Última revisão: 1 Nov 2020
Última atualização: 06 Out 2020

Resumo

Definição

História e exame físico

Principais fatores de diagnóstico

  • presença de fatores de risco
  • padrão desadaptativo do uso de opioides
  • alta pontuação da Escala de Gravidade da Dependência (ASI)
  • redução dos efeitos agradáveis dos opioides
  • miose
  • pupilas dilatadas
  • respirações superficiais/lentas ou apneia
  • marcas de agulha, cicatrizes ou necrose na pele perto das veias
  • inconsciência
  • pulso <40 bpm

Outros fatores de diagnóstico

  • constipação crônica
  • perda de peso
  • náuseas/vômitos
  • sedação
  • sono agitado/insônia
  • prejuízo da memória
  • espirros
  • bocejo
  • cólicas abdominais
  • diarreia
  • dorsalgia/espasmos musculares
  • ondas de calor e frio
  • hipotensão
  • sedação
  • confusão
  • fala indistinta
  • comportamento agressivo
  • excesso de transpiração ou lacrimejamento
  • rinorreia
  • sono agitado
  • piloereção
  • taquipneia
  • hipertensão
  • arritmias
  • convulsões

Fatores de risco

  • sexo masculino
  • idade jovem
  • história de transtorno mental
  • história de abuso de substâncias
  • terapêutica de longa duração com opioides
  • história familiar de abuso de substâncias

Exames diagnósticos

1° exames a serem solicitados

  • exame de urina para detecção de drogas
  • cromatografia gasosa acoplada à espectroscopia de massas (CG-EM)
  • eletrólitos séricos
  • Hemograma completo
  • ureia/creatinina
  • TFHs
  • reagente plasmático rápido (RPR)
  • sorologia para hepatite
  • sorologia do HIV
  • teste cutâneo de derivado proteico purificado (PPD)
  • hemoculturas
  • gonadotrofina coriônica humana subunidade beta (beta-hCG)
Mais 1° exames a serem solicitados

Algoritmo de tratamento

Colaboradores

Associate Professor

Medical Director

Duke Addictions Program

Department of Psychiatry and Behavioral Sciences

Duke University Medical Center

Durham

NC

Divulgações

AAP is a consultant/member of the advisory board for Cubist Pharma, Biodelivery Sciences (BDSI), Kaleo, Forest Research Institute, and Titan Pharma; is on the speaker’s bureau and received honoraria from Otsuka, Alkermes, Sunovion, and BDSI; and is a shareholder in Ironwood Sciences LLC and Patkar Medical Consultants. AAP's institution has received grant support from National Institutes of Health (NIDA, NIAAA), SAMHSA, AstraZeneca, Bristol-Myers Squibb, Cephalon, Daiichi Sankyo, Envivo Pharma, Forest, J & J, Jazz Pharmaceuticals, Lundbeck, Merck, Organon, Pfizer, Sunovion, Shire, and Titan. AAP holds unpaid positions on the Board of Directors of Southlight Inc, the Board of Advisors of People's Medical Care, the Executive Committee of Triangle Indian American Physicians Society, and also as President of Indo American Psychiatric Association.

Medical Director

The Farley Center at Williamsburg Place

Williamsburg

VA

Affiliate Assistant Professor

Department of Psychiatric Medicine

East Carolina University

Greenville

NC

Community Assistant Professor

Department of Family Medicine

Eastern Virginia Medical School

Norfolk

VA

Divulgações

JCL is a full-time employee at The Farley Center at Williamsburg Place.

Assistant Professor

Department of Psychiatry

University of Missouri - Kansas City

Medical Director

Outpatient Behavioral Health

Truman Medical Centers

Kansas City

MO

Divulgações

DMB declares that he has no competing interests.

Dr Ashwin A. Patkar, Dr Jonathan C. Lee, and Dr Douglas M. Burgess would like to gratefully acknowledge Dr Kamal Bhatia and Dr Srilakshmi Musham, previous contributors to this monograph. KB declares that he has received grant support from National Institutes of Health, Lundbeck Pharmaceuticals, Pfizer, and Titan Pharmaceuticals. SM declares that she has received grant support from Pfizer, Titan Pharmaceuticals, Shire Pharmaceuticals, and the Forest Research Institute.

Colegas revisoresMOSTRAR TODOS

Assistant Professor

Department of Emergency Medicine

Johns Hopkins University Hospital

Baltimore

MD

Divulgações

AS declares that he has no competing interests.

Professor

Department of Psychiatry and Behavioral Sciences

University of Texas

Health Science Center

Houston

TX

Divulgações

FGM declares that he has no competing interests.

Consultant Psychiatrist and Honorary Senior Lecturer

Institute of Psychiatry

King's College London

London

UK

Divulgações

CK declares that he has no competing interests.

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