39: Medications and Substance Abuse - Hills Flashcards
withdrawal from alcohol can cause…
seizures
hallucinations
death
management of alcohol withdrawal
benzodiazepines (lorazepman, diazepam, or chlordiazepoxide)
activate the GABA neurotransmitter system like alcohol (downregulated in chronic alcohol use)
benzos can also be used inw ithdrawal from other benzos and barbiturates
medication to decrease cravings or compulsion to drink
naltrexone
- an opiate antagonist that interferes with pleasure response to alcohol
- decreases heavy drinking - potential adverse effects on liver
ALSO
acamprosate
- affects the balance of GABA and glutamate
- reduces hyperarousal of early sobriety
ALSO
topiramate
- anti-epilepsy med that also helps put the brake on glutamate and increase GABA activity in brain
disulfuram MOA
inhibits acetaldehyde dehydrogenase
exposure to alcohol causes the person to become very ill
compliance is not good
management of opiate detox S
symptomatic
- clonidine
- dicyclomine
- loperamide
- benzos
OR
opiate replacement
- methadone (long-acting opiate to taper off)
- buprenorphrin (mixed agonist/antagonist) (started after withdrawal)
Suboxone ***
buprenorphine (mixed) combined with naloxone (antagonist)
- naloxone isn’t orally absorbed but is present is someone tires IV –> prevent euphoria and immediate withdrawal
Naltrexone ***
same opiate antagonist that can be used for maintaining alcohol abstinence can be used to help maintain opiate abstinence
doesn’t reduce craving but stops opiate from having pleasurable effect
nicotinic receptor partial agonist prescribed as way to transition away from tobacco
varenicline (chantix)
bupropion
antidepressant and anti–smoking
Ne/DA reuptake inhibitor
help for cannabis/psychaldelic withdrawal
no meds for withdrawal or maintaining abstinence
treat symptoms
cocaine/stimulant withdrawal
no med to aid in acute withdrawal
*** risk meds for someone using alcohol
lithium (diuresis for alcohol lead to dehydration and increased toxicity)
bupropion (lowers seizure threshold)
any sedating medicine - augmented by alcohol
benzos and barbiturates - additive effect with alcohol - dangerous inhibition
effectiveness of antidepressant meds is limited
don’t mix opiates with
other sedating medications (increase risk of respiratory suppression)
don’t mix cocaine/stimulants with…
prescribed stimulants for ADHD (cardiac risks)
antipsychotics that affect cardiac rhythm
nicotine increases the metabolism of …
antipsychotics
results in reduced effectiveness for a given dose
