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Clinical Pharm > Addiction Meds - Jaynstein > Flashcards

Addiction Meds - Jaynstein Flashcards

1
Q

Addiction defined as ?

A

chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain

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2
Q

Addiction risk factors

A
  • Genetics
  • Psychological
  • Age (early encounter risk for addiction)
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3
Q

What are the treatment barriers?

A
  • Misunderstanding of the disease
  • Negative public attitude
  • Lack of information and resources
  • Insufficient social support
  • Privacy concerns
  • Cost
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4
Q

Speaking with patients about addiction

A

Recommend patients stop but acknowledge how hard it is and discuss a way to decrease over time

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5
Q

Tobacco is just as addictive as what?

A

Heronin

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6
Q

On average, how many attempts does it take for successful at quitting?

A

four

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7
Q

What are the symptoms of nicotine withdrawal?

A
  • Feeling irritable, angry, or anxious
  • Having trouble thinking
  • Craving tobacco products
  • Feeling hungrier than usual
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8
Q

After how many years, the risk of heart attack drops?

A

one year

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9
Q

What happens after 2-5 years after quitting?

A

the risk for stoke reduces to a non-smoker

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10
Q

What happens after smoking cessation?

A

risk of lung cancer drops by half

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11
Q

What are the smoking cessation option?

A
  • varenicline (Chantix), - bupropion (Wellbutrin)
  • nicotine replacement (gum, patches, lozenge)
  • Quitline
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12
Q

T/F Alcohol use screening as part of a routine exam

A

True!

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13
Q

Is CAGE questionnaire clinically useful?

A

Yes

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14
Q

CAGE score of 0 has a

A

good negative predictive value

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15
Q

CAGE score of 3-4 has a

A

supports the diagnosis of alcohol abuse

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16
Q

CAGE score of 1-2 has a

A

interpreted with caution

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17
Q

T/F alcohol withdrawal can be life-threatening

A

True

  • Withdrawal symptoms can start 8-12 hours after last drink
  • and last 48-72 hours
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18
Q

What is mild onset of alcohol dependence?

A

tremor, tachycardia, anxiety, GI upset

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19
Q

When does seizures come on?

A

(24-48 hours): generalized tonic-clonic, risk: h/o prior seizures

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20
Q

When does delirium come on?

A

(onset 24-72 hours, may occur up to 10 days out thou!): confusion, hallucinations (tactile and visual), tremor, autonomic dysfunction, CV instability – can be fatal

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21
Q

What is wernicke encephalopathy?

A

confusion, ataxia, ophthalmoplegia (CN VI), reversible

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22
Q

What is the sequela of wernicke?

A

Korsakoff

23
Q

What is Korsakoff?

A

psychosis, often non-reversible
THIAMINE, THIAMINE, THIAMINE!

24
Q

What are the symptoms of mild withdrawal?

A

?

25
Q

What are the symptoms of moderate withdrawal?

A

?

26
Q

What are the symptoms of severe withdrawal?

A

?

27
Q

What is the legal blood alcohol levels?

A

0.08 or 80mg/dL

28
Q

T/F patients can withdrawal at any level

A

True

29
Q

What is the strategies for cutting down?

A
  • Keep track
  • Be aware of sizes
  • Set goals
  • Eat while drinking
  • Drink slower – one drink per hour
30
Q

What are the four alcohol dependence treatment?

A

(PO) naltrexone, acamprosate, and disulfiram

Injectable (ER naltrexone)

31
Q

What is the goal of alcohol dependence treatment?

A

Reduce drinking, avoid relapse to heavy drinking, achieve and maintain abstinence, or gain a combination of these effects

32
Q

How long is the duration of treatment for alcohol dependance treatment?

A

3 months

  • if meds doesn’t work try another.
  • No evidence from combo medications
33
Q

Naltrexone

A
  • helps reduce drinking by stopping the pleasurable effects of alcohol
  • Patient can be actively working towards abstinence
    Vivitrol is the injectable long-acting form
34
Q

Acamprosate

A
  • reduces cravings
  • Patients must be abstinent prior to initiation
35
Q

Disulfiram (Antabuse)

A
  • blocks the metabolism of alcohol (toxic alcohol compounds cause people to become very ill).
  • Patients must be abstinent prior to initiation
36
Q

What are the two cornerstone of treatment for acute alcohol withdrawal?

A

Benzodiazepines and Barbiturates

Barbs are better

37
Q

T/F Pharmacotherapy for alcohol dependence is most effective when combined with some behavioral support,

A

True

This doesn’t need to be specialized, intensive alcohol counseling

38
Q

When is relapse most common?

A

first 12 months after abstinence

39
Q

T/F

A

Treat depression related to relapse aggressively

40
Q

What are the alcohol reduction resources?

A

-

41
Q

What are the common opioid meds?

A

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

42
Q

what is illicit opiods?

A

Heroin

43
Q

What is the maintenance medication?

A

Methadone

44
Q

T/F opiate dependence is estimated to effect nearly 10% of modern day medical practitioners

A

True!

45
Q

what is the goal for opioid analgesics

A

50T?

46
Q

T/F Fentanyl is 50-100x more potent than morphine

A

True!

47
Q

can you die from opioid withdrawl?

A

No! but they will feel really crappy

48
Q

Two you can die from is

A

benzo and alcohol with drawl

49
Q

What is the opiate withdrawal time line?

A
50
Q

T/F you need to be in significant with drawl before giving suboxone

A

True, you have to wait because you can push into early with drawl.

51
Q

What is the treatment for opioid addiction treatment?

A
  • supervised detox
  • inpatient care
  • Long-tern outpt care
  • cognitive behavioral therapy
52
Q

What are the three med approved for opioid use disorder?

A
  • Methadone
  • Buprenorphine (Suboxone)
  • Naltrexone
53
Q

T/F studies show MAT increase treatment retention and decreases the risk of overdose

A

True

54
Q

If patient is not ready to stop, what can you offer?

A

Naloxone (Narcan) at minimum!

Clinical Pharm (8 decks)

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