Addiction Flashcards
administration of buprenorphine
SL as first-pass metabolism decreases bioavailability almost completely
therapeutic indications for morphine
tx opioid dependence
time frames for short and long-term detox as well as maintenance from opioids
short-term: 7-30 days
long-term: up to 180 days
maintenance: longer than 180 days
what schedule drug is methadone
2
what is the best way to detox heroine
transition to methadone, then buprenorphine, then naltrexone
tx withdraw symptoms w/ clonidine
time frame for avoidance of opioids prior to intiation of buprenorphine
short-acting: 12-24 hours
long-acting: 24-48 hours
effective dosage of methadone
> 60mg
effective dosage of buprenorphine
6-16mg
time frame for development of withdrawal symptoms from methadone
within 3-4 days with peak at 6 days
dosages for methadone in maintenance program
initially 15-20mg then titrate up over several weeks to at least 70mg w/ max of 120mg daily
how long should methadone maintenance programs last
several years
who can administer buprenorphine
specially trained physicians
tramadol dosages for depression/OCD
50-200mg daily
opioid receptor agonists used for withdrawal
morphine
buprenorphine
when does tolerance to naltrexone develop
It doesnt
buprenorphine ceiling effect
eventually increased dosing prolongs action without further increasing agonist effects
opioid receptor antagonists used for opioid addiction
naltrexone
nalmefene
naloxone
how do opioid receptor antagonists work for opioid addiction
bind to opioid receptors without activating them
how long does naltrexone block opioid effects
72 hours
half-life and peak concentration of naltrexone
peak concentration in 1 hour
half-life 1-3 hours and 13 hours for metabolite
why is naloxone used before initiation of naltrexone
to confirm patient is opioid free
what is the most effective treatment for opioid addiction
opioid receptor antagonist with CBT
how do you obtain rapid detox if initiated on the first day of opioid abstinence
continuous administration of clonidine to reduce adrenergic symptoms and adjunct benzodiazepines to reduce muscle spasms and insomnia
how quickly can rapid detox from opioids be accomplished
48-72 hours
why would you use opioid receptor antagonists in alcohol use disorder
to reduce cravings
washout period required between last dose of short acting opioid and antagonist treatment
5 days (heroine)
washout period between last dose of long acting opioids and antagonist use
10 days (methadone)
what happens in a naloxone challenge
it will reduce the effects of opioid causing withdrawal but effects only last about an hour so symptoms are short lived
helps to confirm opioid free state prior to initiating opioid antagonist treatment
symptoms of acute opioid withdrawal
drug craving
feeling of temperature change
musculoskeletal pain
GI distress
what if pain relief is needed during opioid antagonist therapy
use benzodiazepine or nonopioid analgesic
initial dosage of naltrexone
50mg daily
dose-related hepatotoxicity of naltrexone
doses above 50mg daily monitor serum aminotransferase for first 6 months
how quickly do you titrate up dosage of naltrexone and how do you administer it during maintenance
titrate over 1 hour - 2 weeks
average dosage over a week
(100mg qod or 150mg q3 days)
what is used to treat alcohol use disorder
disulfiram and acamprosate
what is the half-life of disulfiram
60-120 hours
(may take 1-2 weeks to be eliminated from the body)
how does disulfiram work
blocks effects of alcohol by causing increase in acetaldehyde in the blood which causes the unpleasant reaction
what are the symptoms of disulfiram reaction
N/V, HA, flushing, sweating, thirst, dyspnea, tachycardia, chest pain, vertigo, blurred vision
how long after alcohol consumption does disulfiram reaction occur and how long does it last
almost immediately and lasts 30 minutes to 2 hours
when is the use of disulfiram contraindicated and why
significant pulmonary or cardiovascular disease because severe reaction can be fatal
typical dosage of disulfiram
500mg daily x2 weeks followed by maintenance dose of 250mg
maintenance range for disulfiram
125mg-500mg
how long must alcohol be stopped prior to starting disulfiram
12 hours
what kinds of alcohol must you avoid with disulfiram
all kinds including mouthwash, cough syrups, perfume
common side effects of acamprosate
HA, diarrhea, flatulence, abdominal pain. [aresthesia, skin reactions
when is acamprosate contraindicated
severe renal impairment
recommended dosage of acamprosate
2 333mg tabs TID
what if you miss a dose of acamprosate
take it ASAP unless almost time for next dose
therapeutic indication for clonidine and guanfacine
withdrawal
tourettes
tic disorders
hyperactivity/aggressiveness in children
PTSD
half life of clonidine
6-20 hours
half-life of guanfacine
10-30 hours
mechanism of action for clonidine and guanfacine
presynaptic a2-receptor agonists
how does clonidine/guanfacine help withdrawal symptoms
reduces autonomic symptoms of rapid withdrawal but not subjective sensations
time frame for therapeutic effect clonidine/guanfacine in tourettes
may take a long time to affect sx
(4-6 months)
common side effects of clonidine
dry mouth/eyes, fatigue, sedation, dizziness, nausea, hypotension, constipation
how does OD of clonidine/guanfacine present
coma and constricted pupils similar to opioids with decreased BP, P, R
when do withdrawal symptoms appear from clonidine
after 20 hours
sx of abrupt cessation of clonidine/guanfacine
anxiety/restlessness
sweating
tremor
abdominal pain
palpitations
HA
dramatic increase in BP
first pass metabolism of methadone
decreases bioavailability by half
First-pass metabolism of buprenorphine
decreases bioavailability almost entirely
(give SL)
