Harm Minimisation

Question 1

What drugs can be used to treat Alcohol dependence?

Answer 1

Disulfiram
Naltrexone
Acamprosate

Question 2

What is the mechanism of action of Disulfiram?

Answer 2

Inhibits ALDH causing acetaldehyde accumulation (causing flushing, nausea, headache etc)
Makes drinking unpleasant

Question 3

What is the mechanism of action of Naltrexone?

Answer 3

opioid (mu) receptor antag

Anti-craving drug –> decreased opioid signalling causes decreased reward.

Question 4

What is the mechanism of action of Acamprosate?

Answer 4

Inhibits NMDA and stimulates GABAa receptors.
(imitating alcohol) –> reduces craving and increases abstinence.
Structurally similar to glutamate and GABA

Question 5

What drugs can be used to treat opioid dependence?

Answer 5

Methadone
Buprenorphine
Naltrexone

Question 6

What is the mechanism of action of Methadone?

Answer 6

Opioid agonist, so used as a “replacement therapy”.
Provides little/no euphoria, but relief from craving.
half life of 24hrs, so must come into pharmacy every day.
Most effective method at promoting & maintaining abstinence.

Question 7

What is the mechanism of action of Buprenorphine?

Answer 7

Partial opioid agonist/antagonist
- mu receptor agonist
- kappa receptor antag
Used as replacement therapy.
Sublingual to increase bioavalibility
Can be given less frequently than methadone (can have take home doses)
Can be combined with naloxone to prevent diversion

Question 8

What is the mechanism of action of Naloxone?

Answer 8

Opioid receptor antagonist.

Blocks effects of opioids when injected. Prevents diversion.

Question 9

What drugs can be used to treat nicotine dependence?

Answer 9

Nicotine Replacement Therapy (NRT)
Bupropion
Varenicline

Question 10

What is the mechanism of action of Bupropion?

Answer 10

Reuptake inhibitor of NA and DA

Helps reduce withdrawal symptoms

Question 11

What is the mechanism of action of Varenicline?

Answer 11

Weakly binds to nicotinic receptor
Blocks nicotine induced reward (makes smoking less satisfying).
Decreases craving and withdrawal.
Do not give with NRT.
Better than bupropion

Question 12

What is the mechanism of action of NRT?

Answer 12

Replace nicotine WITHOUT harmful constituents.
Decreases withdrawal symptoms and allows focus on psycosocial aspects of quitting.
Available in patches, gum, lozenges, sublingual tablets, inhalers.