Alcohol + Opioid Abuse Flashcards
What is the recommended weekly alcohol limit?
14 units
How many units in a bottle of wine?
9
How many units in a 250ml glass of wine?
3
How many units in a pint of 4% beer?
2.3
How is drinking over 14 units per week classified?
Hazardous drinking
Harmful drinking
Alcohol dependence
How is hazardous drinking defined?
> 14 but < 35 units per week for women
> 14 but < 50 units per week for men
How is harmful drinking defined?
> 35 units for women
> 50 units for men
How is alcohol dependence defined?
A strong desire to drink alcohol and difficulties controlling its use
How is alcohol use disorder defined?
Maladaptive pattern of substance use leading to clinically significant impairment or distress
Features of tolerance + withdrawal
Which screening tool can be used to assess alcohol harm?
Alcohol use disorders identification test (AUDIT)
- 10 questions
How is the AUDIT score interpreted?
Score 0-7 –> lower risk drinking
Score 8-14 –> hazardous drinking
Score 15-19 –> harmful drinking
Score 20+ –> possible dependence
What should be done for a lower risk drinking score?
Reinforce current drinking practices
What should be done for a hazardous drinking score?
Deliver brief intervention
What should be done for a harmful drinking score?
Deliver brief intervention
Deliver motivational enhancement therapy sessions
Consider prescribing options
What should be done for a possible dependence score?
Comprehensive assessment
What does the Brief Intervention involve?
FRAMES:
Feedback - review problems experienced because of alcohol
Responsibility - patient responsible for change
Advice - reduction of abstinence
Menu - options for changing behaviour
Empathy
Self-efficacy - encourage optimism about change
Which psychosocial interventions may help prevent relapse?
CBT
Motivational enhancement therapy
12 Step Facilitation Therapy (AA)
Family and couple therapy
What pharmacological treatment is available for alcohol detox?
Chlordiazepoxide
–> medical assisted detoxification
What are the features of alcohol withdrawal syndrome?
Tremor, sweating, nausea, retching Increased HR, BP + temp Anxiety, agitation Insomnia, nightmares Hallucinations Withdrawal seizures (0-48 hours) Delirium tremens (48-72 hours)
What are the features of delirium tremens?
Coarse tremor
Confusion
Delusions
Hallucinations
Which features may occur in a complicated alcohol withdrawal?
Seizures
Hallucinosis
Delirium tremens
Wernicke-Korsakoff syndrome
What pharmacological treatments are available for alcohol relapse prevention?
(to be started after successful withdrawal)
- Acamprosate
- Naltrexone
- Disulfiram
How does disulfiram work?
Causes an unpleasant reaction when taken with alcohol –> psychological deterrent
How is problem drug use defined?
Problematic use of opiates and/or illicit use of benzodiazepines
Routine and prolonged use
What are the effects of heroin on the body?
Euphoria Analgesia Respiratory depression Constipation Reduced conscious level Hypotension + bradycardia Pupillary constriction Tolerance with repeated use
What are the features of heroin withdrawal?
Typically within 6-8 hours Dysphoria and cravings Agitation Tachycardia and hypertension Piloerection Diarrhoea, nausea + vomiting Dilated pupils Joint pains Yawning Rhinorrhoea + lacrimation
What are the options for opioid replacement therapy?
Methadone
Buprenorphine
- can be given with naloxone (Suboxone)
What is the pharmacological difference between methadone + buprenorphine?
Methadone - pure opioid agonist
Buprenorphine - partial opioid agonist (less potent) with a very high affinity for opioid receptors
What are the advantages of buprenorphine compared to methadone?
Safer (less risk of overdose) Less sedative (clear head) More likely to block effect of using other drugs on top Longer effect Quicker titration Easier to detox from Less stigma
What are the disadvantages of buprenorphine compared to methadone?
Not indicated for patients taking high doses of opioids
Can be misused
Risk of induced withdrawal
Is less sedative
What is the starting dose for methadone?
10-30mgs
What is the usually effective dose for methadone?
60-120mgs
Which features would indicate the patient is on the right maintenance dose of opioid replacement?
Patient stops using and is not experiencing craving
If a patient is on more than 100ml of methadone, what monitoring is required?
ECG - increased risk of QTc prolongation/arrhythmia
How many days of methadone prescription can be missed before the pharmacist has to contact the prescriber? Why?
If medication not collected for 3 days
–> may lose tolerance and be at risk of overdosing
