Drug Dependency

Question 1

If a pt wants to withdraw from alcohol dependency, what would they usually be given?

Answer 1

A long acting benzodiazepine (BDZ) such as chlordiazepoxide

Question 2

If a pt is dependent and wants to come away from dependency, what would they usually be given?

Answer 2

Acamprosate but this given for relapse prevention along with counselling

Disulfiram: if this is given with alcohol it will cause unpleasant S/E like tachycardia, N/V, headache - this puts the person off to consume the alcohol (so on a person on metronidazole - avoid alcohol coz it causes disulfiram reactions)

Question 3

What is nalmefene used for?

Answer 3

can be used for alcohol dependency but works a lot more gradually. So not for a patient who wants to be off alcohol immediately

it helps reduce alcohol consumption
These patients will need psychological support

Question 4

Why is thiamine given?

Answer 4

Parenteral form for pts who have suspected or confirmed …

Question 5

What else may a pt need to take?

Answer 5

pancreatic supplements

even corticosteriods if they have alcohol related hepatitis

Question 6

if a person wants to stop smoking what do you provide them with?

Answer 6

Smoking cessation or
Nicotine replacement therapy 
or
meds like bupropion 
or 
meds like varenicline

Question 7

what kind of patches do you get if a pt is receiving NRT?

Answer 7

16 hour patch or 24 hour patch
the difference is 16 hour patch is taken off at night
24 hour patch is for pts who need a cigarette in the first 10 minutes of waking up

Question 8

What kind of NRT formulations are there?

Answer 8

patches, sublingual tablets, lozenges

Question 9

What age group are nicotine replacement therapy licensed for?

Answer 9

over 12 year olds.

Nicotinell lozenges can only be used in under 18 year olds if they’ve been recommended by a GP.

Question 10

Is NRT therapy ok to be used in pregnancy?

Answer 10

Yes but avoid liquorish flavourings

Question 11

what are S/E of withdrawal?

Answer 11

dizziness, cough, irritability

Question 12

what therapy would a person need on opioid dependency?

Answer 12

social, medical and psychological support

Question 13

What are two main forms of substitution therapy?

Answer 13

Buprenorphine and Methadone

Question 14

How long does it take for complete withdrawal to occur?

Answer 14

up to 4 weeks in an in-patient setting

up to 12 weeks in an community setting

Question 15

What happens if a pt misses 3 or 5 doses?

Answer 15

if pt misses up to 3 doses, they are at more risk of overdose because of the reduction of tolerance

if a pt misses more than 5 doses, they will need to be assessed for any illicit drugs before they go back onto substitution therapy.

Question 16

What is the MOA of buprenorphine?

Answer 16

Opioid-receptor partial agonist. Less sedative than methadone and lower risk of overdose

Question 17

What is methadone?

Answer 17

Long-acting opioid agonist.

only once a day and has a long half-life

Question 18

What would a patient need on opioid dependency?

Answer 18

Adjunctive therapy so loperamide if they have diarrhoea
mebeverine if they’re getting cramps
paracetamol for pain
metoclopramide for nausea

Question 19

if a pt has had an overdose due to an opioid, what drug would be given?

Answer 19

Naloxone to help reverse

but also naltrexone to prevent relapse given to a former addict