Addiction and Abuse - Medications

Question 1

opioid use/indications (what about low dose)

Answer 1

1. analgesia
2. low dose: antitussive codeine
3. super low dose: antidiarrheal immodium

Question 2

opioid MOA

Answer 2

mu, delta, kappa opioid receptor agonist

decreases pain signaling, increases reward signaling

Question 3

opioid actions

Answer 3

euphoria, sedation

Question 4

opioid toxicity/OD

Answer 4

respiratory depression

Question 5

opioid withdrawal S/S (initial vs later)

Answer 5

initial: sweating, runny nose, tearing, yawning, diarrhea (everything hyperactive and runny)

Later: insomnia, chills, weakness, N/V, muscle aches, HTN

Question 6

What is anticholinergic action and why is it important?

Answer 6

“everything dries out” - constipation, anhidrosis, urinary retention

can occur with opioid overdose

Question 7

Examples of opioids

Answer 7

1. Hydromorphone/Dilaudid
2. Oxymorphone/Opana
3. Hydrocodone/Vicodin/Norco (Vicodin has acetaminophen in it too)
4. Oxycodone
   - perocet = oxycodone + acetaminophen
   - percodan = oxycodone + aspirin
   - oxycontin (long acting)
5. Methadone

Question 8

opioid contraindications

Answer 8

1. h/o addiction/abuse
2. decreased level of consciousness
3. co-administration w/ sedative/benzodiazepine

Question 9

opioid SE

Answer 9

1. respiratory depression
2. pruritus
3. urinary retention
4. N/V, constipation
5. miosis
6. Sphincter of Oddi spasms –> abdominal pain in RUQ

Question 10

Signs of opioid overdose/abuse

Answer 10

1. track marks
2. hypoventilation
3. miosis
4. decreased LOC

Question 11

opioid withdrawal signs

Answer 11

1. diarrhea
2. hyperthermia
3. nausea/vomiting
4. muscles aches
5. mydriasis
6. increased anxiety, goose bumps
7. hyperventilation

Question 12

opioid overdose antidote

Answer 12

naloxone/narcan

Question 13

naloxone/narcan indication

Answer 13

reversal of opiate effects

Question 14

naloxone/narcan MOA

Answer 14

synthetic opiate antagonist

has higher affinity for mu receptor than opiates so it kicks of opiate from mu receptor

Question 15

naloxone/narcan considerations

Answer 15

1. causes addicts to go into withdrawal (few min - 2hrs) - vomiting, restlessness, abdominal cramps, increased BP and temp, hyperthermia
2. short duration of action - may wear off before opiate if opiate half life is longer

Question 16

What do should monitor after giving naloxone/narcan?

Answer 16

RR, HR/rhythm, BP, LOC for 3-4 hours after peak of drug in system –> if opioid replaces narcan, then can go back into overdose and cause decreased RR & LOC

Question 17

Ethanol MOA

Answer 17

CNS depressant, decreases glutamate (excitatory), increases GABA (inhibition)

Question 18

Ethanol actions

Answer 18

1. Low dose: flushing, sedation, loss of inhibition
2. Moderate dose: slow reaction time, impaired concentration
3. High dose: impaired judgement, confusion, irrational thinking, impaired memory

Question 19

levels of Ethanol to cause death

Answer 19

5000 mg/L or BAC 0.5%

Question 20

Ethanol metabolism

Answer 20

liver

Question 21

chronic Ethanol toxicity

Answer 21

1. liver: cirrhosis, liver failure
2. brain: cognitive impairment
3. CV: HTN, arrhythmias, cardiomyopathy, stroke
4. Nutrition: Wernicke Korsakoff Syndrome
5. Fetal Alcohol Syndrome: mental retardation

Question 22

Ethanol withdrawal

Answer 22

1. excessive excitation –> seizures, hallucinations, tremor, tachycardia, HTN, sweating, insomnia, anxiety

Question 23

Treatment for Ethanol Withdrawal

Answer 23

maintain respiration, IV fluids, benzos

Question 24

maintaining sobreity

Answer 24

antabuse - blocks enzyme that breaks down acetaldehyde

Question 25

what is the schedule of tramadol/ultram

Answer 25

IV, but has less addictive properties than opioids

Question 26

tramadol/ultram MOA

Answer 26

1. milder opioid mu receptor agonist | 2. serotonin/norepinephrine reuptake inhibitor

Question 27

tramadol/ultram indications

Answer 27

mild/moderate analgesia

Question 28

tramadol/ultram contraindicaitons

Answer 28

1. H/O SEIZURE 2. other meds that lower seizure threshold 3. concurrent MAOI use

Question 29

tramadol/ultram SE

Answer 29

flushing, rash, constipation, orthostatic hypotension, seizures, serotonin syndrome, Steven-Johnson syndrome (tutors emphasized last 4)

Question 30

what is serotonin syndrome?

Answer 30

when there is a build up of serotonin in synapses --> agitation, confusion, high HR and BP, dilated pupils, etc.

Question 31

tapentadol/nucynta MOA

Answer 31

opioid receptor agonist, norepinephrine reuptake inhibitor

Question 32

tapentadol/nucynta contraindications

Answer 32

1. respiratory depression 2. concurrent MAOI use 3. paralytic ileus

Question 33

tapentadol/nucynta SE

Answer 33

1. constipation 2. orthostatic hypotension 3. dizziness, nausea

Question 34

drug class of acetaminophen

Answer 34

aniline

Question 35

acetaminophen MOA

Answer 35

COX-3 inhibitor, works by increasing pain threshold, blocks heat regulating center in brain No antiplatelet or anti-inflammatory activity

Question 36

acetaminophen indications

Answer 36

anti-pyretic, pain relief

Question 37

where is acetaminophen metabolized?

Answer 37

liver

Question 38

metabolism process of acetaminophen

Answer 38

1. converted to NAPQI 2. body makes GSH to counteract NAPQI 3. if you take too much, then you run out of GSH

Question 39

What is considered an overdose of acetaminophen and who is at risk?

Answer 39

1. 10x therapeutic dose (6500 mg) | 2. children under 10, malnourished, alcoholics, CYP2E1 deficiency

Question 40

antidote for acetaminophen overdose

Answer 40

N-acetyl cysteine (NAC)

Question 41

contraindications for acetaminophen

Answer 41

1. liver disease | 2. combination drugs that include acetaminophen (ie. vicodin)

Question 42

acetaminophen SE

Answer 42

1. liver failure --> renal failure | 2. hypersensitivity (rash, hives)

Question 43

use of methadone

Answer 43

control withdrawal from heroin