Exam 5 (final) - Ott SUD Flashcards
BAC 80mg/dL (0.08mg%) significance
this is the legal limit to drive or operate machinery
-comes with moderate impairment usually
BAC 50mg/dL (0.05mg%) significance
motor fxn impairment visible
BAC 450mg/dL significance
respiratory depression
BAC 500mg/dL significance
LD50 for ethanol
stage 1 alcohol withdrawal
~6-8 hours after withdrawal
-anxiety, increased HR, NV, craving for alcohol
stage 2 alcohol withdrawal
~24 hours after withdrawal
-same as stage 1 but may some with auditory or visual hallucinations for 1-3 days
stage 3 alcohol withdrawal
~1-2 days after withdrawal
-grand mal seizures in ~4% of those who are untreated
stage 4 alcohol withdrawal
~4 days (96 hours) after withdrawal
-Delirium Tremens (DTs): not common but very high risk (severe)
DT risk factors (5)
-prior history (#1 indicator of future ones)
-number of detoxifications
-consuming the equivalent of 1 pint of whiskey per day for 10-14 days prior to admission
-early sx of withdrawal
-hepatic dysfunction
CIWA-AR stands for what and is important why?
clinical institute withdrawal assessment
-this is the in-pt setting standard of care
-assesses withdrawal severity
treatment of alcohol withdrawal options
-benzodiazepines
-liver dysfxn: use lorazepam or oxazepam (can use these even if pt does not have liver dysfxn)
-no liver dysfxn: diazepam or chlordiazepoxide
when to medicate based on CIWA score?
score of <8: non-pharm
score of 8: medicate
score of 15+: risk of complications if untreated
Thiamine importance w/ AUD
-always recommend thiamine if suspicious of alcohol use
-cofactor in glucose (dextrose) metabolism: if giving dextrose, make sure thiamine is given first
phenytoin importance w/ AUD
-not shown to be effective to treat withdrawal symptoms
-pts can sometimes be left on this for months or years after having withdrawal seizures —>D/C it
Wernicke’s encephalopathy syndrome
-result of thiamine deficiency
-life threatening, characterized by ataxia/confusion
when to consider thiamine for a patient based on BAC
consider giving to any patient coming in with BAC of 0.08 or higher (won’t hurt them)
disulfiram (Antabuse) clinical pearls
-NV or other unpleasant SE if alcohol is used
-pt must already be highly motivated to quit
-250mg maintenance dose
-effects seen up to 14 days after use
acamprosate (Campral) clinical pearls (RSSDA)
-monitor renal fxn, AVOID in severe renal impairment
-suicide warning
-SE: Diarrhea, nausea, depression, anxiety
-333mg tablets (directions: take 2 tablets 3 times daily)
-safe to take if person uses alcohol
of disulfiram, acamprosate, and naltrexone, which is most effective for AUD?
naltrexone
of the drugs used to treat it, which is least effective for OUD?
naltrexone
naltrexone clinical pearls (BTLW)
-decreases binge drinking
-reduces time between drinking days
-monitor LFTs routinely
-pt should carry wallet card to alert emergency providers
naltrexone ______ dosage form is preferred
injection
name 5 sx of opioid withdrawal
muscle aches/tension
agitation/anxiety
NV, ab cramping
diarrhea
sweating, runny nose
in opioid withdrawal sx, how do you treat muscle aches
NSAIDs or APAP
in opioid withdrawal sx, how do you treat anxiety/agitation
hydroxyzine or benzos
in opioid withdrawal sx, how do you treat NV or ab cramping
ondansetron
in opioid withdrawal sx, how do you treat diarrhea
loperamide
in opioid withdrawal sx, how do you treat sweating/runny nose
clonidine or lofexidine
-clonidine preferred bc of price
clonidine dosing based on severity of withdrawal
mild: 0.3-0.6mg/day
severe: up to 1.2mg/day
-these are given in divided dose (0.1-0.2mg/dose up to hourly)
lofexidine dosing (0.18mg tablets)
0.54mg (3 tabs) four times daily for 5-7 days (up to 14 days)
-max daily dose: 2.88mg/day (16 tabs)
-max single dose: 0.72mg (4 tabs)
safe medications for OUD in pregnancy
methadone or buprenorphine
buprenorphine is usually given in combo with ______ in a ______ form due to poor bioavailability of _______ when swallowed
naloxone, SL, buprenorphine or naloxone
methadone normally has the worst interactions with an ______ (inhibitor or inducer) of ________
inhibitor, 3A4
common 3A4 inhibitor drugs
diltiazem, verapamil, alprazolam, grapefruit, and some antibiotics
methadone most serious SE
QTc prolongation
buprenorphine substrate
3A4
buprenorphine use (SL or SQ inj.) with ______ drugs may cause ______ syndrome
serotonergic, serotonin
buprenorphine ER injection brand names
Sublocade, Brixadi
buprenorphine ER injection is used in what case (what severity? how to start it?)
moderate-severe OUD
-pts started on SL form and dose adjusted for 7 days prior to initiation of injection
considerations of methadone compared to buprenorphine (OMLA)
-opioid so it has more effect on receptors
-medicaid covers
-effective long term
-availability or program in area? transportation?
considerations of buprenorphine compared to methadone
-less misuse potential
-medicaid covers
-monthly prescription available
-less stigma
dose of naltrexone long acting injection (for OUD and AUD)
380mg q4weeks
naltrexone considered the “_________” treatment, pts must be ready to be done for good
abstinence
there is an increased risk of OD if patient stops ________ and goes back to using opioids at previous doses
naltrexone
-must educate pts on this
what other comorbidity may come with substance withdrawal and how do you treat it?
depression, treat as normal clinical depression
