Chapter 17: Substance Use Disorder

Question 1

Drugs to help with Alcohol Withdrawal

Answer 1

(Benzodiazepines)

1. Disulfiram (causes unpleasant taste to alcohol).
2. Naltrexone (blocks pleasure effects of alcohol and reduces desire to drink).
3. Acamprosate (reduces alcohol withdrawal symptoms)

Question 2

Drugs to help treat Opioid Addiction

Answer 2

1. Methadone (eliminates withdrawal symptoms and cravings by binding to opioid receptor in the brain).
2. Buprenorphine (decreases pain and increases positive feelings).
3. Naltrexone (blocks pleasure effects of opioids and reduces desire to use them).
4. Suboxone ( combo of buprenorphine & naltrexone).
5. Lofexidine (only FDA approved to treat opioid withdrawal sx)

Question 3

Disulfiram
(Treats alcoholism)

Answer 3

Treats alcoholism by decreasing frequency of drinking.

Action: inhibits the conversation of enzyme (aldehyde dehydrogenase) which becomes toxic in the blood. This accumulation creates unpleasant and harmful effects.

Side effects:
- intense HA
- n/v
- chest pain
- weakness
- blurred vision
- mental confusion
- sweating
- anxiety
- palpitations
- breathing problems

Adverse reactions: fully developed acetaldehyde syndrome can be lethal, respiratory depression

Onset: 12 hours
Peak: 8-10 hours po
Duration: up to 20% of drug can stay in the body for 1-2 weeks after last dose
Half life: 60-120 hours

Pre-treatment : no alcohol for atleast 12-24 hours to avoid serious medication-alcohol reaction.

Contraindication: cardiac disease, psychosis, recent ingestion of metronidazole

Question 4

Naltrexone
(Treats opioids addiction)

Answer 4

An opioid antagonist which inhibits the pleasure effects.

Action: blocks release of dopamine

Side effects: may initiate withdrawal symptoms

Adverse reactions: Nausea, tachycardia and hepatic injury

Onset of action:
- PO 15-30 minutes
- IV 1-2 minutes
- IM injection 2-5 minutes
- SubQ 2-5 minutes

Pre-treatment: patient has to be opioid free for 7-10 days and alcohol free for 3-5 days

Contraindication: hepatitis or other liver dysfunction

Question 5

Which symptom associated with Naltrexone should be reported immediately?

Answer 5

Jaundice (liver damage)

Question 6

Which dose of Naltrexone can be prescribed to a patient who is being discharged and last alcohol drink was 6 days ago.

Answer 6

50 mg orally po

Question 7

Based on oral Naltrexone, which instruction regarding dosing would be included in patient teaching?

Answer 7

Take the prescribed dose at the same time each day

Question 8

Which substances should be avoided while taking Disulfiram?

Answer 8

Beer
Vinegar
Cough syrup
Cologne
Cold remedies

Disulfiram treats alcoholism

Question 9

Which substances may cause adverse reactions with Disulfiram?

Answer 9

St. John wort
Warfarin
Isoniazid

Question 10

Alprozolam
(Xanax)

Answer 10

An anxiolytic (benzo class). Available ORAL only.

Provides short term relief of anxiety symptoms, panic disorder, anxiety with depression.

Onset of Action: 30-60 min
Peak: 1-2 hours
Half life: 10-15 hour
Duration of action: 6 hours

Adverse effects: confusion, ataxia, HA.

Question 11

Which medication is indicated to help manage withdrawal symptoms while detoxifying from alcohol abuse?

Answer 11

Benzodiazepines

Question 12

Which condition would a patient have if they are on lithium?

Answer 12

Manic and bipolar disorders