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Phys/Pharm Drugs Of Abuse > Current and novel treatment for Addiction > Flashcards

Current and novel treatment for Addiction Flashcards

1
Q

Treatments (2)

A

CBT + pharmacotherapy

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2
Q

Phases of Substance Use that are
Targets for Pharmacotherapy(5)

A
  • intoxication/overdose

-withdrawal/detoxification

-abstinence initiation/use reduction

-relapse prevention

-sequelae (psychosis, agitation, etc.)

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3
Q

Some Pharmacological
Treatment Strategies for SUDs (4)

A

-Agonist/partial agonist
(replacement/substitution)

  • antagonist (blockade)
  • aversive (negative reinforcement)
  • correction of underlying/associated
    disorders (such as depression, etc.)
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4
Q

Substances for which
Pharmacotherapy
is Available (4)

A

Opioids
Alcohol
Benzodiazepines Tobacco (nicotine dependence)

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5
Q

Substances for which
Pharmacotherapy
is NOT Available (5)

A

Cocaine
Methamphetamine
Hallucinogens
Cannabis
Solvents/Inhalants

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6
Q

Opioids- Dependence treatment (4)

A

 Lofexidine (non-substitute method of detoxification)
- Central ⍺2-agonist, suppresses some components of withdrawal syndrome = inhib NA release (pre-synap)

 Methadone (substitution method of detoxification)
- Long-acting drug, no euphoria to morphine

 Naltrexone, opioid antagonist, prevents euphoria to opioids
- Given daily to addicts to prevent lapses

 Buprenorphine (substitution method of detoxification)

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7
Q

Loefixidine (2)

A

increased NA release = withdrawal symptoms

so this drug binds with ⍺2r =inhib the release of NA

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8
Q

Opioid Dependence
Maintenance Therapy - Methadone (6)

A

Methadone (must be administered through a registered narcotic treatment program - substitutes heroine) = occupies all mu r (not as much euphoria)

Characteristics:
- Long acting mu agonist

-Duration of action: 24-36hrs

-Dose: important issue and philosophical issue for many programs

-30-40 mg will block withdrawal, but not craving

  • Illicit opiate use decreases with increasing methadone dose
  • 80-100 mg is more effective at reducing opioid use lower doses (e.g.: 40-50 mg/d)
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9
Q

Methadone
Benefits (5)

A
  • Lifestyle stabilization: can’t stop taking it though (otherwise withdrawal)

-Improved health and nutritional status

-Decrease in criminal behaviour

  • Employment
  • Decrease in injection drug use/shared needles
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10
Q

Naltrexone- Why antagonist therapy? + side effects + dosage (8)

A
  • Block effects of a dose of opiate : can’t give to heroine user = withdrawal - needs abstinence

-Prevent impulsive use of drug

-Relapse rates high (90%) following detoxification with no medication treatment

-Dose (oral): 50 mg daily, 100 mg every 2 days, 150mg every third day

-Blocks agonist effects

  • Side effects: hepatotoxicity, monitor liver function tests every 3 months
  • Biggest issue is lack of compliance; but those who “test” naltrexone by taking a dose of opioid and experiencing no effect do better with the medication
  • Injectable naltrexone not currently approved for opioid dependence, but likely to also be effective
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11
Q

Buprenorphine (5)

A

Partial MOPr/KOP antagonist

Advantage/disadvantage over methadone?

-Lower risk of respiratory depression
- Lower retention rate
- Also used with Naloxone (Suboxone).
- Lower risk of withdrawal symptoms/lower
craving for opioids

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12
Q

Endogenous opioid control of
reinforcement - 2 ways of actions (3)

A

substitutes opioids like methadone w/o inducing such a big euphoric effect

however : it will activate mu r = euphoria(DA release)

  • acts on ka r too( activation of ka = dysphoria (big relapse factor)) - drug blocks -ve reinforcement

2 ways of action

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13
Q

Opioid overdose treatment??? (3)

A

NALOXONE
- blocks the r heroine/fentanyl binds to = almost reverses the effects induced (RD)

-NHS: epipen of naloxone

= harsh reaction = acute withdrawal symptom but save their life from RD

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14
Q

Treatment of alcohol dependence (6)

A
  • Benzodiazepines (e.g. diazepam) effective against seizures

-Clonidine ⍺2-adrenoceptor agonist-(inhibits excessive transmitter release)

-Propranolol β-blocker (blocks excessive sympathetic activity)-

-Acamprosate, weak NMDA antagonist (interferes with synaptic
plasticity): reduced craving

-Disulfiram, causes accumulation of acetaldehyde making alcohol consumption unpleasant

-Naltrexone, opioid antagonist reduces alcohol-induced reward

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15
Q

Alcohol Dependence
Pharmacotherapy - 2 phases (3)

A

Two Phases of Alcohol Dependence:
1. Acute Alcohol Withdrawal

  1. Relapse Prevention: Maintenance Medications To
    Prevent Relapse To Alcohol Use (FDA approved):
    - Disulfiram
    - Naltrexone (oral and injectable)
    - Acamprosate

Note: monitor any patient being treated for a SUD for emergence of depression/anxiety/ suicidality as this can occur in the course of treatment

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16
Q

Alcohol - tolerance + dependence (5)

A

when alc stops = withdrawal symptoms because:
- inc. voltage-gated Ca2+ channels
– dec. GABAA receptors

– Marked abstinence syndrome, changes in Ca2+ channels lead to
excessive neurotransmitter release
*Tremor, nausea, sweating, fever, hallucinations
* Seizures, confusion, agitation, aggression

– Alcohol dependence (alcoholism) is common (4-5% of population)

– Susceptibility to dependence, genetic factors
* Linked to alcohol metabolism (alcohol dehydrogenase)

17
Q

Anxiolytic BZDs: Diazepam/
Lorazepam treat alc withdrawal (3)

A

need to inc inhib in brain = GABAa r

BZD + GABAa = cl- channels open up = hyperpolarisation inhib

GABAa has alpha1 subunit = BZD biding site = enhances the cl- channels opening

18
Q

Benzodiazepines
for acute withdrawal - not w/ alc (5)

A
  • DO NOT MIX W/ALC = Overdose:
    – Prolonged sleep without CVS or respiratory depression
    – Can become life threatening (respiratory depression etc.) with
    other CNS depressants e.g. alcohol
    – Reversed with flumazenil (competitive antagonist)
  • Tolerance & Dependence:
    – Tolerance – gradual escalation of dose needed to produce
    required effect (Q Any suggestions what might cause that?)

– Dependence – stopping treatment causes marked inc. in anxiety + tremor / dizziness, insomnia

19
Q

What about Benzo’s for Alcohol Dependence? (8)

A

Clinical Pearls: If your patient is alcoholic, try to avoid prescribing a BZD.

  • BZD produce cross-tolerance with alcohol

-High risk of abuse of BZD

-High risk of relapse to alcohol use

-Combined use of alcohol and prescribed BZD can be very
impairing and produce significant toxicity

-If patient complains of anxiety:

  1. consider use of serotonin reuptake inhibitors SSRI’s (this
    is 1st line treatment of anxiety disorders (not
    Benzos)),
  2. refer to psychotherapeutic interventions (e.g.:
    cognitive-behavioural therapy),
  3. consider relapse to alcohol
20
Q

Alcohol Relapse Prevention Meds:
Disulfiram (Antabuse) (3)

A

How it Works:

Blocks alcohol metabolism= increase in blood acetaldehyde
levels; aims to motivate individual not to drink
because they know they will become ill if they
do

  • Antabuse reaction: flushing, weakness
    nausea, tachycardia, hypotension

-Contraindications: cardiac disease, esophageal
varices, pregnancy, impulsivity, psychotic
disorders, severe cardiovascular, respiratory, or renal disease, severe hepatic dysfunction: transaminases > 3x upper level of nl

21
Q

Pharmacotherapy of Alcohol
Dependence: Naltrexone (2)

A
  • Oral Naltrexone Hydrochloride: 50 mg per day

-Extended-Release Injectable Naltrexone (Vivitrol) : 1 injection per month

22
Q

Naltrexone Pharmacology (4)

A

Similar structure to naloxone (Narcan)

-Potent inhibitor of Mu opioid receptor
binding

-may explain reduction of relapse because endogenous opioids involved in the reinforcing (pleasure) effects of alcohol (endorphins + enkephalins)

-May explain reduced craving for alcohol
because endogenous opioids may be
involved in craving alcohol

23
Q

Naltrexone for alc - Cochrane review of NTX (5)

A

decreased relapse to heavy drinking [RR =
0.64]

decreased return to any drinking [RR =
0.87 ]

NTX increased the time to first drink

NTX reduced craving

NTX was superior to acamprosate in
reducing relapses, drinks and craving

24
Q

Nicotine dependence treatment (3)

A
  • Nicotine replacement therapy:
    ** Relieves psychological and physiological withdrawal syndrome
    ** Reduces cigarette consumption (carcinogens) but not nicotine abstinence - still giving nicotine over longer duration (smoking = goes straight to brain = addiction)
  • Bupropion
    ** Developed as antidepressant (blocks monoamine reuptake)
    ** Nicotinic antagonist
    ** May inc. [DA] in nucleus accumbens
    ** Can induce seizures, eating disorders and mania (bipolar disorder)

-Varenicline (Champix) - most effective!!!!
** Partial a4b2 nAChR agonist, full agonist for AChR
** More effective than NRT

25
Q

Nicotinic Acetylcholine Receptors (4)

A

Multiple subtypes in CNS:
– At least 12 subunits expressed (α2-α10, β2-β4)

– Two subfamilies: αBgtx-sensitive and insensitive

– Arranged to form heteromeric or homomeric
combinations

– “Major” subtypes: α4β2, α7; also α6, α3*

26
Q

New treatment for drug
addiction (3)

A

Therapeutics that block memory reconsolidation

memory of drug so strong (memory) = craving

so disrupting the memories reconsolidation

27
Q

Addiction vaccines (3)

A

vaccinate ppl before drug/ cigarette/alc

if they take the drug = immune response

= neutralise teh drug - so will not pass BBB

28
Q

Deep brain stimulation

A

activating diff brain regions = management of drug addiction not pharmaco

29
Q

What lies in the future? (2)

A

motivational approach - apps

  • e-cigs: keep hand to mouth movement but instead smoke vapour (contains nicotine) - 95% safer than tobacco snoke

Phys/Pharm Drugs Of Abuse (23 decks)

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