Acute Opiate Management
IV opiates should be limited to this amount of time.
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.
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
The two best opioids to use in acute pain management for patients receiving MOUD.
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?
Paperwork that MUST be faxed to the Spectrum clinic for patients on methadone at discharge.
What is the last dose letter?
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
This change of methadone dosing inpatient is appropriate to help with 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)
Suboxone is preferred over methadone in these three medical conditions.
What are COPD, hypertension, and insomnia?
This injectable treatment for AUD 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
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?
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?
This is when it is necessary to hold suboxone for surgery.
What is never?
This is when it is appropriate to discharge a patient with alcohol detox medication.
What is never?
The method of use of xylazine that is caustic to the skin.
What is every method?
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
Berkshire County Clinics: Brien Center, SaVida, Clean Slate