Opioid Withdrawal

18-20 hours after last dose

S&S: dilated pupils, anorexia/loss of appetite, gooseflesh/goosebumps, tremors, restlessness, irritability, anxiety

8-12 hours after last dose

S&S: excessive tearing of the eyes/lacrimation, dilated pupils, sweating, yawning, runny nose/rhinorrhea

suboxone

NOT prescribed in pregnancy because of concern regarding the effects of naloxone on the fetus

suboxone/buprenorphine

OD: very unlikely, naloxone won't work very well, if OD does occur you will see respiratory distress

adverse outcomes of tapered opioid doses or cold turkey

PTL, fetal distress, fetal growth restriction, placental abruption, possible fetal death, relapse to drug use

48-72 hours after last dose

S&S: insomnia/can't sleep, N/V, sneezing, diarrhea, excessive tearing of the eyes/lacrimation, abdominal cramps, muscle spasms, increased HR, increased BP, body aches, low back pain, chills & hyperthermia

narcotic use in hospital setting

S&S: lethargy, drowsiness or "nodding off" mid-conversation, lack of concentration, slurred speech, constricted (small) pupils, itchy skin, tracks/scars on the inner arms from needle use

12-14 hours after last dose

S&S: restless sleep

severity of withdrawal

_________ is related to the dose, length of time, type of drug and the patient

opioid

a group of drugs used for treating pain

methadone or subutex

bind to opiate receptors in the brain and block or partially block the euphoric effects of other opioids

suboxone

blocks other opioids, reduces OD risk

subutex

buprenorphine ONLY; used in pregnancy

suboxone

buprenorphine PLUS naloxone

methadone

crosses the placenta, mother's should be encouraged to remain on drug treatment during pregnancy, reduces or eliminates drug use, maintains abstinence

opioids

derived from opium, which comes from the poppy plant

methadone

doses may need to be increased as pregnancy advances; altered drug metabolism in placenta and fetus, increased fluid space, without increase in level signs and symptoms of withdrawal may be visible

opioids

morphine, dilaudid, oxycodone, oxycontin, Percocet, vicodin, Demerol, fentanyl and heroin

heroin (can be inhaled or injected), oxycodone

most commonly abused in hospital

8-12 hours; 6 hours

opioid withdrawal usually begins _________ after the last dose used, however sometimes symptoms may begin after _____

suboxone/buprenorphine/naloxone

partial opioid agonist (higher safety profile, milder withdrawal), slow detachment from receptor(long duration of action, milder withdrawal), sublingual dosing

Warning signs of withdrawal

patient going in and out of bathroom or spending a long amount of time in the bathroom/ sheets needing to be changed frequently due to excessive sweating/ reports of GI upset (needing to empty bedside commode, frequent BR use or incontinence)/ suspicious patient and visitor activity (does the pt become more lethargic or spend a lot of time in the BR after or during patient visits?)

opioid withdrawal

patient unique, no one-size-fits-all

delivery

patients switched from subutex to naloxone after

naloxone

prevents patients from using other substances like heroin, after delivery because it will make them violently ill if they use illicit substances

medically assisted treatment (MAT)

protects the fetus from repeated withdrawal episodes and exposure to illicit substances

medically assisted treatment (MAT)

reduces risky behaviors associated with drug use while increasing compliance with prenatal care

methadone or subutex

stabilize mother's serum opioid levels to reduce drug cravings for up to 24 hours

suboxone/buprenorphine/naloxone

synthetic opioid with unique properties that make it an effective and safe detox

suboxone

taking any opioid after ____ can result in death/severe respiratory depression (must make this clear to pt and family)

medically assisted treatment (MAT)

term for using methadone or subutex as a highly effective treatment option for pregnant women

opioid withdrawal is poorly treated

when _______, the patient will: self-treat, leave (high rates of AMA), increase in readmission, increases length of hospital stay (increases cost), poor pt experience, low staff morale, make excessive demands for pain meds, become extremely agitated taking away from the care of the primary admitting diagnosis

36-72 hours

withdrawal is worse within