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Y5 Drug Profiles > BASIC - SUBSTANCE MISUSE > Flashcards

BASIC - SUBSTANCE MISUSE Flashcards

1
Q

Drugs used in NRT?

A

Nicotine, Varenicline, Bupropion

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2
Q

Reasons for using drugs in NRT?

A
  • Control physical symptoms of nicotine withdrawal alongside non-pharmacological measures
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3
Q

Mechanism of nicotine?

A
  • Nicotine activates CNS nicotinic acetylcholine receptors – causing euphoria and relaxation
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4
Q

Withdrawal symptoms in nicotine withdrawal?

A
  • Nicotine withdrawal causes intense craving, anxiety, depression, irritability and weight gain
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5
Q

Mechanism of NRT?

A
  • NRT – maintains receptor activation
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6
Q

Mechanism of varenicline?

A
  • Varenicline – partial agonist of nicotinic receptors, reduces withdrawal and rewarding effects of smoking
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7
Q

Mechanism of bupropion?

A
  • Bupropion – increases concentrations of NA and dopamine in synaptic cleft, inhibiting reuptake
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8
Q

SE of NRT?

A

local irritation, GI upset, abnormal dreams

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9
Q

SE of varenicline?

A

nausea, headache, insomnia, abnormal dreams, suicidal ideation

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10
Q

SE of bupropion?

A

dry mouth, GI upset, headache, dizziness, impaired concentration, insomnia, depression

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11
Q

Interactions of bupropion?

A
  • Metabolised by CYP450 enzymes

- Increased risk of adverse effects with MAOIs and TCAs

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12
Q

Cautions in varenicline and bupropion?

A
  • Risk of seizures
  • Prior head injury
  • Drugs that lower seizure threshold
  • Psychiatric disease
  • Hepatic and Renal impairment
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13
Q

Prescription of NRT?

A
  • Continuous-release patch or immediate-release tablet/gum/spray
  • Applied in morning to dry, hairless area of skin and taken off at night
  • Treatment started a few weeks before cessation attempt (at least 2 weeks) and last 3 months before reducing dose
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14
Q

Prescription of varenicline & bupropion?

A
  • Treatment with varenicline and bupropion should start 1-2 weeks before stopping – continued for 9-12 weeks
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15
Q

How often do you review NRT therapy?

A
  • Review monthly
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16
Q

Name of vitamin B1?

A

Thiamine

17
Q

Indications of thiamine?

A
  • Treatment and prevention of Wernicke’s encephalopathy and Korsakoff’s psychosis (manifestations of severe thiamine deficiency)
18
Q

Mechanism of thiamine?

A
  • Increases thiamine levels in body
19
Q

Side effects of thiamine?

A
  • High-dose thiamine rarely causes anaphylaxis
20
Q

Prescription of thiamine?

A
  • Patients at high risk of thiamine deficiency given Pabrinex (compound preparation of B and C vitamins)
    o Prophylaxis dose – 1 pair 12-hourly for 3 days
    o Treatment dose are higher
  • Oral thiamine 25-300mg daily started subsequently
21
Q

Names of benzodiazepines?

A

Diazepam, Temazepam, Lorazepam, Chlordiazepoxide, Midazolam

22
Q

Indications of benzodiazepines?

A

1st line – Seizures, status epilepticus
- Long-acting lorazepam/diazepam
1st line – alcohol withdrawal
- Oral long-acting chlordiazepoxide
Sedation for interventional procedures
- Short-acting midazolam
Short-term treatment of severe anxiety, insomnia
- Intermediate-acting temazepam given at bedtime
Adjunct in opioid dependence
- By mouth using oral solution
- Initially 10-30mg daily, increased in steps of 5-10mg daily until no signs of dependence

23
Q

Palliative care indications of benzodiazepines?

A
  • Agitation
  • Nausea due to anxiousness or agitation
  • Terminal restlessness
  • Major haemorrhage
  • Anticipatory medicines
24
Q

Mechanism of benzodiazepines?

A
  • γ-aminobutyric acid type A (GABAA) receptor is a chloride channel
  • Opens in response to GABA, making the cell more resistant to depolarisation, the main inhibitory neurotransmitter in the brain
  • Benzodiazepines facilitate and enhance binding of GABA to the GABAA receptor
  • Depressant effect on synaptic transmission
25
Q

side effects of benzodiazepines?

A
  • Dose-dependent drowsiness, sedation and coma
    o Relatively little cardiorespiratory depression in benzodiazepine overdose
  • Loss of airway reflexes can lead to airway obstruction and death
  • If used regularly, tolerance and dependence develop
26
Q

Withdrawal symptoms of benzodiazepines?

A

o Anxiety, insomnia, tremor, agitation, nausea, sweating, seizures, delirium

27
Q

Cautions of benzodiazepines?

A

o Elderly more susceptible to effects (lower dose)

o Avoid in respiratory impairment, neuromuscular disease (myasthenia gravis), liver failure (lorazepam if needed)

28
Q

Prescription of benzodiazepines?

A
  • Therapy only short-term for anxiety or insomnia
    o Risk of dependence (<4 weeks)
  • Do not drive or operate heavy machinery after taking drug
  • Sedation may persist for a few days
29
Q

Management of benzo dependence?

A
  • Methadone given and supervised for at least 3 months

Y5 Drug Profiles (17 decks)

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