Acute Opiate Management
Suggested time period to provided IV opiates post-op for patients on MOUD.
What is 3-5 days?
(Exceptions to the rule)
Tool to predict complicated withdrawal which helps direct monitoring protocol choice
What is PAWSS?
Additionally ask about: last drink, if they take days off, most recent period of sobriety, history of DUI/incarceration
The most stigmatized syndrome in clinical medicine.
What is SUD?
Methadone affects this biologic metric.
What is QTc?
Other QTc prolonging agents include: ondansetron, hydroxyzine, trazodone, amantadine, psychotropics, etc.
A negative urine drug screen rules out illicit substance use.
What is false.
The recommended opioids to use in acute pain management for patients receiving MOUD (Methadone Suboxone).
What are fentanyl and dilaudid?
Dilaudid 2 mg = 10 MME
Oxycodone 5 mg; 10 mg = 7.5MME; 15 MME
The legal blood alcohol limit in Massachusetts.
What is <80 mg/dL or 0.80 g/dL?
The patient population that Narcan is harmful in.
What is NO ONE?
A once monthly injectable form of buprenorphine for OUD.
What is Sublocade or Brixadi.
Not available inpatient, PDMP unreliable
Benzodiazepines poorly detectable by the inpatient UDS.
What are lorazepam, clonazepam, midazolam, and chlordiazepoxide?
Supportive care team with patient approval will adjust methadone dosing inpatient to help with acute pain .
What is split dosing?
PRN dosing of methadone for acute pain is NOT indicated in patients with OUD
45 year old male with no documented medical history presents to ED with fall. Imaging shows some fractures for which surgical correction is required and patient is admitted. 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?
CIWA with phenobarbital
CIWA with diazepam/lorazepam
CIWA with PRNs only
Appropriate times to consult SUD team.
What is: patients on MOUD, patients with positive UDS, patients in withdrawal (AUD/OUD/StUD), patients in remission of SUD with acute pain management needs, patients with chronic pain in SUD
PLUS any time you have questions :)
The only way to confirm methadone dosing for OUD.
What is calling the designated clinic? Verify dose and last given
Methadone will not appear in the PDMP (unless prescribed for chronic pain)
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.
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
A medication FDA approved for AUD treatment that studies have since shown has no significant benefit.
What is acamprosate (Campral)?
Trazodone, risperidone, haloperidol, pipamperone, and labetalol can result in a false positive of this substance
What is fentanyl?
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, initiation of Suboxone can be challenging/ with long half-life street Fentanyl -options inpatient that have been helpful are Butrans etc.
Name 3 of the many contaminates found in our street Fentanyl drug supply
what is?
MDMA
Lidocaine
Medetomidine
Xylazine
Cocaine
Procaine
Caffeine
A patient taking Suboxone is scheduled for major surgery. The surgeon says, "We need to stop the Suboxone because opioids won't work otherwise." What is the best response?
What is "Buprenorphine should not be routinely stopped; involve anesthesia, pain, and SCT to help develop an individualized plan.
A medication method used to treat alcohol use disorder, not commonly used.
What is the Sinclair method.
This method of xylazine use is caustic to the skin.
What is every 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
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.