Exam 5 - Substance Use/Alcohol Ott Flashcards
at what BAC is there risk of respiratory depression?
a. 50 mg/dL
b. 80 mg/dL
c. 450 mg/dL
d. 500 mg/dL
c. 450 mg/dL
at what BAC do we see observable motor function impairment?
a. 50 mg/dL
b. 80 mg/dL
c. 450 mg/dL
d. 500 mg/dL
a. 50 mg/dL
LD50 for ethanol
a. 50 mg/dL
b. 80 mg/dL
c. 450 mg/dL
d. 500 mg/dL
d. 500 mg/dL
legal BAC intoxication limit
a. 50 mg/dL
b. 80 mg/dL
c. 450 mg/dL
d. 500 mg/dL
b. 80 mg/dL
how many stages of alcohol withdrawal are there?
4
Moderate autonomic hyperactivity (anxiety, tremulousness, tachycardia, insomnia, nausea, vomiting, diaphoresis) and a craving for alcohol
a. stage 1 alcohol withdrawal
b. stage 2 alcohol withdrawal
c. stage 3 alcohol withdrawal
d. stage 4 alcohol withdrawal
a. stage 1 alcohol withdrawal
Autonomic hyperactivity with auditory or visual hallucinations lasting ~ 1 – 3 days – most remain lucid and oriented
a. stage 1 alcohol withdrawal
b. stage 2 alcohol withdrawal
c. stage 3 alcohol withdrawal
d. stage 4 alcohol withdrawal
b. stage 2 alcohol withdrawal
~4% of those untreated develop grand mal seizures ~ 7 – 48 hours after drop in BAC
a. stage 1 alcohol withdrawal
b. stage 2 alcohol withdrawal
c. stage 3 alcohol withdrawal
d. stage 4 alcohol withdrawal
c. stage 3 alcohol withdrawal
Delirium tremens (DTs) in ~5% of patients (confusion, illusions, hallucinations, agitation, tachycardia, hyperthermia)
a. stage 1 alcohol withdrawal
b. stage 2 alcohol withdrawal
c. stage 3 alcohol withdrawal
d. stage 4 alcohol withdrawal
d. stage 4 alcohol withdrawal
what is the time of onset for each stage of alcohol withdrawal?
stage 1 -> 6-8 hours
stage 2 -> 24 hours
stage 3 -> 1-2 days
stage 4 -> 3-5 days
mortality percentage associated with delirium tremens; what is mortality due to?
5-15%, attributable to arrhythmias, shock, infection, trauma or aspiration
Number 1 predictor of future delirium tremens
a. prior history of DTs
b. number of detoxifications
c. consuming the equivalent of 1 pint of whiskey per day for 10 of 14 days prior to admission
d. early sx of withdrawal
e. hepatic dysfunction
a. prior history of DTs
what is “kindling” in regards to delirium tremens?
repeated withdrawal episodes inc the severity of subseq withdrawal syndromes
which is NOT a risk factor for delirium tremens
a. prior history of DTs
b. number of detoxifications
c. consuming the equivalent of 1 pint of whiskey per day for 10 of 14 days prior to admission
d. early sx of withdrawal
e. renal dysfunction
e. renal dysfunction (hepatic not renal)
tx of alcohol withdrawal CIWA < 8
nonpharm tx
common drug class for treating alcohol withdrawal
BZDs
T or F: prophylaxis/fixed dosing for alcohol withdrawal tx uses the CIWA scale
F (CIWA is used in individualized dosing, not prophylaxis/fixed dosing)
what should we do if pt is 8-15 on the CIWA scale?
a. nonpharm
b. medicate
b. medicate
CIWA > ___ has risk of complications if untreated
> 15
drug options for alcohol withdrawal if pt has no liver dysfunction (4 of them)
diazepam, chlordiazepoxide, lorazepam, oxazepam
(diazepam and chlordiazepoxide have long half life and dec risk of breakthrough sx)
2 benzos for alcohol withdrawal and pt has liver dysfunction
lorazepam, oxazepam
T or F: phenytoin is effective for treating withdrawal seizures
F
Wernicke’s encephalopathy is a result of _______ deficiency
thiamine
should we give thiamine before or after dextrose-containing fluids when treating Wernicke’s encephalopathy?
before
why is thiamine important for preventing Wernicke’s encephalopathy?
Thiamine is co-factor in glucose metabolism,
Wernicke’s can be precipitated by high glucose
loads
which drug has the brand name Antabuse?
Disulfiram
how is acamprosate eliminated?
renal; monitor renal function, avoid in severe renal impairment
which of the following is FALSE about acamprosate?
a. dosed as 2 tablets TID
b. hepatic elimination
c. suicidality warning
d. SE include diarrhea, nausea, depression, anxiety
b. hepatic elimination (renal)
tx for muscle aches/tension due to opioid withdrawal
a. acetaminophen or NSAID
b. hydroxyzine/BZDs
c. ondansetron
d. loperamide
e. clonidine or lofexidine
a. acetaminophen or NSAID
tx for agitation/anxiety/insomnia due to opioid withdrawal
a. acetaminophen or NSAID
b. hydroxyzine/BZDs
c. ondansetron
d. loperamide
e. clonidine or lofexidine
b. hydroxyzine/BZDs
(hydroxyzine preferred)
tx for abdominal cramping/nausea/vomiting due to opioid withdrawal
a. acetaminophen or NSAID
b. hydroxyzine/BZDs
c. ondansetron
d. loperamide
e. clonidine or lofexidine
c. ondansetron
tx of diarrhea due to opioid withdrawal
a. acetaminophen or NSAID
b. hydroxyzine/BZDs
c. ondansetron
d. loperamide
e. clonidine or lofexidine
d. loperamide
tx of sweating/yawning/inc tearing/runny nose due to opioid withdrawal
a. acetaminophen or NSAID
b. hydroxyzine/BZDs
c. ondansetron
d. loperamide
e. clonidine or lofexidine
e. clonidine or lofexidine
which of the following is FALSE about naltrexone?
a. Decreases binge drinking, helps to increase time between drinking days
b. no monitoring required
c. patient should have wallet card or be able to tell emergency providers that they are taking this
d. warning for injection site rxns
b. no monitoring required (elevated LFTs common, must monitor at baseline and routinely)
look at slide 25 for the ASAM Guidance Update 2020
sounds good
two oral drugs for maintenance tx of opioid use disorders
methadone and buprenorphine
which drug for maintenance of opioid use disorder must be given in a licensed tx program?
methadone
why is buprenorphine sublingual?
poor oral bioavailability when swallowed
T or F: methadone is a 2B6, 2D6, 2C19, 3A4 substrate
T
what is the serious concern with methadone?
QTc prolongation (ECG monitoring is recommended)
buprenorphine is given with ________ to decreased misuse
naloxone
which of the following is TRUE about buprenorphine?
a. must be taken orally
b. 2D6 substrate
c. no monitoring required
d. risk of respiratory depression in overdose is much less than opioids
d. risk of respiratory depression in overdose is much less than opioids
buprenorphine ER injection is for _____-_____ opioid use disorder initiated on sublingual _______ and dose adjustment for at least ___ days prior to first injection
moderate-severe; buprenorphine; 7
monitoring for buprenorphine injection
serotonin syndrome with serotonergic drugs
FDA-approved in pregnancy
a. methadone
b. buprenorphine
a. methadone
for buprenorphine how should the doses be administered on day 1?
divided doses (to avoid precipitating withdrawal, initiate when there are clear signs of withdrawal)
which has less stigma and less misuse potential?
a. methadone
b. buprenorphine
b. buprenorphine
naltrexone can be used for what two disorders?
alcohol use; opioid use
which drug is the “abstinence treatment” for alcohol and opioid use disorder?
naltrexone long-acting injection (Vivitrol)
T or F: naltrexone LA injection (Vivtriol) can be discontinued without any consequences
F (risk of overdose, must tell pt of this risk)
