CNS - DEPENDENCE

Question 1

Which medication can be affected by nicotine?

Answer 1

• theophylline, ropinorole and some antipsychotics (clozapine, olanzapine, haloperiodol) - increase the metabolism of them
• when stopping smoking the doses of these may need to be reduced

Question 2

Which drugs are associated in nicotine replacement therapy?

Answer 2

• varenicline

- bupropion hydrochloride

Question 3

What are the side effects caused by swallowed nicotine?

Answer 3

GI - e.g. n&v, dyspepsia, hiccup

Question 4

What is a common side effect of lozenges, patches, oral spray and sublingual tabs used for nicotine therapy?

Answer 4

dry mouth

Question 5

With what form of nicotine replacement therapy can abnormal dreams occur?

Answer 5

• patches

- take the patch off before bed time

Question 6

How early do withdrawal symptoms show for untreated heroin dependence?

Answer 6

within 8 hours

Question 7

What is used as substitution therapy in opioid dependence?

Answer 7

• methadone - more sedating

- buprenorphine

Question 8

What if patients miss 3 or more doses of their regular daily dose OF OPIOIDS?

Answer 8

at risk of overdose due to loss of tolerance

Question 9

Methadone:

Answer 9

• more sedating
• long half life
• qt interval prolongation

Question 10

Buprenorphine:

Answer 10

• less sedating - better for drivers
• less interactions
• milder withdrawal reaction
• if withdrawal symptoms are severe, adjunctive therapy with lofexidine hydrochloride may be required
• suboxone = buprenorphine and naloxone - use when there is a risk of dose diversion for parenteral administration

Question 11

What should be reported straight away if breastfeeding mothers are taking opioids?

Answer 11

increased sleepiness, limpness or breathing difficulties in babies

Question 12

What are the opioid withdrawal symptoms?

Answer 12

• diarrhoea - give loperamide
• stomach cramps - give mebeverine
• muscle pain and headaches - NSAIDs and paracetamol
• n&v - metoclopramide

Question 13

What can be used to attenuate alcohol withdrawal symptoms?

Answer 13

• long acting benzos e.g. diazepam
• alternative = clomethiazole - do not use with alcohol (Resp dep)
• carbamazepine = unlicensed

Question 14

What is used for relapse prevention in moderate to severe alcohol dependence?

Answer 14

• acamprostate calcium
• oral naltrexone
• alternative to both - disulfram

Question 15

What is used to treat wernickes encephalopathy?

Answer 15

thiamine (vit B)