hills 1 Flashcards
1
Q
Alcohol
A
- Withdrawal from alcohol can be DANGEROUS
- causes seizures, hallucinations and even death
- MANAGEMENT of acute withdrawal involves a taper of benzodiazepeines (lorazepam, diazepam or chlordiazepoxide)
- activate GABA NT system (similar to alcohol)
- Chronic alcohol abuse, GABA is downregulated
- benzo allow transition back to a safe level of GABA functioning
- WITHDRAWAL from Benzos is also done with a controlled taper
- withdrawal-related halluciantion –> tx with haloperidol
2
Q
barbiturates
A
- Benzos can also be used in withdrawal from barbiturates
- phyntoin can also be used
3
Q
Naltrexone
A
AID ALCOHOL ABSTINENCE
- Opiate antagonist that interferes with PLEASURE RESPONSE TO ALCOHOL
- seems to decrease heavy drinking more than it helps total abstinence
- ADVERSE = liver toxicity
4
Q
Acamprosate
A
Aiding alcohol abstinence
- Decrease cravings or compulsions to drink
-
Affects the balance of GABA and glutamate
- HELPS REDUCE HYPERAROUSAL OF EARLY SOBRIETY
5
Q
Topiramate (topamax)
A
Aiding alcohol abstinence
- Decrease cravings or compulsions to drink
- ANTI-EPILEPSY medication that also helps put the brake on glutamate and INCREASE GABA activity in the brain
6
Q
Disulfuram
A
Aiding alcohol abstinence
- INHIBITS ACETALDEHYDE DEHYDROGENASE –> necesary enzyme for metabolizing of alcohol
- LEADS TO ACCUMUALTIONG OF ACETALDEHYDE
- exposure to alcohol causes the persone to become VERY VERY ILL
*
- exposure to alcohol causes the persone to become VERY VERY ILL
7
Q
Opiate withdrawal
A
- Withdrawal from opiates is utterly miserable, but rarely medically dangerous
- Management of detox can be handled in two ways:
- symptomatic tx
- opiate replacement
8
Q
Symptomatic tx of opiate withdrawal
A
- clonidine = reduces the physiologic arousal of withdrawal
- dicyclomine = anti-cramping
- loperamide = anti-diarrhea
- benzodiazepines = anxiety/agitation/insomnia
9
Q
Methadone
A
Opiate replacement therapy
- long-acting opiate that can be used to taper off illicit opiates
- distribution is highly controlled because of abuse potential
- “harm reduction” = used chronically as an alternative to illicits
10
Q
Buprenorphine*****
A
Opiate replacement
-
mixed opiate agonist/antagonist = prevent withdrawal symptoms
- less analgesic and euphoric effects than full agonists, and is thus less likely to itself bea buse
- STARTED AFTER perseon goes through ACUTE WITHDRAWAL
-
BUPRENORPHINE is GIVEN AS SUBOXONE = combined with NALOXONE (full opiate antagonist
- NALOXONE isn’t orally absorbed, but is present if someone tries to use suboxone IV
- prevent any euphoria and promptly put the user in withdrawal
- NALOXONE isn’t orally absorbed, but is present if someone tries to use suboxone IV
11
Q
NALTREXONE****
A
- same opiate antagonists that can be used for maintaining alcohol abstinence
- though it doesn’t greatly reduce craving, it will PREVENT AN OPIATE FROM HAVING ANY PLEASURABLE EFFECT
12
Q
VARENICLINE (chantix)
A
- a way of replacing tobacco use
- Nicotininc receptor partial agonist prescribed as a way to transition away from tobacco
- there have be recent concern raised about pssible adverse psychiatric effects
13
Q
Bupropion (wellbutrin)
A
- Norepinephrine/dopamine reuptake inhibitor
- its benefit may be related to dopamine effects on the reward pathway in the brain
14
Q
cocaine/stimulants
A
- withdrawal is related to depleted dopamine, norepinephrien and epinephrine supplies
- Topiramate have mixed results in helping to maintain abstinence
15
Q
Risky meds: Lithium
A
- diuresis from alcohol leads to dehydration, which in turn leads to higher blood levels of lithium and increased risk of toxicity
