Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Therapeutics 1 > Exam 2 - Opiate and Alcohol tx > Flashcards

Exam 2 - Opiate and Alcohol tx Flashcards

1
Q

Define opiate abuse

A

Problematic pattern of substance use leading to clinical significant impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Signs and symptoms of opiate use?

A

Reduced mental status “nodding off”, decreased bowel sounds/constipation, miotic pupils, decreased RR, decreased BP, track marks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Clonidine, Phenergan, BZDs, Neurontin are used to do what with opiate highs?

A

Supplement and make even higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Opiate withdrawl signs and symptoms?

A

Tachy, diaphoresis, restless/anxiety, tremor, goosebumps, yawning, myalgia, corzya, GI upset, flu-like w/o fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

COWS is clinical scale for assessing what?

A

Opiate withdrawl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which drug used for acute opioid intoxication and provoked immediate withdrawl?

A

Narcan (Naloxone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Narcan MOA?

A

Rapid Opioid antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If give more than 10mg (5 doses) of Narcan over 15 minutes and no change in patient what to consider?

A

Not opioid intoxication but something else

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is first-line drug for managing opioate addiction?

A

Suboxone (Bup + Narcan)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Suboxone MOA?

A

Partial Mu-agonist. Bup has higher affinity for opiate Mu-receptors than any other opiate so displaces what in those receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If a PT on Suboxone and they take an opiate what happens?

A

Suboxone lessens effect of opiate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dosing for Suboxone?

A

BID-TID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What special license needed for Suboxone?

A

X-license needed to prescribe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Suboxone and preggers?

A

No, use Methadone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If give Suboxone when PT is high what will happen?

A

PT will go into immedaite withdrawl. Wait until PT is in moderate withdrawl and then give Suboxone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Suboxone ADRs?

A

Sedating, decreased RR, HA, naused, constipation, insomnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Methadone MOA?

A

Full Mu-agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Methadone is used for what?

A

Chronic management of opiate abuse. To prevent ilicit use.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does Methadone control and allow?

A

Controls cravings and allows a person to function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Where is Methadone dispensed?

A

At Methadone clinic only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What type of arrythmia does Methadone cause?

A

QT prolongation. Get EKG before starting Methadone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Methadone ADRs?

A

OD, sedation, decreased RR, HA, nausea, constipation, diaphoresis, hypogonadism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Methadone and preggers?

A

OK to use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Methadone dosing?

A

Once a day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Acute EtOH intoxication signs and symptoms?

A

Bradycradic, hypotension. Slurred speech, nystagmus, disinhibition, incoordination, unsteady gait, coma, stupor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When does Acute EtOH withdrawl start?

A

6-12h (or 6-24h) after last drink

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Autonomic Hyperactivity is a sign of what?

A

Acute EtOH withdrawl

28
Q

Acute EtOH withdrawl signs and symptoms

A

AMS, tremor, diaphoresis, hypertension, hyperthermia, N/V, anxiety/agitation, tactile disturbances, HA, seizure, auditory and visual hallucinations.
Life-threatening arrythmias, severe HTN, hyperthermia, seizure
DTs=48-96 hours in

29
Q

When do the DTs start? Looks like what?

A

48-96 hours into EtOH withdrawl.

AMS, hallucinations, etc. Tx with BZDs.

30
Q

Long-term EtOH abuse signs and symptoms?

A

Cirrhosis, cardiomyopathy, peripheral neuropathy (stocking glove distro), Wernicke’s Korsakoff’s, pancreatitis

31
Q

Wernicke’s Korsakoff looks like? How to treat?

A

Confabulation, nystagmus, ataxis.

Tx=Thiamine

32
Q

First-line tx for EtOH abuse?

A

Naltrexone/Vivitrol

PO, IM

33
Q

Naltrexone/Vivitrol MOA?

A

Mu-opioid antagonist. Not fully understood with EtOH.

34
Q

Naltrexone/Vivitrol is able to do what

A

Decrease total days drinking, decrease heavy drinking days, decrease cravings

35
Q

Can give Naltrexone is PT is drunk? If on opiate?

A

Drunk=yes

Opiate=no, wait 7-10 days d/t inducing withdrawl

36
Q

If PT does well on Naltrexone then what to consider next?

A

Vivitrol IM

37
Q

Naltrexone and Vivitrol dosing?

A

Naltrexone=50mg/day

Vivitrol=380mg/month in butt

38
Q

If PT has liver dysfunction can give Naltrexone/Vivitrol?

A

Use Campral instead

39
Q

Campral MOA?

A

GABA-agonist; Glutamate antagonist

40
Q

When to use Campral?

A

Second-line in EtOH withdrawl. Used it PT fails Naltrexone/Vivitrol.

41
Q

Campral used for what?

A

Long-term management of EtOH abuse

42
Q

Campral dosing?

A

Two 333mg tab BID

43
Q

Campral and renal?

A

Adjust for renal

44
Q

Campral ADRs?

A

Diarrhea for 1-2 weeks, GI upset, decreased libido, insomnia, anxiety, suicidal ideation, muscle weakness, dizzy

45
Q

Treatment of Acute EtOH Withdrawl?

A

BZDs

46
Q

Which med for Acute EtOH withdrawl under 60 and no liver issues

A

Librium

47
Q

Which med for Acute EtOH withdrawl over 60 or liver issues?

A

Ativan

48
Q

What else to manage/give during Acute EtOH withdrawl?

A

Give IV fluids, manage lytes

49
Q

OK to give Suboxone and Naltrexone together?

A

NO

50
Q

What is the half-life of Diazepam?

A

20-80h

51
Q

What is the half-life of Chlordiazepoxide?

A

5-30h

52
Q

What is the half-life of Lorazepam and Oxazepam?

A

10-20h

53
Q

What is the half-life of Midazolam?

A

2-6h

54
Q

Stage 1 EtOH withdrawl time range and symptoms?

A

6-12h after last drink. Minor withdrawl symptoms=tremor, diaphoresis, N/V, HTN, tachy, hyperthermic, tachypnea

55
Q

Stage 2 EtOH withdrawl time range and symptoms?

A

Alcohol hallucinosis, 12-24h after last drink. Dysperceptions: auditory and visual hallucinations, tactile parasthesia

56
Q

Stage 3 EtOH withdrawl time range and symptoms?

A

Alcohol withdrawl seizures, 24-48h after last drink. Generalized tonic-clonic seizures with little or no postictal period.

57
Q

Stage 4 EtOH withdrawl time range and symptoms?

A

Delerium Tremens, 48-72h after last drink. Delerium, psychosis, hallucionations, malignant hypertension, seizures, and coma.

58
Q

What is the main treatment goal of Alcohol Withdrawl Syndrome?

A

Minimize severity of symptoms in order to prevent more severe manifestations seizure, delerium, and death, and to improve patient’s quality of life.

59
Q

First-line tx for Alcohol Withdrawl Syndrome?

A

Non-pharmacologic supportive care: quiet room, frequent assurance, nursing care, etc

60
Q

How to prevent Wernicke’s Encephalopathy?

A

B-complex vitamins and Folates

61
Q

Routine tests during Alcohol Withdrawl Syndrome?

A

Blood or breath EtOH concentration, CBC, renal function tests, electrolytes, glucose, liver enzymes, urinalysis and urine toxicology screening.

62
Q

General supportive care during Alcohol Withdrawl Syndrome?

A

Correct fluid depletion, hypoglycaemia and electrolyte disturbances, and should include hydration and vitamin supplementation. In particular, thiamine supplementation and B-complex vitamins (including Folates).

63
Q

Can Thiamine be given routinely during Alcohol Withdrawl Syndrome?

A

Yes. Absence of contraindications or significant adverse effects. Safe to give.

64
Q

Can glucose be given before Thiamine in Alcohol Withdrawl Syndrome?

A

NO! Glucose before Thiamine makes Wernicke’s Encephalopathy worse. Give Thiamine before glucose!

65
Q

What are 2 long-lasting BZD agents?

A

Diazepam and Chlordiazepoxide

66
Q

“Gold Standard” for treating Acute Alcohol Withdrawl?

A

BZDs. Can actually prevent progression to next worse stage.

67
Q

Criteria for ideal drug for Alcohol Withdrawl Syndrome?

A

Rapid onset, long duration of action for reducing withdrawal symptoms, relatively simple metabolism, not dependent on liver function. It should not interact with alcohol, should supppress the ‘drinking behaviour’ without producing cognitive and/or motor impairment and it should not have a potential for abuse

Clin Therapeutics 1 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions