chapter 18- drugs of abuse

Question 1

what is the mechanism of action of disulfiram

Answer 1

inhibits aldehyde dehydrogenase and prevents metabolism of acetaldehyde

Question 2

what is the clinical application of disulfiram

Answer 2

alcoholism

Question 3

what is the clinical application of naloxone

Answer 3

opioid overdose; rapid reversal of opioid activity

Question 4

what is the clinical application of naltrexone

Answer 4

opioid dependence; alcohol dependence

Question 5

what is the clinical application of methadone

Answer 5

opioid detoxification; severe pain

Question 6

what are some adverse reactions seen with disulfiram

Answer 6

hepatitis, peripheral neuropathy, psychotic disorder, metallic/garlic-like aftertaste

Question 7

what are some adverse reactions seen with naloxone

Answer 7

cardiac arrhythmia, blood pressure lability

Question 8

what are some adverse reactions seen with naltrexone

Answer 8

hepatotoxicity; abdominal pain, constipation, nausea, headache, anxiety

Question 9

what are some adverse reactions seen with methadone

Answer 9

cardiac arrest, shock, respiratory arrest; constipation, asthenia

Question 10

what are some contraindications for disulfiram

Answer 10

psychoses; coronary occlusion severe myocardial disease

Question 11

what are some contraindications for naltrexone use

Answer 11

acute hepatitis or liver failure; concomitant opioid analgesics

Question 12

what does acetaldehyde accumulation cause

Answer 12

facial flushing, headache, nausea, orthostatic hypotension

Question 13

what co-administration with disulfiram can cause adverse CNS effects

Answer 13

isoniazid

Question 14

what are some therapeutic consideration for naloxone

Answer 14

interactions with opioid analgesics; short half life

Question 15

what is the clinical application of buprenorphine

Answer 15

opioid dependence; moderate to severe pain

Question 16

what is the clinical application of acamprosate

Answer 16

maintenance of abstinence in alcoholism

Question 17

what is the clinical application of vareniciline

Answer 17

smoking cessation aid

Question 18

what are some adverse reactions seen with varenicline

Answer 18

suicidal thoughts, erratic/aggressive behavior, abnormal dreams

Question 19

what are some adverse reactions seen with buprenorphine

Answer 19

brady/tachyarrhythmia, hyper/hypotension, cyanosis

Question 20

what are some adverse reactions seen with acamprosate

Answer 20

cardiomyopathy, suicide attempt, back pain

Question 21

what is the mechanism of action of buprenorphine

Answer 21

partial u-opioid receptor agonist and k-opioid receptor antagonist

Question 22

what is the mechanism of action of acamprosate

Answer 22

analog of homotaurine, a GABAergic agonist

Question 23

what is a contraindication for acamprosate use

Answer 23

severe renal impairment

Question 24

how does acamprosate reestablish a more stable state for the treatment of alcohol dependence

Answer 24

modulates glutamate hyperactivity

Question 25

what is the mechanism of action of varenicline

Answer 25

partial neuronal alpha4beta2 nicotinic receptor agonist that prevents nicotine stimulation of mesolimbic dopamine system

Question 26

what is a contraindication for varenicline use

Answer 26

exercise caution with preexisting psychiatric illnesses because patients with these illnesses were not included in clinical trials

Question 27

when should varenicline be started

Answer 27

1 week before target quit date and titrated to maintenance dose over that week