addictions

Question 1

risk of depression after smoking cessation

Answer 1

smoking cessation can have a large ‘antidepressant-like’ effect in reducing the symptoms of depression in those who suffer from depression

Question 2

prise en charge de arret tabagique chez une pte avec Hx de dépressions

Answer 2

Bupropion - first choice
varenicline is not preferred in patients with a history of depression due to its association with suicidality

Question 3

Proshaska model: étapes

Answer 3

precontemplation
contemplation
action
maintenance

Question 4

chez un pt avec pb hépatique qui cherche desintox de ROH: options

sans pb hépatiques: options

Answer 4

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

Question 5

meilleure option pour maintenir une abstinence chez un pt avec ROH type binges et présentement sous opiodes pour douleur

Answer 5

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.

Question 6

diagnostic categories related to cannabis use in DSM-V

Answer 6

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

Question 7

Kinaesthetic hallucinations are reported in cases with

Answer 7

benzo withdrawal

Question 8

effects of chronic use of cocaine

Answer 8

verebrovascular: strokes
cardiac: MI, arrhythmias
seizures

Question 9

In Canada, which is considered first line best practice for the treatment of opioid use
disorder?

Answer 9

buprenorphine-naloxone

Question 10

facteurs qui prédisposent à l’addiction

Answer 10

type de drogue (activité DA etc cocaine/amphet - 10% of initial users)

dose (+ dose + addictif)

voie d’expo (+ vite + addiction)

Question 11

ROH intox: management

Answer 11

supportive
Thiamine then glucose
no charcoal or lavage

Question 12

sevrage ROH: timeline, sx, tx

Answer 12

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

Question 13

Wernicke encephalopathy triad

Answer 13

nystagmus + 6th nerve palsy
ataxia
delirium

cause acute B1 deficiency

Question 14

APA guidelines on Tx of ROH

Answer 14

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

Question 15

Topiramate use in ROH use

Answer 15

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

Question 16

gabapentin use in ROH

Answer 16

900-1800 mg die

renally excreted

potential for misuse

1 large RCT = 3 small

Question 17

nicotine withdrawal: facts

Answer 17

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)

Question 18

buprenorphine-naloxone: facts

Answer 18

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

Question 19

methadone: facts

Answer 19

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

Question 20

highest risk of mortality from overdose in opiod and sedative use disorders

Answer 20

after cure of detox

Question 21

SUD: clinical assessment goals

Answer 21

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

Question 22

to determine type an severity of SUD: components of assessment

Answer 22

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

Question 23

naltrexone: facts

Answer 23

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