Alcohol

Question 1

Contraindications to naltrexone

Answer 1

Opioid used in last 10 days (can precipitate withdrawal), severe liver disease

Question 2

Dose titration of topiramate for alcohol dependence

Answer 2

Start 25 mg daily, increase by 25-50 mg weekly. Must be titration gradually. Dosing is in 2 divided doses.

Question 3

Maximum dose of topiramate for alcohol dependence

Answer 3

300 mg per day (doses of 400 mg daily have been studied for epilepsy)

Question 4

Side effects of topiramate

Answer 4

Concentration and memory problems, somnolence.

Question 5

Usual dose of acamprosate.

Answer 5

666 mg tid; can start at the therapeutic dose.

Question 6

Does acamprosate need to be discontinued in event of relapse to alcohol?

Answer 6

No.

Question 7

Why is disulfiram use no longer favorited?

Answer 7

Significant adverse reactions if alcohol is ingested.

Question 8

Usual dose of gabapentin for alcohol use

Answer 8

300-600 mg tid

Question 9

Maximum dose of gabapentin for alcohol dependence.

Answer 9

2400 mg / day

Question 10

Usual dose of baclofen for alcohol dependence.

Answer 10

5-25 mg tid

Question 11

Maximum dose of baclofen for alcohol dependence.

Answer 11

25 mg tid

Question 12

Usual dose of naltrexone for alcohol dependence

Answer 12

50mg PO daily (this is the maximum dose)

Question 13

Canadian low risk drinking guidelines

Answer 13

Males under 65, 3 drinks / day, 15 per week.

Females and males over 65, 2 drinks / day, 10 per week.

Based on actuarial methods - more use predicts higher risk of health problems.

Question 14

Screening questions for alcohol

Answer 14

Do you drink? How much?

Does drinking cause problems or concerns? What would your partner / friend say?

How many times in the past year have you had X or more drinks in a day? (5 for men, 4 for women - 8 or more is the optimum cut-off)

Question 15

Caution with lithium for patients who use alcohol

Answer 15

Getting effective blood levels may be more difficult

Question 16

Which patients can try for harm reduction?

Answer 16

Mild users; for moderate to severe users, abstinence is recommended.

Question 17

How long does it take for mood and sleep problems to improve after stopping alcohol / substances?

Answer 17

Mood and sleep improve gradually by day 28.

Question 18

What symptoms of mental illness to look for in early addiction recovery

Answer 18

Particularly PTSD and social anxiety.

Question 19

Risk factors for suicide in addiction

Answer 19

Alcohol intoxication

Alcohol relapse during recovery (middle aged divorced men)

MDD in lengthy recovery

Chronic opioid use

Withdrawal from stimulants (2 week period)

Post-ecstasy run (can last months)