exam 5 SUD

Question 1

what is the legal limit for driving BAC?

Answer 1

0.08mg%

Question 2

what are the risk factors for delirium tremens?

Answer 2

prior DTs
kindling - repeat withdrawal episodes
early symptoms of withdrawal
hepatic dysfunction

Question 3

how to treat alcohol withdrawal?

Answer 3

use BZD if symptoms warrant
CIWA scale >8 treat

Question 4

what should you replace in vitamin deficient patients?

Answer 4

thiamin

Question 5

what is not effective to treat withdrawal seizures?

Answer 5

phenytoin

Question 6

what is wernicke’s encephalopath?

Answer 6

result of thiamine deficiency
give thiamine before dextrose containing fluids
thiamine is co-factor for glucose metabolism –> so it can result in high glucose

Question 7

what benzos are given if they have liver dysfunction?

Answer 7

lorazepam and oxazepam

Question 8

what is disulfiram?

Answer 8

aversive therapy for alcohol use disorder
irreversible –> so needs to stop for 14 days if planning on consuming alcohol

Question 9

what is acamprosate?

Answer 9

maintence of abstinence
renal elminination, monitor renal function
avoid in severe renal impairment
suicidality

Question 10

what a-2 agonists are used for opioid withdrawal?

Answer 10

clonidine and lofexidine

Question 11

how is naltrexone used?

Answer 11

decreases binge drinking and helps increase time between drinking days
elavated LFTs, must monitor at baseline and routinely
need to evaluate pain managment needs
injection site reaction

Question 11

what is maintenance treatment for opioid use disorders?

Answer 11

methadone must be given in a licensed treatment program
buprenorphine is usually given in combo with naloxone

Question 11

what is the difference between clonidine and lofexidine?

Answer 11

clonidine is cheaper and has better dosing
lofexidine has less CV risk

Question 12

what is important about methadone?

Answer 12

QT prolongation
CYP 3A4, 2b6, 2c19, 2d6 substrate

Question 13

what is important about buprenorphine?

Answer 13

given with naloxone in the same dosage form
to avoid precipitating withdrawal, initiate therapy when there are signs of withdrawal administer in divided doses on day 1
3A4 substrate

Question 14

what is important about bupenorphine ER injection

Answer 14

moderate to severe opioid use disorder
monitor for use with serotonergic drugs since there is risk for serotonin syndrome

Question 15

what is important about naltrexone ER injection?

Answer 15

given in the same dose that used for alcohol use disorder
abstinence treatment, so patient must be ready to quit
risk for overdose if patient discontinues treatment