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Clin Pharm > Addiction med > Flashcards

Addiction med Flashcards

1
Q

SUD (4), AUD, OUD

A

Substance use do (Tobacco, ETOH, Marijuana, Ilicit drugs
Alcohol use do
Opioid use do

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2
Q

Addiciton def.

A

CHRONIC, RELAPSING disorder
“disease necessisating tx”

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3
Q

T/F: Treat relapse slowly

A

False, treat relapse QUICKLY

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4
Q

OD deaths largely from

A

FENTANYL and synthetic opioids

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5
Q

___% of pts prescribed opiates will misuse them
___% of provider Rx will lead pts to SUD

A

30%
10%

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6
Q

T/F: Using drugs alone leads to more OD’s?

A

Trueee

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7
Q

Which NT is most commonly overstimulated w/opioids?

A

DOPAMINE
“Nearly all addictive drugs directly or indirectly target the brain’s reward system by flooding the circuit with dopamine”.

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8
Q

__% of a pts propensity for addiction is genetic

A

50%

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9
Q

**Children of parents with SUD/AUD are __x more likely to develop an addiction

A

8

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10
Q

Earlier age at 1st encounter w/drugs or ETOH, more likely to develop addiction
adult mental illness:
__before 14yo,
____before 24yo

A

1/2
3/4

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11
Q

___% ind w/mental illness also struggle w/SUD

A

50%

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12
Q

Alcoholics __x more likely to be dx w/antisocial personality compared to gen pop

A

21

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13
Q

Women who abuse Rx opioids are ___% more likely to be dx with PTSD

A

200%

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14
Q

Addcition is a ___ not a lack of ___

A

Disease
Willpower

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15
Q

T/F: Addicts fear community judgement

A

True

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16
Q

T/F: we should ask addcition questions like “we ask this of everyone”

A

NO. JUST ASK IT. Dont give it a pretext

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17
Q

5 Points of speaking to pts about addcition

A

*Recommend that pt stop, but acknowledge diffculty & discuss ↓ over time.
*Keep discussion medicine-based
**∙ Provide EBM facts
“60% smokers die of complication 2/2 smoking”
∙ Openly discuss the health consequences
“80-90% more likely2 get lung CA as a smoker”
∙ Phrase from a QOL perspective
“Conseq of heavy ETOH inc liver failure which…”
∙ Addiction is a disease and is treatable

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18
Q

**_____ leading preventable COD

A

Cigarette smoking

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19
Q
  • Smoking ↑ the risk of CAD & CVA ___x
A

2-4x

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20
Q

1 in __ Americans smoke cigarettes

A

7

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21
Q

T/F: Vaping is decreasing

A

False. its going UPP

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22
Q

A 3–10-min discussion with a provider:
- ↑ the likelihood for pt’s success in quitting __x
- ↑ __x if the discussion exceeds 10 min
- However, if pt not ready to quit- don’t harass!

A

1.6
2.3x

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23
Q

Avg of __ attempts before cessation of cig smoking

A

4

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24
Q

Nicotine w/d Sx

A
  • Feeling irritable, angry, or anxious
  • Having trouble thinking
  • Craving tobacco products
  • Feeling hungrier than usual
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25
Q

1yr after quitting, risk for a heart attack ↓ sharply
2-5yr after quitting, risk for CVA ↓ by 1/2
10yrs after quitting, risk for lung CA ↓ by 1/2

A

just saying

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26
Q

Rx for Smoking cessation

A

Varenicline (Chantix)
Bupropion (Welbutrin)
Nicontine replacement (gum, patches, lozenge)

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27
Q

T/F: you can have a pt on nicotine replacement with no plan to stop later

A

false

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28
Q

Ecgarettes?

A

No FDA regulation
Lack of research

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29
Q

1:__ adults suffer AUD

A

12

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30
Q

Which pt interactions need ETOH use screening? (2)

A

ALL pts as part of routine exam
Before prescribing Rx that can interact w/ETOH

31
Q

Screen ETOH use for these pts

A
  • Pregnant
  • H/o other substance abuse
  • Have depression, anxiety, or mental health do.
  • Have liver disease
32
Q

CAGE Questionnaire
Score 0
Score 3-4
Score 1-2

A

CAGE score 0 has a good (-)predictive value
CAGE score 3-4 strongly supports dx of AUD
CAGE 1-2 interpreted with caution

33
Q

T/F: ETOH w/d can be life threatening

A

TRUE

34
Q

ETOH w/d starts at __-__hrs after last drink and lasts __-__hrs

A

8-12
48-72hrs

35
Q

Mild ETOH w/d

A
  • onset 6-12h, can last 3d
    tremor, tachy, anxiety, GI upset
36
Q

Seizures ETOH w/d

A
  • 24-48h gen tonic-clonic
    risk: h/o prior seizures
37
Q
  • Delirium tremens
A

onset 24-72h
confusion, hallucination (tactile & visual), tremor, autonomic dysfunction, CV instability
–can be fatal

38
Q

What kind of hallucinations with delirium tremens?

A

Tactile, visual

39
Q

T/F: Delirium tremens can occur 10d out from w/d

A

True. Scary

40
Q

Wernicke Encephalopaty
Korsakoff

S/Sx of both? Which one is reversible? Tx for both?

A
  • Wernicke encephalopathy: Wernicke’s “CAN”
    Confusion, Ataxia,
    Neuralgia=ophthalmoplegia (CN VI), reversible
  • Korsakoff: sequela of Wernicke: psychosis irrreversible
    THIAMINE, THIAMINE, THIAMINE!
    For active W/d
41
Q

Avg person clears __-__mg/dL/hr of ETOH

A

15-20

42
Q

Rx for acute ETOH w/d sx?

A

**Barbiturates> Benzos cornerstone of Tx
*Phenobarbitol
works well, doesn’t cause a “High”

43
Q

5 Strategies for Cutting down on ETOH?

A
  • Keep track
  • Be aware of sizes
  • Set goals
  • Eat while drinking
  • Drink slower
44
Q

ETOH: *Treat depression-rel to relapse ______

A

Aggressively
don’t let them spiral

45
Q

3 oral ETOH MAT Rx
1 Injectable

A

1)**Naltrexone – helps ↓ drinking by stopping the pleasurable effects of ETOH.

Cannot drink on these Rx (Patients must be abstinent prior to initiation of these):
2) Acamprosate – ↓ cravings
3) Disulfiram (Antabuse) – blocks the metabolism of alcohol (toxic ETOH compounds→ pt becomes ill)

4) Vivitrol is the injectable long-acting form

46
Q

Can you combo the MAT Rx?

A

Research doesnt support it.
If pt cannot tolerate 1 for >3mo, try another

47
Q

Alcohol reduction Resources

A

AA

48
Q

Common Opioid Rx? (7)

A

Hydrocodone, Oxycodone, Percocet, Vicodin, Morphine, Codeine, Fentanyl

49
Q

Illicit Opioid?

A

Heroin

50
Q

Maintenance Opioid Tx?

A

Methadone

51
Q

___ OD is leading accidental COD

A

Drug

52
Q

__% of opioid misuse begins with using drugs that are not prescribed to that individual

A

75%

53
Q

< ___ MME is goal

A

50

54
Q

Acute pain Opioid Rx script

A

<14d
<50MME

55
Q

Why is fentanyl an epidemic?

A

“dirt cheap & simple to make”
Very few steps
- Every batch is different
could be 50x or 100x more potent than morphine
- Used to cut with other drugs

56
Q

T/F: Opiate w/d can kill you

A

FALSE. ETOH and Benzo w/d can kill you

57
Q

Opiate W/d
10-24hrs

A

Emesis

58
Q

Opiate W/d
36-48hrs

A

Diaphoresis, Nausea, Rhinorrhea, MYDRIASIS, Conjunctiva

59
Q

Opiate W/d
48-72hrs

A

Anxiety, Insomnia, Localized pain

60
Q

Opiate W/d
72hrs-1wk

A

All sx gradually start fading away

61
Q

COWS

A

w/d scale for initation & amt of Saboxone to distribute

62
Q

What happens if you give saboxone too early?

A

Precipitate w/d

63
Q

Which tx can cause a high?
Methadone or Saboxone?

A

Methadone

64
Q

T/F: COWS sx are objective?

A

No, they ar subjective

65
Q

T/F: *Supervised Detox
- Provider/patient create a ↓ usage plan
Is a good method?

A

FALSE
- Research actually shows this is fairly unsuccessful and might actually lead to more overdoses

66
Q

MAT Tx for Opioids (3 Rx)

A
  • Methadone
  • Buprenorphine (Suboxone)
  • Naltrexone
67
Q

T/F: MAT↑ tx retention & ↓ risk of OD

A

So true

68
Q

If pt is not ready to stop opioids, __ should be given at a minimum

A

Narcan yall

69
Q

What is an electronic database that tracks controlled substance Rx/state?

A

Prescription drug monitoring programs (PDMPs)

70
Q

T/F: In colorado, all pharmacies in CO required to input all controlled substance prescriptions AND
report on same day as suspensement

A

TRUE

71
Q

T/F: Not all providers must be registered with PDMP

A

FALSe

72
Q

Bill 18-22

A

Clinical Practice for Opioid Prescribing
Initial prescription of an opioid is limited to a seven-day supply, if the prescriber has not written an opioid prescription for the patient in the last 12 months

The prescriber may exercise discretion in including a second fill for a seven-day supply.

73
Q

T/F: We should use stats when communicating with pts about addction

A

True

74
Q

T/F: You can tell patients who are not currently interested in cessation that you can discuss it in the future

A

yes

Clin Pharm (6 decks)

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