Commonly Confused Concepts
| Medication |
Mechanism |
Setting |
Key Risk |
| Methadone |
Full agonist |
OTP only |
QT prolongation |
| Buprenorphine |
Partial agonist |
Office-based |
Precipitated withdrawal |
| Naltrexone |
Antagonist |
Any setting |
Overdose risk if relapse |
Clinical Scenario
A patient on naltrexone for 6 months relapses and uses heroin. Due to blocked opioid receptors, they may use larger amounts to overcome the blockade, significantly increasing overdose risk when naltrexone wears off.
Nursing Considerations
Assessment and Monitoring
- Monitor for signs of withdrawal, intoxication, and medication adherence through regular urine drug screening and clinical assessment.
- Assess for concurrent mental health disorders, as dual diagnosis is common and requires integrated treatment approaches.
- Evaluate social support systems, housing stability, and employment status as these factors significantly impact treatment success.
Key Points
- Document baseline vital signs and pain levels
- Screen for hepatitis B, C, and HIV due to high prevalence
- Monitor for drug interactions, especially with CNS depressants
Memory Aid: "SOAR" - Support systems, Opioid-free period, Adherence monitoring, Risk assessment
Study Tips
- Remember the "3 A's": Agonist (methadone), pArtial agonist (buprenorphine), Antagonist (naltrexone)
- Focus on safety concerns: respiratory depression with agonists, precipitated withdrawal with partial agonists/antagonists
- Understand regulatory differences: methadone requires specialized clinics, buprenorphine allows office-based treatment
Quick Check
- ☐ Can identify mechanism of action for each medication class
- ☐ Understand when to use each medication type
- ☐ Know major safety concerns and contraindications
- ☐ Recognize signs of withdrawal vs. intoxication
Common Pitfalls: Don't confuse naltrexone (oral/injectable addiction treatment) with naloxone (emergency overdose reversal). Remember buprenorphine can cause precipitated withdrawal if given too soon after last opioid use.