NU 665B Week 13 Assignment 3: MAT Waiver Submission
Sample Answer for NU 665B Week 13 Assignment 3: MAT Waiver Submission
What diagnostic tests would you order? (Epocrates, 2023).
CBC: To check for anemia or infection, which could be secondary to intravenous drug use.
Urinalysis: To detect the use of additional substances and to identify potential renal damage.
Hepatitis B and C and HIV Screening: Essential due to the elevated risk associated with intravenous drug practices.
LFT: Due to intravenous drug use, these tests can help assess liver damage or hepatitis.
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EKG: Performed to identify any arrhythmias and to monitor the patient’s reported rapid heart rate, which could affect the treatment approach.
Electrolyte Panel: To check for electrolyte imbalances that can occur with nausea, vomiting, and diarrhea.
What diagnosis will you give this patient? Identify and discuss 3 appropriate differentials?
Anxiety Disorder: Mr. W reports long-standing severe anxiety, which often co-occurs with substance use disorders. Mr. W was previously treated with Seroquel for depression and Xanax for anxiety. However, this regimen is not typically recommended as initial therapy due to the potential for dependency, particularly in individuals with a history of substance misuse (Lavender, 2023). Benzodiazepines, when combined with opioids, elevate the chances of experiencing respiratory depression, sedation, and the potential for an overdose (Epocrates, 2024).
Depressive Disorder: Given his history of mild depression, substance use could be a coping mechanism. Patients with Opioid Use Disorder (OUD) frequently experience mood disorders, often turning to opioids or other substances as a form of self-medication to cope with their mood, stress, or trauma. This behavior can lead to isolation and various physical and psychosocial issues (Stahl & Grady, 2021).
Opioid Use Disorder: The patient shows signs of opioid addiction based on the physical exam, his history, and admitting to using heroin that morning, which made him feel unwell. Symptoms include small pupils, red and watery eyes, a runny nose, feeling sick to his stomach, diarrhea, feeling restless, constipation, fast breathing, high blood pressure, stomach pain, back pain and muscle spasms, and shaking (Epocrates, 2024). Based on the history and symptoms presented, the most likely diagnosis is opioid use disorder.
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NU 665B Week 14 Assignment 1: iHuman Simulation
Assuming MAT with Suboxone to be the treatment modality, describe the sequence of treatment for this patient (Stahl & Grady, 2021).
When prescribing medications for patients with Opioid Use Disorder, healthcare providers need to perform an in-depth assessment that covers the patient’s medical and surgical past, history of substance use, mental health, and social support to create an optimal treatment plan (Kumar R.,2023). Before initiating treatment with Suboxone, it’s necessary for the patient to have abstained from heroin for at least 12 hours and to achieve a score > 12 on the Clinical Opioid Withdrawal Scale (Stahl & Grady, 2021).
Treatment with longer-acting opioids, like methadone, should start 36 hours following the last dose taken. In the initial phase of opioid withdrawal, the first dose of Buprenorphine/Naloxone 4mg, should be administered under medical observation. This is to watch for signs of precipitated withdrawal, including symptoms like pain, nausea, vomiting, or diarrhea (Kumar R.,2023).
If, after one hour, the patient experiences relief and their COW score is below 6, their vital signs are stable, and there are no reported adverse effects, he may be discharged with an additional dose of 4mg. This dose can be taken if the patient experiences withdrawal symptoms before the following morning (UpToDate, 2024).
What are the concerns with initiating Suboxone treatment for this patient?
When considering starting Suboxone for this patient, it’s important to address potential side effects. The drug may lead to gastrointestinal problems like nausea and vomiting, as well as headaches, muscle aches, cramps, changes in mood, sweating, dry mouth, constipation, and respiratory depression. In extreme instances, it could even result in death. (Kumar R.,2023). Although Suboxone includes naloxone, which helps lower the risk of misuse and diversion, offering Narcan to the patient could still be advantageous due to his elevated risk of overdosing or being in situations where he might encounter others at risk of an overdose (Hektor et al., 2023).
How will you address his psychiatric care along with the MAT? What medications might you consider for any psychiatric conditions?
Referring the patient to support services and counseling is crucial for continuous care. The patient has experienced depression and anxiety since his teenage years. Considering the negative impacts associated with benzodiazepines, clonidine would be a suitable adjunct medication to Suboxone, particularly due to its off-label effectiveness in managing opioid withdrawal symptoms. I would advise the patient to regularly check their blood pressure since it could lead to feelings of drowsiness and dizziness (Epocrates, 2024).
References
PCSS. (2023). Medications for Opioid Use Disorders. Heroin overdose. https://pcssnow.org/?s=heroin%2Boverdose
Kumar R, Viswanath O, Saadabadi A. Buprenorphine. (2023).In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459126/
Lavender, T. W., & McCarron, B. (2013). Acute infections in intravenous drug users. Clinical medicine (London, England), 13(5), 511–513. https://doi.org/10.7861/clinmedicine.13-5-511https://pcssnow.org/?s=heroin%2Boverdose
Stahl, S. M., & Grady, M. M. (2021). Stahl’s essential psychopharmacology: The Prescriber’s Guide. Cambridge University Press.
Epocrates.(2023). Opioid use disorder – Symptoms, Causes, Images, and Treatment Options. (n.d.). https://www.epocrates.com/online/diseases/200/opioid-use-disorder