addictions Flashcards
risk of depression after smoking cessation
smoking cessation can have a large ‘antidepressant-like’ effect in reducing the symptoms of depression in those who suffer from depression
prise en charge de arret tabagique chez une pte avec Hx de dépressions
Bupropion - first choice
varenicline is not preferred in patients with a history of depression due to its association with suicidality
Proshaska model: étapes
precontemplation
contemplation
action
maintenance
chez un pt avec pb hépatique qui cherche desintox de ROH: options
sans pb hépatiques: options
benzo sans passage hépatique (oxazepam)
plus de risque de ROH withdrawal seizures avec oxazepam
In patients with a good degree of hepatic function, chlordiazepoxide is the drug of choice as it has a low dependence forming potential
meilleure option pour maintenir une abstinence chez un pt avec ROH type binges et présentement sous opiodes pour douleur
Acamprosate can prevent relapse to alcohol use and has been found to have a modest treatment effect that is best suited to supporting abstinence in individuals who are concerned that craving will lead to a lapse/relapse.
It should be commenced as soon as possible after abstinence has been achieved and should be maintained if the patient relapses.
Naltrexone can reduce alcohol craving, but precipitate opioid withdrawal and worsen chronic pain in this case.
diagnostic categories related to cannabis use in DSM-V
cannabis-induced psychotic disorder ( along with Schizophrenia Spectrum and Other Psychotic Disorders);
cannabis-induced anxiety disorder (in Anxiety Disorders chapter);
cannabis-induced sleep disorder (in Sleep-Wake Disorders chapter),
cannabis intoxication delirium (in the chapter ““Neurocognitive Disorders.””) are recognised
Kinaesthetic hallucinations are reported in cases with
benzo withdrawal
effects of chronic use of cocaine
verebrovascular: strokes
cardiac: MI, arrhythmias
seizures
In Canada, which is considered first line best practice for the treatment of opioid use
disorder?
buprenorphine-naloxone
facteurs qui prédisposent à l’addiction
type de drogue (activité DA etc cocaine/amphet - 10% of initial users)
dose (+ dose + addictif)
voie d’expo (+ vite + addiction)
ROH intox: management
supportive
Thiamine then glucose
no charcoal or lavage
sevrage ROH: timeline, sx, tx
debut 6-24h
seizures in 24-48h
DT 48-72h
increase sympathetic activity
monitor: CIWA
Tx:
benzos (if liver ok - diazepam or chlordiazepoxide) - CIWA = 10: start
if previous complicated withdrawal - do not wait
avoid antipsychotics
B1 IV or IM
refer to therapy
Wernicke encephalopathy triad
nystagmus + 6th nerve palsy
ataxia
delirium
cause acute B1 deficiency
APA guidelines on Tx of ROH
acamprosate and naltrexone: moderate to severe ROH use (if no effect of nonRx approaches or pt desire)
disulfiram/topiramate/gabapentin - if preferred or acamprosate/naltrexone not tolerated
Topiramate use in ROH use
significant reduction in ROH use in 4/6 studies
preffered option in bipolar pts or mood disorders
pt can be still drinking
side effects: cognitive, paraesthesia, met acidosis
gabapentin use in ROH
900-1800 mg die
renally excreted
potential for misuse
1 large RCT = 3 small
nicotine withdrawal: facts
starts in 2-4hrs
pic in 24-48hrs
3 approved Rx for cessation
- NRT
- Bupropion 300 (preferred in depression; double risk of cessation)
- Varenicline 1mg bid (3mo, highly potent partial agonist of NAchR)
buprenorphine-naloxone: facts
first line Tx of opiod use disorder
partial mu-R agonist with HIGH affinity
can precipitate withdrawal if opiod use
should be started in partial withdrawal
in pts with high opiod tolerance - use methadone
avoid benzos
methadone: facts
2nd line
in high opiod tolerance or poor responders to B-N
full agonist of mu-R
risk overdose if concominant use of opiods
studied in pregnancy
QT prolongation
highest risk of mortality from overdose in opiod and sedative use disorders
after cure of detox
SUD: clinical assessment goals
determine type and severity of SUD
DX other conditions and other substance use
perception and readiness for change
psyc and med co-morbidities
barriers and facilitators to reducing use
inform on plan
to determine type an severity of SUD: components of assessment
Type, frequency and amount
Hx of prior SUD, Tx
route of administration
overdose Hx
consequences of use
last use
severity
2-3 criteria - mild
4-5 criteria - moderate
>6 - severe
naltrexone: facts
1st line treatment for ROH use d/o
blockage recepteurs mu
inhibition axe HPA
pas besoin abstinence pour Tx
CI - liver failure; opiod use
oral or IM
