16 hr waiver training with
verified solutions 2024
continued medication tx vs medically supervised withdrawal -
outcomes - answer continued med tx associated with better
outcomes
(TIP doesn't recommend med supervised short term withdrawal
alone because of high rates of relapse)
What makes less than daily dosing of buprenorphine possible? How
would this dosing work? - answer long t1/2 (variable from 24-69
hours) and partial agonist properties along for less than daily
dosing
ex. doubling daily dose once stable and giving on alternate days -
12mg QD = 24 mg every other day
transmucosal formulations of buprenorphine - answer Zubsolv
5.7/1.4
Bunavail 4.2/0.7
Suboxone film 8/2 (tablets no longer available)
Is at home induction of buprenorphine safe and effective? - answer
yes (at home induction shouldn't be a reason for insurance to deny
because there is data that shows it's safe and effective)
Bup/nx induction: FDA label recommends a max dose of -- mg on day
1 and -- mg on day 2 - answer 8 mg day 1
16 mg day 2
,(initiate when in withdrawal with initial 2-4 mg dose of bup/nx for
those with physical dependence; for those NOT currently dep, lower
doses to start e.g. 1mg with slow incremental increases)
bup 6 months implant - answer probuphine
indication for 6 month implant (probuphine) - answer clinically
*stable* pt on bup/nx </= 8 mg/day for at least 90 days
dosing of probuphine - answer 4 implants (each has 80 mg bup),
inserted in upper arm x 6 months
removed and replaced after 6 months
(peak plasma conc 12 hrs after insertion)
What if pt with probuphine implant destabilize? - answer
transmucosal supplementation - low dose (2/0.5mg) for short
periods
bup IM injection - answer Sublocade (abd injection)
dose for bup IM injection (sublocade) - answer Month 1 & 2: 300 mg
Month 3 & beyond: 100 mg (may inc if indicated)
labs with sublocade - answer baseline LFTs and monitor monthly
extended release naltrexone (XR-NTX) injection - answer Vivitrol
(gluteus injection)
, Why does pts have to wait 7-10 days after a short-acting or 10-14
days after a long-acting opioid to initiate XR-NTX? - answer because
XR-NTX can precipitate opioid withdrawal
What is the difficulty in using XR-NTX? - answer initiating it because
of required 7-10 days of no use
dose and injection instructions for XR-NTX - answer IM 380 mg
monthly into upper outer quadrant of buttock
alternate injection sides every month
labs for XR-NTX - initiation and monitoring - answer prior to start:
negative opioid test (and consider naloxone challenge prior to
starting naltrexone), baseline LFTs
monitor: periodic LFTs (ex. 6 and 12 months intervals)
is benzo use an absolute contraindication to bup? - answer no
methadone treatment can only be delivered through - answer
licensed and accredited opioid treatment programs (OTPs)
not in office-based setting
admission criteria for methadone tx - answer 1 year+ opioid
addiction;
can be waived for pregnant women, pts within 6 months of release
from incarceration, former pts within 2 years of discharge
verified solutions 2024
continued medication tx vs medically supervised withdrawal -
outcomes - answer continued med tx associated with better
outcomes
(TIP doesn't recommend med supervised short term withdrawal
alone because of high rates of relapse)
What makes less than daily dosing of buprenorphine possible? How
would this dosing work? - answer long t1/2 (variable from 24-69
hours) and partial agonist properties along for less than daily
dosing
ex. doubling daily dose once stable and giving on alternate days -
12mg QD = 24 mg every other day
transmucosal formulations of buprenorphine - answer Zubsolv
5.7/1.4
Bunavail 4.2/0.7
Suboxone film 8/2 (tablets no longer available)
Is at home induction of buprenorphine safe and effective? - answer
yes (at home induction shouldn't be a reason for insurance to deny
because there is data that shows it's safe and effective)
Bup/nx induction: FDA label recommends a max dose of -- mg on day
1 and -- mg on day 2 - answer 8 mg day 1
16 mg day 2
,(initiate when in withdrawal with initial 2-4 mg dose of bup/nx for
those with physical dependence; for those NOT currently dep, lower
doses to start e.g. 1mg with slow incremental increases)
bup 6 months implant - answer probuphine
indication for 6 month implant (probuphine) - answer clinically
*stable* pt on bup/nx </= 8 mg/day for at least 90 days
dosing of probuphine - answer 4 implants (each has 80 mg bup),
inserted in upper arm x 6 months
removed and replaced after 6 months
(peak plasma conc 12 hrs after insertion)
What if pt with probuphine implant destabilize? - answer
transmucosal supplementation - low dose (2/0.5mg) for short
periods
bup IM injection - answer Sublocade (abd injection)
dose for bup IM injection (sublocade) - answer Month 1 & 2: 300 mg
Month 3 & beyond: 100 mg (may inc if indicated)
labs with sublocade - answer baseline LFTs and monitor monthly
extended release naltrexone (XR-NTX) injection - answer Vivitrol
(gluteus injection)
, Why does pts have to wait 7-10 days after a short-acting or 10-14
days after a long-acting opioid to initiate XR-NTX? - answer because
XR-NTX can precipitate opioid withdrawal
What is the difficulty in using XR-NTX? - answer initiating it because
of required 7-10 days of no use
dose and injection instructions for XR-NTX - answer IM 380 mg
monthly into upper outer quadrant of buttock
alternate injection sides every month
labs for XR-NTX - initiation and monitoring - answer prior to start:
negative opioid test (and consider naloxone challenge prior to
starting naltrexone), baseline LFTs
monitor: periodic LFTs (ex. 6 and 12 months intervals)
is benzo use an absolute contraindication to bup? - answer no
methadone treatment can only be delivered through - answer
licensed and accredited opioid treatment programs (OTPs)
not in office-based setting
admission criteria for methadone tx - answer 1 year+ opioid
addiction;
can be waived for pregnant women, pts within 6 months of release
from incarceration, former pts within 2 years of discharge
