shelbi (kfisher17) via cheatography.com/79317/cs/21866/
Terminology Opioid Use Disorder | TREATMENT
Natural Opiates Semi-Synthetic Synthetic Opioids FIRST LINE SECOND LINE
Codeine Burprenorphine Fentanyl APA:
Morphine Heroin Meperidine Buprenorphine Naltrexone PO
Hydrocodone Methadone Methadone
Hydromorphone Sufentanil BAP:
Oxycodone Sufentanil Buprenorphine Naltrexone PO
Oxymorphone Methadone
Tramadol VA/DOD:
Suboxone Naltrexone
PATHOPHYSIOLOGY
Buprenorphine
Risk Factors: males, history of depression or anxiety, family history of
Methadone
alcohol or drug abuse, age ≤ 30, long-term opioid use
Psychosocial treatment is also the first line in addition to
Involves the mesolimbic reward system
pharmacotherapy
Standardized Assessment Tools
Buprenorphine Formulations
Score Severity
Buprenorphine Buprenorphine-Nalox‐
5 to 12 Mild
one
13 to 24 Moderate
Brand Subutex Suboxone, Zubsolv
25 to 36 Moderate to Severe
MOA Mu opiate receptor - partial Mu-partial agonist and
> 36 Severe agonist opioid antagonists
COWS: Clinical Opiate Withdrawal Scale Formul‐ SL tablet SL tablet, SL film; (4:1
• used clinically to monitor withdrawal ation ratio of bupren. and
• often utilized to determine when PRNs are needed naloxone)
Dosing 8 to 32 mg bupren./day 8 to 32 mg bupren/day
NALOXONE
range
MOA Opioid Antagonist Warnings initiation should not begin same
Warning‐ Cardiac or respiratory effects associated with rapid until pt is experiencing
s/ADRs reversal of opioids withdrawal
Aggression (from immediate withdrawal) respiratory depression same
Administra‐ Call 911 FIRST risk of abuse or dependence same
tion DDIs CYP3A4 inhibitors/inducers same
Administer CNS depresants same
If no response after 3 minutes, administer 2nd dose
• It only works on opioid receptors!
• It will NOT affect someone (positively or negatively) if they do not
have opioids in their system
By Shelbi (kfisher17) Published 23rd February, 2020. Sponsored by Readable.com
cheatography.com/kfisher17/ Last updated 25th February, 2020. Measure your website readability!
Page 1 of 4. https://readable.com
SUD I | Opioid-Related Disorders Cheat Sheet
by Shelbi (kfisher17) via cheatography.com/79317/cs/21866/
Buprenorphine Formulations (cont) Preferred treatment
Monitoring Tolerability, resp. depression, same Methadone buprenorphine
(LFTs), urine drug screening, Chronic Pain Prolonged QT interval
PMP, urine buprenorphine
history or diversion or not able to attend daily clinic
Clinical Preferred in pregnancy; higher naloxone added pilysubstance use
Pearls abuse potential as an abuse
requires closer requires less monitoring and no untreated
deterrent;
monitoring psychiatric comorbidities
preferred formul‐
pregnant women dependent on lower doses of opioids
ation in non-pr‐
(ceiling effect)
egnant patients
requires wide dosing range
partial agonist activity results in same
ceiling effect, higher binding
Terms
affinity than other opioids, newer
formulation include sub-dermal Opioid Person using opioids begins to experience a reduced
implant, and subcutaneous Tolera‐ response to medication requiring more opioids to
injection nce experience the same effect
Prescribing Restrictions: Opioid Occurs when the body adjusts its normal functioning
Schedule III Depen around regular opioid use (unpleasant physical symptoms
DATA waiver dence occurs when med is stopped)
Initial no. of pts is 30 Opioid Occurs when attempts to cut down use are unsuccessful
May apply 1 year to increase no. of patients to 100, then 275 Addict‐ or when results insocial problems and a failure to fulfill
DEA number will begin with X ion obligations; often comes after person has developed
opioid tolerance and dependence
Signs and Sx of opioid WITHDRAWAL
Dysphoric mood Fever Narcan MOA
Lacrimation or Rhinorrhea Muscle aches
Yawning Diarrhea
N/V Insomnia
Pupillary Dilartion Piloerection (goosebumps)
Sweating
WITHDRAWAL TIMELINE
Onset of withdrawal will depend upon the half-life of the opioid used
(normally within 36 to 72 hours)
Completed within 7 days for short acting opioids (heroin) and 14
days for long-acting opioids (buprenorphine, methadone)
By Shelbi (kfisher17) Published 23rd February, 2020. Sponsored by Readable.com
cheatography.com/kfisher17/ Last updated 25th February, 2020. Measure your website readability!
Page 2 of 4. https://readable.com
SUD I | Opioid-Related Disorders Cheat Sheet
by Shelbi (kfisher17) via cheatography.com/79317/cs/21866/
DSM-5 DIAGNOSTIC CRITERIA Methadone (cont)
A problematic pattern of substance use leading to clinically Mainte‐ 80 to 120 mg daily
significant impairment or distress, manifested by ≥ 2 of the nance
following over a 12-month period dose
Substance is taken in larger amounts or over a longer period than Warnings QTc prolongation, respiratory depression, risk of abuse
intended or dependence
Persistent desire or unsuccessful efforts to reduce or control use DDI QTc prolongating meds, CYP3A4 inhibitors or
A great deal of time is spent in activities necessary to obtain, use, inducers, Medications that induce hypokalemia,
or recover from effects hypocalcemia, or hypomagnesemia; CNS depressants
Cravings or a strong desire to use Monitoring Tolerability, respiratory depression, HR/BP, EKG,
electrolytes, UDS, urine methadone, PMP
Recurrent use resulting in a failure to fulfill major obligations
Clinical prolonged or delayed withdrawal due to long half-life;
Continued use despite having persistent social or interpersonal
Pearls overdose risk is highest during initial 2 weeks of
problems caused by the substance
treatment
Important social, occupational, or recreational activities are given up
Prescribing restrictions:
or reduced
- schedule II; restricted to certified opioid treatment program (OTP)
Recurrent use in situations that are physically hazardous
- it is not appropriate to dispense methadone from a community
Recurrent use despite knowledge of having a persistent or recurrent pharmacy for the purposes of opioid detox, withdrawal, or mainte‐
physical or psychological problem due to use nance
Tolerance - pts must be currently addicted and have opioid use disorder ≥ 1
Withdrawal year
- exceptions: pregnancy, recently released from correction, and
FIRST - LINE TREATMENT previous treatment in OTP
APA British Association of Psychopharmacology
know difference between prescribing of methadone and
Buprenorphine Alpha-2 agonist buprenorphine
Methadone Buprenorphine
Methadone Signs and Sx of INTOXICATION
Targeted at individual symptoms of withdrawal Pulillary Constriction
Common practice if an opioid treatment program (OTP) or bridging Slurred Speech
medication-assisted treatment (MAT) Drowsiness
Impaired attention or memory
Methadone
Brand METHADOSE Signs and Sx of Opioid OVERDOSE
MOA opioid agonist Pupillary constriction
Formul Liquid (opioid maintenance); tablets (pain only) | this is for Shallow or slow respirations
ation pharmacies (methadone clinics do tabs)
Stupor
Coma
Hypothermia
Bradycardia
By Shelbi (kfisher17) Published 23rd February, 2020. Sponsored by Readable.com
cheatography.com/kfisher17/ Last updated 25th February, 2020. Measure your website readability!
Page 3 of 4. https://readable.com
SUD I | Opioid-Related Disorders Cheat Sheet
by Shelbi (kfisher17) via cheatography.com/79317/cs/21866/
Narcan Formulations
Naloxone IM/IV/SQ
Naloxone Intranasal
Evzio IM auto-injector
Narcan Intranasal
SYMPTOMATIC TREATMENT (PRN)
Medication Class/MOA Indication
Clonidine Alpha-2 agonist reduced the noradr‐ Generalized
energic hyperactivity associated with Sx of opioid
opioid withdrawal withdrawal
Loperamide Anti-diarrheal Diarrhea
Ondans‐ Antiemetic N/V
etron
Trazodone Sedatine antidepressant Insomnia
Hydrox‐ Antihistamine/anxiolytic Anxiety
yzine
Ibuprofen NSAID muscle pain
Cyclobenz‐ skeletal muscle relaxant muscle
aprine cramps
By Shelbi (kfisher17) Published 23rd February, 2020. Sponsored by Readable.com
cheatography.com/kfisher17/ Last updated 25th February, 2020. Measure your website readability!
Page 4 of 4. https://readable.com
