Drug Withdrawal Syndrome

Question 1

Supportive dietary interventions given to individuals with drug withdrawal syndrome?

Answer 1

-Thiamine (B1)
-IV fluids
-Magnesium & K+
-Electrolyte Replenishment
-Glucose Supplementation

Question 2

What is used in cases of resistant alcohol withdrawal syndrome?

Answer 2

benzo + addition of phenobarbital.However, phenobarbital monotherapy can be used if benzo therapy is ineffective.

Question 3

How is the severity of drug withdrawal syndrome assessed?

Answer 3

The Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-AR)

Question 4

T/F: Low doses of methadone are more effective than higher doses due to lower side effects.

Answer 4

FALSE!Higher maintenance doses (methadone 60–120 mg or buprenorphine/naloxone 8–24 mg/day) are more effective than lower doses.

Question 5

Minimum length of treatment for opioid-related disorders ?

Answer 5

ATLEAST 1 year; relapse typically occurs within the first year

Question 6

How are methadone OR buprenorphine/naloxone doses tapered down?

Answer 6

To taper, lower the dose by 5–10% every 2–4 weeks and regularly monitor.​

Question 7

Although the American Academy of Pediatrics considers any maternal dose of methadone to be compatible with breastfeeding,​ doses above ______ may increase risk of sedation and respiratory depression in the infant, and more so if the baby was not exposed to methadone in utero

Answer 7

100 mg/day

Question 8

what is the maintenance dose of methadone?

Answer 8

40–80 mg/day PO; higher maintenance doses (60–100 mg)

Question 9

initial dose of methadone (*as per provincial guidelines) given to patients ?

Answer 9

5–30 mg starting dose depending on risk stratification

Question 10

Why should domperidone and methadone not be taken together?

Answer 10

risk of QT prolongation

Question 11

why is clonidine used in the management of drug withdrawal syndrome?

Answer 11

used to manage chills associated with drug withdrawal syndrome.
class: alpha-2 agonist (*anti-hypertensive agent)

Question 12

Why should citalopram and methadone not be taken together?

Answer 12

risk of QT prolongation

Question 13

1st line management of opioid withdrawal syndrome in pregnancy/breastfeeding?

Answer 13

1st line: Non-pharm (CBT)
2nd line: (standard therapy):Recent evidence suggests that buprenorphine is as safe and effective as methadone in pregnancy and is associated with a lower incidence of neonatal opioid withdrawal syndrome.​When buprenorphine is used, the single-entity tablet (without naloxone) is preferred when available.

Question 14

T/F:Hallucinations are one of the common symptoms opioid withdrawal

Answer 14

FALSE (*common in -OH & Benzos)