UDS
The purpose of the UDS.
What is a tool for discussion?
Tool to predict complicated withdrawal and 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.
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, methadone is preferred
Two positive results on the UDS that enable continuity of SUD treatment while inpatient.
What is methadone and suboxone?
The legal blood alcohol limit in Massachusetts.
What is <80 mg/dL or 0.80 g/dL?
The most undertreated syndrome in clinical medicine.
What is AUD?
Paperwork that MUST be faxed to the Spectrum clinic for patients on methadone at discharge.
What is the last dose letter?
Clinical tool to assess opiate withdrawal and the symptoms it assesses.
What is COWS?
Fever, yawning, pupils, sweating, vitals, vomiting, diarrhea, goosebumps, runny nose, tears
Trazodone, risperidone, haloperidol, pipamperone, and labetalol can result in a false positive of this substance
What is fentanyl?
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?
CIWA with phenobarbital
CIWA with diazepam/lorazepam
CIWA with PRNs only
The patient population that Narcan is harmful in.
What is NO ONE?
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)
Three Berkshire County buprenorphine clinics for the treatment of OUD.
What is the Brien Center, SaVida, and Clean Slate?
Suboxone/Sublocade/Brixadi are all verifiable through PDMP
The benzodiazepines poorly detectable by UDS.
What are lorazepam, clonazepam, midazolam, and chlordiazepoxide?
A medication FDA approved for AUD treatment that studies have since shown has no significant benefit.
What is acamprosate (Campral)?
The method of use of xylazine that is caustic to the skin.
What is every method?
The day of the week Spectrum has limited hours and availability for new patients.
What is Sunday?
Discharge planning
Methadone can be provided in the ED up to 72 hrs
Minimum COWS score required to initiate suboxone.
What is 10?
A 26 year old female 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
2. Monitoring with COWS until MOUD is determined
3. Checking QTc
This medication used for the treatment of AUD that has an injectable form and complicates pain management.
What is Vivitrol?
Opiate antagonist effects for a month; treat acute pain with non-opiates
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
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 St Ste 201 Pittsfield
6 W Main St North Adams
The lowest dose Spectrum Pittsfield will start a patient on.
What is 30 mg daily?
For admission purposes: safe place to start if dose cannot be confirmed
A once monthly injectable form of buprenorphine for OUD.
What is sublocade?
Not available inpatient, PDMP unreliable