CNS - Substance Dependence

Question 1

Alcohol dependence treatment?

Answer 1

• CBT (Cognitive behavioural therapy)
• Acamprosate or Naltrexone

(Alternative disulfram can be used - puts pt off alcohol by bad reaction to it)

Question 2

Treating withdrawal symptoms?

Answer 2

Long acting benzodiazepines
(Chlorodiazepoxide or Diazepam)

(Alternative: Carbamazepine or Clomethiazole)

Question 3

Treating Delirium?

Answer 3

Lorazepam

Question 4

Treating wernicke’s encephalopathy?

Answer 4

Vitamin B1 (THIAMINE)

Question 5

Nicotine dependence treatment ?

Answer 5

• Varenicline (BLOCKS RECEPTOR NUMB)
  AVOID IN EPILEPSY, CVD, Psychiatric illness
• Bupropion
  AVOID IN SEIZURES, psychiatric illness and eating disorders

Question 6

If taking varenicline or bupropion the pt is feeling depressed, what should they do?

Answer 6

STOP IMMEDIATELY & Refer to GP

Question 7

Nicotine replacement therapy

Answer 7

OTC or Prescribed

Question 8

When should 16hr NRT patch be used?

Answer 8

If pregnant or having nightmares

Question 9

Opioid dependence who can prescribe it

Answer 9

Appropriate Qualified prescriber (Not any doctor)

Question 10

Blue script are called? Max supply?

Answer 10

FP10MDA

Max supply 14 days

Question 11

What if 3 or more methadone doses are missed?

Answer 11

Refer back to specialist

Question 12

Pregnancy and methadone, when to stop?

Answer 12

Continue through treatment!

More harm to stop for mother/foetus

Question 13

High risk of overdose of methadone, what is prescribed?

Answer 13

Naloxone

Question 14

Why is Buprenorphine preferred over methadone?

Answer 14

Can be Less sedating

Milder withdrawal symptoms

Lower risk of overdose

Given as Naloxone as suboxone when risk of injecting

Question 15

Methadone side effect?

Answer 15

QT PROLONGATION

Question 16

Why is high in sugar sometimes preferred to prescribe in methadone?

Answer 16

Due to misuse, high in sugar hurts more when injecting —-> DETERRENT

Local irritation caused

Important to give correct one