Final - Ott Flashcards
Alcohol Withdrawal: Time of Onsets
Stage 1: ______ hours
6 - 8
Alcohol Withdrawal: Time of Onsets
Stage 2: ______ hours
~24 hours
`Alcohol Withdrawal: Time of Onsets
Stage 3: ______ hours
~1 - 2 days
Alcohol Withdrawal: Time of Onsets
Stage 4: ______ hours
3 - 5 days
what are the clinical features of alcohol withdrawal during stage 1
autonomic hyperactivity (tachycardia, insomnia, N/V,diaphoresis)
what are the clinical features of alcohol withdrawal during stage 2
still autonomic hyperactivity but w/ auditory and visual hallucinations
what are the clinical features of alcohol withdrawal during stage 3
~4% of pts that go untreated develop GRAND MAL seizures after the drop in BAC
what are the clinical features of alcohol withdrawal during stage 4
~5% of pts: delirium tremens!
People are more likely to develop delirium tremens if they have ______ dysfunction
hepatic
what things make a pt more likely to have DTs when alcohol withdrawal
prior hx of DTs # of detoxs early symptoms during withdrawal hepatic dysfunction consuming 1 pint of whiskey per day for 10 - 14 days prior to admission
what is CIWA/how do we use it
validated scale —- known as Clinical Institute withdrawal assessment
ranks diff. symptom types from 0 - 7
(symptoms include N/V, tremors, sweats, anxiety, agitation, tactile disturbances, auditory/visual hallucinations)
Main tx option for alcohol withdrawal?
BZDs
Diazepam, Chlordiazepoxide, Lorazepam
BZDs for Alcohol Withdrawal:
Use _______ if no liver dysfunction
Use _______ if pt has liver dysfunction
Diazepam, Chlordiazepoxide
Lorazepam
Using CIWA scores for Alcohol Withdrawal:
What to do it CIWA < 8 - 10
nonpharm tx
Using CIWA scores for Alcohol Withdrawal:
What to do it CIWA 8 - 15
medicate
Using CIWA scores for Alcohol Withdrawal:
What to do it CIWA > 15
risk of complications if not treated
what other drugs can be used for alcohol withdrawal rather than BZDs
Thiamine!!
Anticonvulsants - Valproic acid 1st; CBZ 2nd
what is wernicke korsakoff syndrome
when there is low thiamine — give thiamine before you give ppl dextrose containing fluids because this could cause encephalopathy
Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders?
is known as aversive therapy
disulfiram
Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders?
is best for binge drinking
naltrexone
Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders?
need to monitor renal function
acamprosate
remember prosate —prostate— urination…
Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders?
monitor LVTs
disulfiram and naltrexone
Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders?
has a suicidality warning
acamprosate
Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders?
has to take 6 tabs daily (TID dosing)
acamprosate
Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders?
which one has IM dosing option
naltrexone
Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders?
which one is problematic if pt has pain management needs/gets in accident and needs pain meds
naltrexone (opioid antagggggg)
Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders?
is for maintenance of abstinence
acamprosate
Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders?
lasts in body for 14 days after last dose
disulfiram (aka pt counseling pt if they want a glass of wine for a special occasion, they have to stop it 2 weeks in advance)
what drugs can be used to help with opioid withdrawal
clonidine (new drug of lofexidine is just like clonidine)
antidiarrheals
analgesics
antiemetics
maintenance tx options for opioid use disorders
methadone and buprenorphine
which drug needs DATA 2000 certified physicians
buprenorphine (X_______ DEA)
Methadone Tx Pearls:
_____ half life
long
Methadone Tx Pearls:
______ dosing — pts earn ______
witnessed
earn TAKE home bottles
Methadone Tx Pearls:
Urine tox screen results?
+ for methadone
- for everything else
Methadone Tx Pearls:
CYP_____ substrate
3A4
Methadone Tx Pearls:
Most serious concern?/Monitoring to go with this concern?
QT prolongation
EKG monitoring
Buprenorphine Tx Pearls:
it is commonly given with ______ to decrease abuse
naloxone
Buprenorphine Tx Pearls:
for initial dosing you should wait _____ hours since last opioid use so that the pt does not have early withdrawal to prevent buprenorphine induced withdrawal
4 hours
Buprenorphine Tx Pearls:
can keep titrating the buprenorphine/naloxone dosing til you achieve what?
achieve minimizing withdrawal but also not providing euphoric effects
what are the buprenohrpone ER forms?
implant and injection
issue with the buprenorphine impalnt?
pt must be stable on a low dose of buprenorphine
aka most pts starting off - this is NOT a good option
Buprenorphine ER Injection:
Dosed every _____?
month
why does buprenorphine ER injection have a REMS program
has a REMS program to prevent ppl taking the drug and giving it IV— giving IV can cause thromboembolism
if someone comes in to hospital with psychosis from K2/spice of bathsalts — should you give antipsychotics or not?
No! psychosis induced by those drugs is not typically responsive to antipsychotics
if a pt comes in with HTN due to cocaine intoxication— do we give them a beta blocker to chill?
don’t think so — it is controversial – worried about cardiovascular collapse
