addiction yun kim

Question 1

A. buprenorphine
B. methadone
C. both
what is a more effective heroine substitution therapy?

Answer 1

C. both
Methadone and buprenorphine are both effective heroin substitution therapies. The choice between the two may depend on individual patient factors and preferences, as well as the specific treatment setting.

Question 2

how will you manage this situation?

Answer 2

follow this order:

Assess the severity of alcohol withdrawal: Use a validated tool like the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) to assess the severity of the patient’s withdrawal symptoms.

Prescribe pharmacological treatment: For alcohol withdrawal management, benzodiazepines (such as chlordiazepoxide or diazepam) are the first-line treatment. The dosage and duration should be tailored to the patient’s individual needs, considering factors like the severity of withdrawal symptoms, medical history, and risk of seizures.

Monitor and adjust treatment: Regularly monitor the patient’s withdrawal symptoms and adjust the benzodiazepine dosage accordingly. It is important to ensure that the patient is not over- or under-medicated.

Address electrolyte imbalances: As the patient has low magnesium and potassium levels, provide appropriate supplementation to correct these imbalances. Monitor the patient’s electrolyte levels regularly.

Manage co-existing conditions: Continue the patient’s current medications for PTSD, depression, anxiety, and asthma. Reassess the need for adjustments in the medications or dosages based on the patient’s response to withdrawal management.

Provide psychosocial support: Offer psychosocial interventions, such as cognitive-behavioral therapy (CBT) or motivational interviewing, to help the patient cope with withdrawal symptoms and support long-term abstinence.

Plan for long-term management: After the patient has successfully completed withdrawal, consider offering relapse prevention medications like acamprosate or naltrexone, in conjunction with psychosocial interventions such as CBT, support groups (e.g., Alcoholics Anonymous), or other community-based resources.

Involve family and social support: Encourage the involvement of family members or friends in the patient’s treatment, as appropriate, to provide support during the recovery process.

Monitor progress: Regularly review the patient’s progress and adjust the management plan as needed.

Question 3

Quiz 3 which of the two drugs are recommended for the management of heroin dependence?

A. methadone and buprenorphine
B. methadone and bupropion
C. methadone and naltrexone
D. buprenorphine and naltrexone
E. bupropion and naloxone

Answer 3

A. methadone and buprenorphine

Question 4

Q1: What are the three alcohol withdrawal assessment tools mentioned in the lecture?
A1: The three alcohol withdrawal assessment tools are Glasgow Modified Alcohol Withdrawal Score (GMAWS), Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar), and Severity of Alcohol Dependence Questionnaire (SADQ).

Question 5

Q2: How should alcohol withdrawal seizures be managed according to NICE guidelines?
A2: Alcohol withdrawal seizures should be managed with a quick-acting benzodiazepine, such as lorazepam, to reduce the likelihood of further seizures. If seizures develop during treatment for acute alcohol withdrawal, the withdrawal drug regimen should be reviewed. Phenytoin should not be offered to treat alcohol withdrawal seizures.

Question 6

Q3: Which medication is contraindicated for patients with a SeCr > 120 micromole/L when aiming to maintain abstinence from alcohol?
A3: Acamprosate is contraindicated for patients with a SeCr > 120 micromole/L.

Question 7

Q4: What are the aims of treatment and management of drug misuse?
A4: The aims are to achieve the patient’s expressed goals, reduce or prevent withdrawal symptoms, break completely with all illicit opioid drug use and associated unhealthy risky behaviors, reduce illicit opioid use with positive change in drug-taking and risk behavior, and encourage cessation of injecting.

Question 8

Q5: What are the clinical factors to consider when choosing between buprenorphine and methadone for opioid dependence treatment?
A5: Factors to consider include the patient’s pre-existing preference, previous treatment history, safety concerns, requirement for additional pain management, drug-drug interactions, local pragmatic factors, and pharmacological properties such as half-life.

Question 9

Q6: How should a patient’s buprenorphine dose be reduced during opioid detoxification?
A6: Buprenorphine doses can be reduced initially by 2mg every 2 weeks or so, with final reductions being around 400 micrograms.

Question 10

Q7: What is the role of naltrexone in the management of addiction?
A7: Naltrexone is an opioid antagonist used for the prevention of relapse of heroin use. It blocks the effects of opioids completely and should only be started after a patient is completely opioid-free.

Question 11

Q8: How should Wernicke-Korsakoff Syndrome (WKS) be prevented and managed in alcohol-dependent patients?
A8: WKS should be prevented and managed by administering parenteral thiamine (e.g., IV Pabrinex for 3-5 days, followed by PO thiamine) and correcting electrolyte imbalances (e.g., potassium, phosphate, magnesium).

Question 12

Q9: In the management of alcohol withdrawal, why are long-acting benzodiazepines with active metabolites preferred?
A9: Long-acting benzodiazepines with active metabolites, such as diazepam or chlordiazepoxide, are preferred because they seem to result in a smoother clinical course with a lower chance of recurrent withdrawal or seizures.

Question 13

Q10: How can lofexidine be used in the management of opioid withdrawal?
A10: Lofexidine is a non-opioid alpha-adrenergic agonist that can be used as an adjuvant to opioid substitution therapy or as an opioid substitute in patients who have mild or uncertain dependence and those with a short history of illicit drug use.

Question 14

Q11: What are the signs and symptoms of Delirium Tremens (DTs)?
A11: Signs and symptoms of DTs include severe agitation, disorientation, confusion, coma, delusion, hallucination, seizure, deranged temperature/BP/glucose, and severe hypophosphatemia.

Question 15

Q12: How should initial management of Delirium Tremens be approached?
A12: Chlordiazepoxide/oxazepam 20mg should be administered every 30 minutes until symptoms are controlled or the patient becomes markedly sedated (maximum 250mg in 24 hours). Higher doses can be administered under specialist advice. IV diazepam 10mg every 30-60 minutes or IV lorazepam can be used if the patient has Child-Pugh B/C liver impairment.

Question 16

Q13: Which medication can be used to control psychiatric symptoms associated with Delirium Tremens, and what precautions should be taken?
A13: IM/PO haloperidol can be used to control psychiatric symptoms in addition to benzodiazepines. However, it carries the risk of decreasing seizure threshold, so it should be used only short-term, and ECG monitoring for QT interval prolongation should be considered.

Question 17

Q14: When should acamprosate be used to maintain abstinence from alcohol, and what are the contraindications and cautions for its use?
A14: Acamprosate should be used for patients aged 18-65 years, along with psychological support, and reviewed monthly for 6 months. It is contraindicated in patients with a SeCr >120 micromole/L and breastfeeding. Caution should be exercised in patients with hepatic impairment (Child-Pugh C).

Question 18

Q15: What are the formulations of methadone available for use in opioid dependence treatment?
A15: Methadone formulations include oral solution, sugar-free oral solution, oral solution concentrate, tablet, and solution for injection.

Question 19

Q16: What are the potential adverse effects of naltrexone in the management of addiction?
A16: Potential adverse effects of naltrexone include hepatotoxicity (requiring monitoring of LFTs before and during treatment), risks of overdose, and severe and prolonged withdrawal symptoms if opioids are used while on naltrexone.

Question 20

Q17: What is naloxone’s role in buprenorphine-naloxone combination therapy for opioid dependence?
A17: Naloxone is combined with buprenorphine in a 4:1 ratio to deter intravenous misuse of the medication. It is especially useful when supervised dispensing is difficult to deliver or when there is concern about a patient’s risks of reverting to injecting.

Question 21

Q18: How can symptomatic treatment be used to manage opioid withdrawal?
A18: Symptomatic treatments include loperamide (diarrhea), metoclopramide or prochlorperazine (nausea and vomiting), mebeverine (stomach cramps), diazepam (agitation, anxiety, and sleeplessness), and paracetamol, aspirin, or other NSAIDs (muscular pains and headaches).

Question 22

Q19: How should a patient’s methadone dose be reduced during opioid detoxification?
A19: Methadone doses can be reduced at a rate that will result in zero in around 12 weeks (e.g., 5mg every 1-2 weeks).

Question 23

Q20: What are the available fast-acting and long-acting forms of buprenorphine for opioid dependence treatment?
A20: Fast-acting forms include Espranor oral lyophilisate, which is administered oromucosally on the tongue (not under it). Long-acting forms