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Pharmacology · chapter 15 · Substance Use Disorder Treatment Drugs

Opioid Use Disorder Drugs

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. The triad of opioid intoxication

    Opioid intoxication is classically described as a triad of symptoms consisting of reduced consciousness, slow and/or shallow breathing, and miosis (i.e., pinpoint pupils).

  2. Lost tolerance and relapse overdose

    It is vital to educate clients about this, since clients who go on to relapse and use opioids at their previous doses may experience more opioid effects than they were intending, leading to accidental overdose and risk for death due to respiratory depression.

  3. A negative urine screen is not proof

    For the clinician, it is important to keep in mind that a negative urine opioid screen does not always rule out the possibility that someone is experiencing opioid intoxication.

  4. What causes opioid withdrawal

    Opioid withdrawal occurs in clients using opioids for a chronic period who have abruptly discontinued the drug, or from rapid reversal of the drug’s effect with an opioid antagonist (e.g., naloxone).

  5. Signs of opioid withdrawal

    Gastrointestinal effects of opioid withdrawal include severe abdominal cramping, diarrhea, nausea, and vomiting. Flu-like symptoms can occur including rhinorrhea, shivering, myalgias, and piloerection (i.e., goosebumps).

  6. Sympathetic signs of withdrawal

    Symptoms of excessive sympathetic and CNS activation include dilated pupils, tachycardia, anxiety, irritability, agitation, and tremor.

  7. Teach family to give naloxone

    Those who are most likely to be around the client should an overdose occur (e.g., family members, roommates) need to be educated on proper recognition of an opioid overdose and how to administer naloxone should the need arise.

  8. Call emergency services after naloxone

    It is imperative that whoever administers naloxone to a client should promptly call emergency services to provide definitive treatment to the client prior to the re-sedating effects of the opioid.

  9. Naltrexone needs 5–7 days abstinence

    Once a client is abstinent from opioids for 5–7 days, they can then begin taking naltrexone daily. The purpose of this waiting period is to prevent an immediate withdrawal syndrome.

  10. Why naloxone is added to buprenorphine

    The inclusion of naloxone with oral preparations of buprenorphine may seem nonsensical given that naloxone has poor oral bioavailability, but this is done to discourage intravenous abuse of buprenorphine, as the naloxone would cancel out the euphoric effects of buprenorphine upon injection.

  11. When to start buprenorphine

    Buprenorphine has a high affinity for the opioid receptor and can displace other opioids that can cause opioid withdrawal to occur. Because of this, buprenorphine should be initiated once withdrawal symptoms begin to occur to reduce these symptoms to aid in opioid abstention.

  12. Methadone is given under observation

    Instead, methadone must be given in a monitored setting as a part of direct observed therapy.

  13. Not every methadone client has OUD

    This is the most traditional way for methadone to be used, but in recent years, clinicians have realized the potential for methadone to be an effective agent to treat chronic pain, so it is important for health care providers to not assume that all clients using methadone have an OUD.

  14. Methadone and the QTc interval

    Methadone can prolong the QTc interval on an electrocardiogram (ECG, EKG), and clients should be monitored if taking multiple medications that prolong the QTc interval due to risk for the ventricular dysrhythmia torsades de pointes.

Terms to know

Naloxone
Naloxone is the prototypical mu opioid receptor antagonist used to rapidly reverse the life-threatening effects of opioid overdose.
Buprenorphine
Buprenorphine is a partial mu opioid receptor agonist that is designed to reduce the symptoms of opioid withdrawal and cravings in clients abstaining from opioid use.
abuse deterrence
The inclusion of naloxone in these oral dosages is a form of abuse deterrence.
Methadone
Methadone is a full mu opioid receptor agonist that has been used for many years to wean clients off opioids.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. A client is about to start naltrexone for opioid use disorder. Which assessment is the nurse's priority before the first dose?

    1. Whether the client smokes
    2. The client's weight
    3. The client's blood glucose
    4. When the client last used an opioid

    Answer: When the client last used an opioid

    Naltrexone is an opioid antagonist, so starting it soon after opioid use can cause immediate withdrawal; the client needs 5–7 days of abstinence. Weight, glucose and smoking do not determine whether the first dose is safe.

  2. A client is brought to the emergency department with reduced consciousness, slow shallow breathing and pinpoint pupils. The urine opioid screen is negative. How should the nurse interpret this?

    1. The client is in opioid withdrawal.
    2. The signs fit opioid intoxication, and a standard screen may miss opioids such as fentanyl or oxycodone.
    3. Opioid intoxication is ruled out.
    4. The pupils prove the client used a stimulant.

    Answer: The signs fit opioid intoxication, and a standard screen may miss opioids such as fentanyl or oxycodone.

    Reduced consciousness, slow or shallow breathing and miosis are the classic triad of opioid intoxication, and standard urine screens may miss agents such as oxycodone or fentanyl. Withdrawal causes dilated pupils, not pinpoint ones.

  3. A client who uses opioids daily has stopped abruptly. Which findings would the nurse expect with opioid withdrawal? Select all that apply.

    1. Pinpoint pupils and slow breathing
    2. Tachycardia
    3. Piloerection (goosebumps)
    4. Diarrhea and abdominal cramping
    5. Dilated pupils

    Answer: Tachycardia, Piloerection (goosebumps), Diarrhea and abdominal cramping, Dilated pupils

    Opioid withdrawal causes gastrointestinal effects, flu-like symptoms including piloerection, and sympathetic signs such as dilated pupils and tachycardia. Pinpoint pupils and slow breathing are signs of intoxication, not withdrawal.

  4. A client finishing a 30-day inpatient rehabilitation stay for opioid use disorder is being discharged. Which teaching point is most important?

    1. Tolerance increases during abstinence.
    2. Rehabilitation permanently prevents overdose.
    3. Your tolerance may be lower now, so using your previous dose could cause an accidental overdose.
    4. If you relapse, your usual previous dose is safe.

    Answer: Your tolerance may be lower now, so using your previous dose could cause an accidental overdose.

    Clients who abstain lose tolerance over time, so a relapse at the previous dose can cause accidental overdose and death from respiratory depression. The other statements are the reverse of what the section says.

  5. The nurse is teaching the family of a client at risk for opioid overdose about naloxone. Which statements are correct? Select all that apply.

    1. Learn to recognise the signs of an opioid overdose.
    2. The client can give naloxone to themselves during an overdose.
    3. Once the client wakes up, no further care is needed.
    4. Naloxone lasts only about 20–30 minutes, so the client can become sedated again.
    5. Call emergency services any time naloxone is given.

    Answer: Learn to recognise the signs of an opioid overdose., Naloxone lasts only about 20–30 minutes, so the client can become sedated again., Call emergency services any time naloxone is given.

    Family members need to recognise overdose, give naloxone and call emergency services because naloxone wears off in about 20–30 minutes, before many opioids do. A client in overdose is too sedated to self-administer, and waking up does not end the need for care.

  6. A client on methadone for opioid use disorder has a new prescription for another drug that prolongs the QTc interval. What should the nurse monitor?

    1. The ECG for QTc prolongation
    2. Visual acuity
    3. Blood glucose
    4. Urine color only

    Answer: The ECG for QTc prolongation

    Methadone can prolong the QTc interval, and combining it with other QTc-prolonging drugs raises the risk of torsades de pointes, so the ECG must be monitored. The other options are not the concern named in the section.

Where every quote comes from

Section 15.2 Opioid Use Disorder Drugs of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.