Methadone/Suboxone
Methadone affects this biologic metric.
What is QTc?
Other QTc prolonging agents include ondansetron, hydroxyzine, trazodone, amantadine, psychotropics, etc.
The most undertreated syndrome in clinical medicine?
What is alcohol use disorder.
Untreated alcohol withdrawal can progress to this life threating condition.
What is delirium tremens (DTs)
The most stigmatized syndrome in clinical medicine.
What is substance use disorders.
Trazodone, risperidone, haloperidol, pipamperone, and labetalol can result in a false positive of this substance
What is Fentanyl ?
The recommended dose of Methadone to prescribe a patient with an OUD at discharge is.
What is 0mg.
Methadone will not appear in the PDMP or be prescribed for patients with OUD (this medication is prescribed for pain not OUD)
What medication can reverse opioid overdose
What is Narcan
Who should carry this ?
What is the Legal blood alcohol limit in Massachusetts?
What is <80 mg/dL or 0.80 g/dL?
HCV can be tested for and treated at Berkshire Harm reduction.
What is true.
Benzodiazepines poorly detectable by the inpatient UDS.
What are lorazepam, clonazepam, midazolam, and chlordiazepoxide?
Adverse effect of suboxone if it is initiated too early due to its mechanism of action.
What is precipitated withdrawal?
MOA: Partial agonist
If patient is not in withdrawal, COWS is to be started and monitor for symptoms of withdrawal
Kratom is non habit forming and does not require detox management.
What is false, Kratom use has become increasingly more common with some patients requiring Suboxone and additional medications for detox management.
This medication used for the treatment of AUD that has an injectable form, PO form and complicates pain management.
What is Vivitrol?
Opiate antagonist effects for a month; treat acute pain with non-opiates/Ketamine
To initiate naltrexone: must be opiate free 7-10 days; longer if methadone/buprenorphine; no time limit with alcohol
Side note: vivitrol is NOT available through inpatient pharmacy -PO Naltrexone/Revia
Narcan can cause harm to this population if used on.
Who is NO ONE!!
A 26-year-old presents to the ED with UDS positive for buprenorphine, methadone, fentanyl. It is Sunday at 3 PM. Next best steps include:
What is:
1. Checking the PDMP (ask patient)
2. Monitoring with COWS until MOUD is determined/confirmed
3. Checking QTc
A once monthly injectable form of buprenorphine for OUD.
What is Brixadi or Sublocade .
Name two harm reduction strategies.
What are syringe services, fentanyl/xylazine test strips, Hep C and HIV testing, Hep C treatment, supervised consumption sites (where legal), safer use education
A medication method used to treat alcohol use disorder, not commonly used.
What is the Sinclair method.
Location for free hepatitis C/HIV/STI treatment, Narcan, syringe services, sharps disposal, harm reduction test strips, etc.
What is?
Berkshire Harm Reduction
42 Summer Street 2nd Floor Suite 201
Pittsfield, MA 01201 413-447-2654
Prescription Drug Monitoring Program often referred to as PDMP can provide
What is a secure database that tracks controlled substance prescriptions. It can act as a clinical tool for healthcare providers.
What medication is the best treatment for OUD, how do you decide what to order (ex-methadone, suboxone, Sublocade)
What is whatever works best for patient, and whatever the patient wants. Talk with the patient.
Methadone -daily
Suboxone different regulations
People admitted to the hospital and meet criteria for a opioid use disorder should always leave the hospital with this.
What is a Naloxone Kit/prescription
45 year old male with no documented medical history presents to ED with altered mental status. CT head is negative, labs are all within normal limits, UDS is negative. Husband reports significant daily alcohol use; however, BAL<10 mg/dL. This protocol should be started.
What is CIWA with phenobarbital? Monitor closely, contact provider if scores go above 10 to add medication.
Name 3 of the many contaminates found in our street Fentanyl drug supply
MDMA
Lidocaine
Medetomidine
Xylazine
Cocaine
Procaine
Caffeine
A negative urine drug screen rules out opioid use.
What is False?