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% Document Info
\author{Shelbi (kfisher17)}
\pdfinfo{
  /Title (sud-i-opioid-related-disorders.pdf)
  /Creator (Cheatography)
  /Author (Shelbi (kfisher17))
  /Subject (SUD I | Opioid-Related Disorders Cheat Sheet)
}

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\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{SUD I | Opioid-Related Disorders Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Shelbi (kfisher17)} via \textcolor{DarkBackground}{\uline{cheatography.com/79317/cs/21866/}}}
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\noindent
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Shelbi (kfisher17) \\
  \uline{cheatography.com/kfisher17} \\
  \end{tabulary}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 23rd February, 2020.\\
   Updated 25th February, 2020.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{multicols*}{2}

\begin{tabularx}{8.4cm}{x{2.508 cm} x{2.356 cm} x{2.736 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Terminology}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Natural Opiates}} & {\bf{Semi-Synthetic}} & {\bf{Synthetic Opioids}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Codeine & \seqsplit{Burprenorphine} & Fentanyl \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
Morphine & Heroin & Meperidine \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
 & Hydrocodone & Methadone \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & \seqsplit{Hydromorphone} & Sufentanil \tn 
% Row Count 8 (+ 2)
% Row 5
\SetRowColor{white}
 & Oxycodone & Sufentanil \tn 
% Row Count 9 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & Oxymorphone &  \tn 
% Row Count 10 (+ 1)
% Row 7
\SetRowColor{white}
 & Tramadol &  \tn 
% Row Count 11 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{PATHOPHYSIOLOGY}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Risk Factors: males, history of depression or anxiety, family history of alcohol or drug abuse, age ≤ 30, long-term opioid use \newline % Row Count 3 (+ 3)
Involves the mesolimbic reward system% Row Count 4 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.64 cm} x{5.36 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Standardized Assessment Tools}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Score}} & {\bf{Severity}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
5 to 12 & Mild \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
13 to 24 & Moderate \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
25 to 36 & Moderate to Severe \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\textgreater{} 36 & Severe \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{COWS: Clinical Opiate Withdrawal Scale \newline • used clinically to monitor withdrawal \newline • often utilized to determine when PRNs are needed}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.48 cm} x{5.52 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{NALOXONE}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{MOA}} & Opioid Antagonist \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
{\bf{Warnings/ADRs}} & Cardiac or respiratory effects associated with rapid reversal of opioids \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
 & Aggression ({\emph{from immediate withdrawal}}) \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{Administration}} & {\bf{Call 911 FIRST}} \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & Administer \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
 & If no response after 3 minutes, administer 2nd dose \tn 
% Row Count 11 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{• It only works on opioid receptors! \newline  \newline • It will {\bf{NOT}} affect someone ({\emph{positively or negatively}}) if they do not have opioids in their system}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.76 cm} x{3.648 cm} x{3.192 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Opioid Use Disorder | TREATMENT}}  \tn
% Row 0
\SetRowColor{LightBackground}
 & {\bf{FIRST LINE}} & {\bf{SECOND LINE}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{3}{x{8.4cm}}{{\bf{APA:}}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & Buprenorphine & Naltrexone PO \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
 & Methadone &  \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{{\bf{BAP:}}} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
 & Buprenorphine & Naltrexone PO \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & Methadone &  \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{3}{x{8.4cm}}{{\bf{VA/DOD:}}} \tn 
% Row Count 8 (+ 1)
% Row 8
\SetRowColor{LightBackground}
 & Suboxone & Naltrexone \tn 
% Row Count 9 (+ 1)
% Row 9
\SetRowColor{white}
 & Buprenorphine &  \tn 
% Row Count 10 (+ 1)
% Row 10
\SetRowColor{LightBackground}
 & Methadone &  \tn 
% Row Count 11 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{{\bf{Psychosocial treatment is also the first line in addition to pharmacotherapy}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{1.216 cm} x{3.192 cm} x{3.192 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Buprenorphine Formulations}}  \tn
% Row 0
\SetRowColor{LightBackground}
 & {\bf{Buprenorphine}} & {\bf{Buprenorphine-Naloxone}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Brand & Subutex & Suboxone, Zubsolv \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
MOA & Mu opiate receptor - partial agonist & Mu-partial agonist and opioid antagonists \tn 
% Row Count 7 (+ 3)
% Row 3
\SetRowColor{white}
\seqsplit{Formulation} & SL tablet & SL tablet, SL film; (4:1 ratio of bupren. and naloxone) \tn 
% Row Count 11 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\seqsplit{Dosing} range & 8 to 32 mg bupren./day & 8 to 32 mg bupren/day \tn 
% Row Count 13 (+ 2)
% Row 5
\SetRowColor{white}
\seqsplit{Warnings} & initiation should not begin until pt is experiencing withdrawal & same \tn 
% Row Count 17 (+ 4)
% Row 6
\SetRowColor{LightBackground}
 & respiratory depression & same \tn 
% Row Count 19 (+ 2)
% Row 7
\SetRowColor{white}
 & risk of abuse or dependence & same \tn 
% Row Count 21 (+ 2)
% Row 8
\SetRowColor{LightBackground}
DDIs & CYP3A4 \seqsplit{inhibitors/inducers} & same \tn 
% Row Count 23 (+ 2)
% Row 9
\SetRowColor{white}
 & CNS depresants & same \tn 
% Row Count 24 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\seqsplit{Monitoring} & Tolerability, resp. depression, (LFTs), urine drug screening, PMP, urine buprenorphine & same \tn 
% Row Count 30 (+ 6)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{1.216 cm} x{3.192 cm} x{3.192 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Buprenorphine Formulations (cont)}}  \tn
% Row 11
\SetRowColor{LightBackground}
\seqsplit{Clinical} \seqsplit{Pearls} & Preferred in pregnancy; higher abuse potential & naloxone added as an abuse deterrent; preferred formulation in non-pregnant patients \tn 
% Row Count 6 (+ 6)
% Row 12
\SetRowColor{white}
 & partial agonist activity results in ceiling effect, higher binding affinity than other opioids, newer formulation include sub-dermal implant, and subcutaneous injection & same \tn 
% Row Count 17 (+ 11)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{Prescribing Restrictions: \newline Schedule III \newline DATA waiver \newline Initial no. of pts is 30 \newline May apply 1 year to increase no. of patients to 100, then 275 \newline DEA number will begin with X}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Signs and Sx of opioid WITHDRAWAL}}  \tn
% Row 0
\SetRowColor{LightBackground}
Dysphoric mood & Fever \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Lacrimation or Rhinorrhea & Muscle aches \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{Yawning}} & {\bf{Diarrhea}} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
N/V & Insomnia \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Pupillary Dilartion & Piloerection (goosebumps) \tn 
% Row Count 7 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Sweating} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{WITHDRAWAL TIMELINE}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Onset of withdrawal will depend upon the half-life of the opioid used (normally within 36 to 72 hours)} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Completed within {\bf{7 days}} for short acting opioids (heroin) and 14 days for long-acting opioids (buprenorphine, methadone)} \tn 
% Row Count 6 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Preferred treatment}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Methadone}} & {\bf{buprenorphine}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Chronic Pain & Prolonged QT interval \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
history or diversion or pilysubstance use & not able to attend daily clinic \tn 
% Row Count 6 (+ 3)
% Row 3
\SetRowColor{white}
requires closer monitoring & requires less monitoring and no untreated psychiatric comorbidities \tn 
% Row Count 10 (+ 4)
% Row 4
\SetRowColor{LightBackground}
pregnant women & dependent on lower doses of opioids (ceiling effect) \tn 
% Row Count 13 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{requires wide dosing range} \tn 
% Row Count 14 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.72 cm} x{5.28 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Terms}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Opioid Tolerance}} & Person using opioids begins to experience a reduced response to medication requiring more opioids to experience the same effect \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
{\bf{Opioid Dependence}} & Occurs when the body adjusts its normal functioning around regular opioid use (unpleasant physical symptoms occurs when med is stopped) \tn 
% Row Count 11 (+ 6)
% Row 2
\SetRowColor{LightBackground}
{\bf{Opioid Addiction}} & Occurs when attempts to cut down use are unsuccessful or when results insocial problems and a failure to fulfill obligations; often comes after person has developed opioid tolerance and dependence \tn 
% Row Count 19 (+ 8)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Narcan MOA}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/kfisher17_1582588523_NALOXONE+MECHANISM+OF+ACTION.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{DSM-5 DIAGNOSTIC CRITERIA}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\bf{A problematic pattern of substance use leading to clinically significant impairment or distress, manifested by ≥ 2 of the following over a 12-month period}}} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{⓵ Substance is taken in larger amounts or over  a longer period than intended} \tn 
% Row Count 6 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{⓶ Persistent desire or unsuccessful efforts to reduce or control use} \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{⓷ A great deal of time is spent in activities necessary to obtain, use, or recover from effects} \tn 
% Row Count 10 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{⓸ Cravings or a strong desire to use} \tn 
% Row Count 11 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{⓹ Recurrent use resulting in a failure to fulfill major obligations} \tn 
% Row Count 13 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{⓺ Continued use despite having persistent social or interpersonal problems caused by the substance} \tn 
% Row Count 15 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{⓻ Important social, occupational, or recreational activities are given up or reduced} \tn 
% Row Count 17 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{⓼ Recurrent use in situations that are physically hazardous} \tn 
% Row Count 19 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{⓽ Recurrent use despite knowledge of having a persistent or recurrent physical or psychological problem due to use} \tn 
% Row Count 22 (+ 3)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{⓾ Tolerance} \tn 
% Row Count 23 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{⑪ Withdrawal} \tn 
% Row Count 24 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2 cm} x{6 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{FIRST - LINE TREATMENT}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{APA}} & {\bf{British Association of Psychopharmacology}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\seqsplit{Buprenorphine} & Alpha-2 agonist \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
Methadone & Buprenorphine \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
 & Methadone \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Targeted at individual symptoms of withdrawal \newline Common practice if an opioid treatment program (OTP) or bridging medication-assisted treatment (MAT)}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.32 cm} x{5.68 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Methadone}}  \tn
% Row 0
\SetRowColor{LightBackground}
Brand & METHADOSE \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
MOA & opioid agonist \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Formulation} & Liquid (opioid maintenance); tablets (pain only) | this is for pharmacies (methadone clinics do tabs) \tn 
% Row Count 6 (+ 4)
% Row 3
\SetRowColor{white}
\seqsplit{Maintenance} dose & 80 to 120 mg daily \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
Warnings & QTc prolongation, respiratory depression, risk of abuse or dependence \tn 
% Row Count 11 (+ 3)
% Row 5
\SetRowColor{white}
DDI & QTc prolongating meds, CYP3A4 inhibitors or inducers, Medications that induce hypokalemia, hypocalcemia, or hypomagnesemia; CNS depressants \tn 
% Row Count 16 (+ 5)
% Row 6
\SetRowColor{LightBackground}
Monitoring & Tolerability, respiratory depression, HR/BP, EKG, electrolytes, UDS, urine methadone, PMP \tn 
% Row Count 20 (+ 4)
% Row 7
\SetRowColor{white}
Clinical Pearls & prolonged or delayed withdrawal due to long half-life; overdose risk is highest during initial 2 weeks of treatment \tn 
% Row Count 25 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Prescribing restrictions: \newline - schedule II; restricted to certified opioid treatment program (OTP) \newline - it is not appropriate to dispense methadone from a community pharmacy for the purposes of opioid detox, withdrawal, or maintenance \newline - pts must be currently addicted and have opioid use disorder ≥ 1 year \newline - exceptions: pregnancy, recently released from correction, and previous treatment in OTP \newline  \newline {\bf{know difference between prescribing of methadone and buprenorphine}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Signs and Sx of INTOXICATION}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Pulillary Constriction} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Slurred Speech} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Drowsiness} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Impaired attention or memory} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Signs and Sx of Opioid OVERDOSE}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Pupillary constriction} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Shallow or slow respirations} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Stupor} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Coma} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Hypothermia} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Bradycardia} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.64 cm} x{5.36 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Narcan Formulations}}  \tn
% Row 0
\SetRowColor{LightBackground}
Naloxone & IM/IV/SQ \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Naloxone & Intranasal \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Evzio & IM auto-injector \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
Narcan & Intranasal \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{1.292 cm} x{3.344 cm} x{2.964 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{SYMPTOMATIC TREATMENT (PRN)}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Medication}} & {\bf{Class/MOA}} & {\bf{Indication}} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\seqsplit{Clonidine} & Alpha-2 agonist reduced the noradrenergic hyperactivity associated with opioid withdrawal & Generalized Sx of opioid withdrawal \tn 
% Row Count 9 (+ 6)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Loperamide} & Anti-diarrheal & Diarrhea \tn 
% Row Count 11 (+ 2)
% Row 3
\SetRowColor{white}
\seqsplit{Ondansetron} & Antiemetic & N/V \tn 
% Row Count 13 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\seqsplit{Trazodone} & Sedatine antidepressant & Insomnia \tn 
% Row Count 15 (+ 2)
% Row 5
\SetRowColor{white}
\seqsplit{Hydroxyzine} & \seqsplit{Antihistamine/anxiolytic} & Anxiety \tn 
% Row Count 17 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\seqsplit{Ibuprofen} & NSAID & muscle pain \tn 
% Row Count 19 (+ 2)
% Row 7
\SetRowColor{white}
\seqsplit{Cyclobenzaprine} & skeletal muscle relaxant & muscle cramps \tn 
% Row Count 22 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}