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