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PT2 Psyche 1-6 > abuse disorder therapeutics > Flashcards

abuse disorder therapeutics Flashcards

1
Q

DSM-5 severity scale

A
  • mild = 2-3 symptoms
  • moderate = 4-5 symptoms
  • severe = >5
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2
Q

steps in brief intervention

A
  • express concern about current use and health risks
  • provide feedback on the health risks
  • advise patient to abstain or limit use
  • if patient is ready to change support a goal
  • offer referral to addiction specialty treatment
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3
Q

tips for brief interventions

A
  • listen for discrepancies between goals and their actions
  • be empathetic
  • avoid arguments about diagnosis
  • indicated responsibility for change is with them
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4
Q

5 stages of change

A
  • precontemplation
  • contemplation
  • preparation
  • action
  • maintenance
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5
Q

management of acute intoxication

A

consider:

  • safety of user
  • safety of others
  • level of intoxication
  • assess general health and withdrawal risk
  • observe and triage if needed
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6
Q

best treatment for acute intoxication

A

time

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7
Q

recommended drinking limit for men

A

-14 or less drinks per week
OR
-4 or less drinks at a time

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8
Q

recommended drinking limit for women

A

-7 or less drinks per week
OR
-3 or less drinks at a time

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9
Q

contraindications for alcohol use

A
  • pregnancy
  • liver disease
  • other conditions worsened by alcohol
  • use of meds with interactions
  • alcohol use disorder
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10
Q

AUDIT-C

A

assessment of alcohol use

  • best for screening because it detects hazardous drinking and abuse
  • detects recent use
  • greater sensitivity in populations w/ less prevalence
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11
Q

positive AUDIT-C score

A

4 or greater for men

3 or greater for women

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12
Q

ethyl glucoronide test

A

positive shortly after alcohol intake and can be detected up to 5 days after heavy binge drinking

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13
Q

signs and symptoms of alcohol withdrawal

A
  • N/V
  • diaphoresis
  • agitation/anxiety
  • headache
  • tremor
  • seizures
  • hallucinations
  • delirium tremens
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14
Q

when to refer a person with alcohol withdrawal to hospital

A
  • hx of delirium tremens or seizures
  • risk of harm to self or others
  • active psychosis
  • inability to take oral meds
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15
Q

average duration of withdrawal symptoms

A

3-5 days

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16
Q

CIWA-Ar

A

scale used to evaluate symptoms of alcohol withdrawal
< 8 mild
8-15 moderate
>15 severe

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17
Q

alcohol withdrawal symptom prevention medications

A

benzos
thiamine
anticonvulsants?

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18
Q

supportive care meds for alcohol withdrawal

A
  • clonidine
  • loperimide
  • APAP
  • ibuprofen
  • promethazine/ondansetron
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19
Q

benzo of choice in alcohol withdrawal

A

lorazepam, less interactions especially with liver dysfunction

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20
Q

benzo dosing methods

A
  • symptom trigger dosing using CIWA to determine need

- fixed dosing following a regular schedule gradually tapered

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21
Q

supplements to give in alcohol withdrawal

A 
thiamine
folic acid
multivitamin
potassium
phosphorus
magnesium
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22
Q

first line alcohol maintenance medications

A
  • naltrexone oral (ReVia)
  • naltrexone LA injection (Vivitrol)
  • acamprosate
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23
Q

second line alcohol maintenance medications

A

disulfiram

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24
Q

use of naltrexone

A
  • reduce drinking, cravings, and increase abstinence

- start 7 to 10 days after detox and last dose of opioid

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25
Q

naltrexone oral dosing

A
  • first give test dose of 25 mg

- 50 mg for maintenance

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26
Q

naltrexone injection dosing

A
  • 380 mg IM every 4 weeks

- must be refrigerated

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27
Q

naltrexone contraindications

A
  • recent opioid use
  • hepatitis
  • pregnant women
28
Q

naltrexone side effects

A
  • N/V
  • injection site reactions
  • change in appetite and sleep
29
Q

how long must a pt. be opioid free to use naltrexone

A

7-10 days

30
Q

naltrexone renal considerations

A

for Vivitrol (injection) must have CrCl of 50 or greater

31
Q

acamprosate MoA

A

NMDA receptor modulator

32
Q

acamprosate dosing

A

666 mg 3 times per day

33
Q

acamprosate side effects

A

diarrhea

flatulence

34
Q

acamprosate renal considerations

A
  • CrCl 30-50 start 1 tab TID

- CrCl < 30 do not give

35
Q

disulfiram MoA

A

aldehyde dehydrogenase inhibitor

36
Q

disulfiram use

A
  • 2nd line due to severe side effects

- may use after pt has abstained for 24 hr

37
Q

disulfiram dosing

A

250 mg daily
can crush and mix with liquid
AVOID ALCOHOL

38
Q

disulfiram side effects

A

fatigue
drowsiness
metallic/garlic aftertaste

39
Q

disulfiram contraindications

A
  • severe heart disease
  • psychosis
  • metronidazole use
40
Q

disulfiram monitoring

A
  • baseline blood alcohol level
  • EKG
  • pregnancy test
  • LFTs baseline, 10-14 days after starting, then yearly
41
Q

off label alcohol maintenance medications

A

topiramate

gabapentin

42
Q

House bill 11

A

Good samaritan law

43
Q

house bill 119

A

naloxone law, physicians can prescribe to 3rd parties and no legal liability for administering it

44
Q

UCA §26‐55‐105

A

allows pharmacists to dispense

45
Q

opioid withdrawal symptoms

A
  • diarrhea
  • lacrimation
  • rhinorrhea
  • sweating
  • irritability
46
Q

COWS

A 
opiate withdrawal scale to evaluate symptoms
5-12 mild
13-24 moderate
25-36 mod-sev
>36 severe
47
Q

opioid replacement therapies

A

methadone

buprenorphine

48
Q

supportive drug for opioid withdrawal

A

clonidine
loperamide
dicyclomine
antiemetics

49
Q

methadone duration of action

A

24-36 hours

50
Q

methadone adverse effects

A
  • QT prolongation

- hypotension

51
Q

methadone prescribing

A

only done at licensed treatment center

52
Q

methadone dosing

A

40-120 mg once daily

53
Q

best treatment option for opioid abuse in pregnancy

A

methadone

54
Q

drug that needs an X DEA number to prescribe

A

buprenorphine

55
Q

buprenorphine dosing

A

4-8 mg on first day, titrate up

56
Q

buprenorphine in pregnancy

A

the buprenorphine only formulation can be used in pregnancy, not the combos

57
Q

buprenorphine compared to methadone

A

less overdose risk and abuse potential

58
Q

what drug can be used for alcohol and opioid use disorders

A

naltrexone

59
Q

when to avoid nicotine replacement therapy

A

MI in last 2 weeks or has unstable angina or arrhythmia

60
Q

drugs for smoking cessation

A

bupropion

varenicline

61
Q

bupropion dosing

A
  • Days 1-3 150 mg in morning
  • Days 4-end 150 mg BID
  • start 1-2 weeks before quit date
62
Q

bupropion contraindications

A

seizure disorders
eating disorder
heavy alcohol use

63
Q

varenicline cautions

A

renal impairment

psychiatric illness

64
Q

varenicline dosing

A

start 1 week before quit date

  • days 1-3 0.5 mg qam
  • days 4-7 0.5 mg BID
  • day 8-end 1 mg BID
65
Q

varenicline side effects

A

nausea
insomnia
abnormal dreams

PT2 Psyche 1-6 (6 decks)

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