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Diagnosis_Management 1 > Addiction > Flashcards

Addiction Flashcards

1
Q

administration of buprenorphine

A

SL as first-pass metabolism decreases bioavailability almost completely

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2
Q

therapeutic indications for morphine

A

tx opioid dependence

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3
Q

time frames for short and long-term detox as well as maintenance from opioids

A

short-term: 7-30 days
long-term: up to 180 days
maintenance: longer than 180 days

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4
Q

what schedule drug is methadone

A

2

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5
Q

what is the best way to detox heroine

A

transition to methadone, then buprenorphine, then naltrexone

tx withdraw symptoms w/ clonidine

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6
Q

time frame for avoidance of opioids prior to intiation of buprenorphine

A

short-acting: 12-24 hours
long-acting: 24-48 hours

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7
Q

effective dosage of methadone

A

> 60mg

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8
Q

effective dosage of buprenorphine

A

6-16mg

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9
Q

time frame for development of withdrawal symptoms from methadone

A

within 3-4 days with peak at 6 days

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10
Q

dosages for methadone in maintenance program

A

initially 15-20mg then titrate up over several weeks to at least 70mg w/ max of 120mg daily

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11
Q

how long should methadone maintenance programs last

A

several years

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12
Q

who can administer buprenorphine

A

specially trained physicians

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13
Q

tramadol dosages for depression/OCD

A

50-200mg daily

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14
Q

opioid receptor agonists used for withdrawal

A

morphine
buprenorphine

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15
Q

when does tolerance to naltrexone develop

A

It doesnt

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15
Q

buprenorphine ceiling effect

A

eventually increased dosing prolongs action without further increasing agonist effects

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16
Q

opioid receptor antagonists used for opioid addiction

A

naltrexone
nalmefene
naloxone

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17
Q

how do opioid receptor antagonists work for opioid addiction

A

bind to opioid receptors without activating them

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18
Q

how long does naltrexone block opioid effects

A

72 hours

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19
Q

half-life and peak concentration of naltrexone

A

peak concentration in 1 hour
half-life 1-3 hours and 13 hours for metabolite

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20
Q

why is naloxone used before initiation of naltrexone

A

to confirm patient is opioid free

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21
Q

what is the most effective treatment for opioid addiction

A

opioid receptor antagonist with CBT

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22
Q

how do you obtain rapid detox if initiated on the first day of opioid abstinence

A

continuous administration of clonidine to reduce adrenergic symptoms and adjunct benzodiazepines to reduce muscle spasms and insomnia

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23
Q

how quickly can rapid detox from opioids be accomplished

A

48-72 hours

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24
Q

why would you use opioid receptor antagonists in alcohol use disorder

A

to reduce cravings

25
Q

washout period required between last dose of short acting opioid and antagonist treatment

A

5 days (heroine)

26
Q

washout period between last dose of long acting opioids and antagonist use

A

10 days (methadone)

27
Q

what happens in a naloxone challenge

A

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

28
Q

symptoms of acute opioid withdrawal

A

drug craving
feeling of temperature change
musculoskeletal pain
GI distress

29
Q

what if pain relief is needed during opioid antagonist therapy

A

use benzodiazepine or nonopioid analgesic

30
Q

initial dosage of naltrexone

A

50mg daily

31
Q

dose-related hepatotoxicity of naltrexone

A

doses above 50mg daily monitor serum aminotransferase for first 6 months

32
Q

how quickly do you titrate up dosage of naltrexone and how do you administer it during maintenance

A

titrate over 1 hour - 2 weeks

average dosage over a week
(100mg qod or 150mg q3 days)

33
Q

what is used to treat alcohol use disorder

A

disulfiram and acamprosate

34
Q

what is the half-life of disulfiram

A

60-120 hours
(may take 1-2 weeks to be eliminated from the body)

35
Q

how does disulfiram work

A

blocks effects of alcohol by causing increase in acetaldehyde in the blood which causes the unpleasant reaction

36
Q

what are the symptoms of disulfiram reaction

A

N/V, HA, flushing, sweating, thirst, dyspnea, tachycardia, chest pain, vertigo, blurred vision

37
Q

how long after alcohol consumption does disulfiram reaction occur and how long does it last

A

almost immediately and lasts 30 minutes to 2 hours

38
Q

when is the use of disulfiram contraindicated and why

A

significant pulmonary or cardiovascular disease because severe reaction can be fatal

39
Q

typical dosage of disulfiram

A

500mg daily x2 weeks followed by maintenance dose of 250mg

40
Q

maintenance range for disulfiram

A

125mg-500mg

41
Q

how long must alcohol be stopped prior to starting disulfiram

A

12 hours

42
Q

what kinds of alcohol must you avoid with disulfiram

A

all kinds including mouthwash, cough syrups, perfume

43
Q

common side effects of acamprosate

A

HA, diarrhea, flatulence, abdominal pain. [aresthesia, skin reactions

44
Q

when is acamprosate contraindicated

A

severe renal impairment

45
Q

recommended dosage of acamprosate

A

2 333mg tabs TID

46
Q

what if you miss a dose of acamprosate

A

take it ASAP unless almost time for next dose

47
Q

therapeutic indication for clonidine and guanfacine

A

withdrawal
tourettes
tic disorders
hyperactivity/aggressiveness in children
PTSD

48
Q

half life of clonidine

A

6-20 hours

49
Q

half-life of guanfacine

A

10-30 hours

50
Q

mechanism of action for clonidine and guanfacine

A

presynaptic a2-receptor agonists

51
Q

how does clonidine/guanfacine help withdrawal symptoms

A

reduces autonomic symptoms of rapid withdrawal but not subjective sensations

52
Q

time frame for therapeutic effect clonidine/guanfacine in tourettes

A

may take a long time to affect sx
(4-6 months)

53
Q

common side effects of clonidine

A

dry mouth/eyes, fatigue, sedation, dizziness, nausea, hypotension, constipation

54
Q

how does OD of clonidine/guanfacine present

A

coma and constricted pupils similar to opioids with decreased BP, P, R

55
Q

when do withdrawal symptoms appear from clonidine

A

after 20 hours

56
Q

sx of abrupt cessation of clonidine/guanfacine

A

anxiety/restlessness
sweating
tremor
abdominal pain
palpitations
HA
dramatic increase in BP

57
Q

first pass metabolism of methadone

A

decreases bioavailability by half

58
Q

First-pass metabolism of buprenorphine

A

decreases bioavailability almost entirely
(give SL)

59
Q
A

Diagnosis_Management 1 (16 decks)

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