Insomnia & substance dependance

Question 1

why have BZ superseded barbituates?

Answer 1

less s/e & interactions

less dangerous in overdose

Question 2

How long are BZs indicated for anxiety for

Answer 2

short term 2-4 weeks

Question 3

Should be use BZs for insomnia

Answer 3

only when severe and disabling or causing extreme distress

Question 4

BZ withdrawl may occur when

Answer 4

1 day - 3 weeks after stoppping

depending on how long acting the BZ is

Question 5

For withdrawl what BZ would we switch to?
Would you switch one BZ at a time or all at once?
When is it given?

Answer 5

Switch to diazepam one at a time

At night

Question 6

How much can you reduce a BZ by when withdrawing per 1-2 weeks?

Answer 6

usually 1-2mg every 1-2 weeks but up to one tenth

Question 7

When are short acting hyponotics most apprpriate (3)

Answer 7

for people with trouble getting to sleep - sleep onset insomnia.
To minimise hangover effects the next day
And
for elderly patients

Question 8

Two antidepressants that can help sleep if the underlying cause is depression

Answer 8

mirtazipine

clomipramine

Question 9

Which z drug is short acting

Answer 9

zolpidem

Question 10

Which 2 BZ are most suitable for dentistry

Answer 10

diazepam and temazepam

Temazepam if short acting is desirable

Question 11

Which BZs are short acting (3)

Answer 11

loprazolam
temazepam
lormatazepam

Question 12

why is clomethiazole a useful hypnotic in the elderly ?

Answer 12

free from handover effects

Question 13

When is melatonin liscenced

what age

Answer 13

short term treament of insomnia in over 55

Question 14

what is the problem with antihistamines for insomnia

Answer 14

headache
psychomotor impairment
antimuscurinic effects

Question 15

what is the purpose of beta blockers in anxiety

Answer 15

reduce autonomic symptoms like palpitation and tremor

Question 16

do short acting or long acting BZs have more withdrawl effect

Answer 16

short acting

Question 17

why is meprobamate not recommended

Answer 17

less effective than BZs and more hazardous in overdoseage

still causes dependance

Question 18

does buspirone aleviate symptoms of BZ withdrawl

Answer 18

no - it is specific to 5HT1A

therefore taper down BZ before starting

Question 19

Two alternatives to chlordiazepoxide for alcohol withdrawl

Answer 19

carbemazepine

clomethiazole

Question 20

what is the role of antispyschotics in alcohol withdrawl

Answer 20

should not be used alone - may lower seizure threshold

may be used as an adjuvant to BZs for agitation/halucinations

Question 21

Nalmefene is licensed for which type of patients

Answer 21

only those with high drinking level but no physical alcohol withdrawl

Question 22

Which medication for alcohol dependance gives an unpleasant systemic reaction when alcohol is ingested

Answer 22

disulfaram

Question 23

acamprostate and naltrexone are used for

Answer 23

alcohol dependance

1st line

Question 24

Toiletries and mouthwashes containing alcohol should be avoided on this medicaiton

Answer 24

disulfuram

Question 25

What drug is prrescribed for patients concerned that strong alcohol cravings will result in relapse, continued for 1 year after abstinence has been achieved. Treatment should be maintain if a patient has a temporary relapse

Answer 25

acamprostate

Question 26

Which alcohol depandance treatment is not appropriate if the patient is aiming for immediate abstiance

Answer 26

Nalmefene

Question 27

what drug is useful as an adjuvant in alcohol withdrawl but should be stopped if the patient continues drinking for 4-6 weeks after starting treatmetn

Answer 27

Naltrexone (opiate receptor antagonist)

Question 28

Drugs whose doses may need to be changed when smoking is stopped (4)

Answer 28

Ropinerole
Some antipsychotics
theophylline
cinacalcet (wtf is dis?)

Question 29

when is a 24 hour nicotine patch more appripriate

Answer 29

if the pt has cravings in the morning

Question 30

missing over …. doses of methadone requires retitrating

Answer 30

3

Question 31

why is buprenorphine preferred to methadone

Answer 31

less sedating and lower risk of over dose

Question 32

what is percipitate withdrawl

Answer 32

when buprenorphine which is a partial antagonist is given with a stronger opioid and causes withdrawl

Question 33

why is there naloxone in some buprenorphine preparations

Answer 33

for pt at risk of diverting for injection (the naloxone prevents the effects of the buprenorphine)

Question 34

during pregnancy is it safe to withdraw

Answer 34

no - particularly in first trimester (spntaneous mischarrige)

Question 35

what adjuvants to opioid withdrawl are recommended for nausea

Answer 35

metoclopramide or prochlorperazine

Question 36

what adjuvants to opioid withdrawl are recommended for diarrhoea

Answer 36

loperimide

Question 37

what adjuvants to opioid withdrawl are recommended for abdo cramps

Answer 37

mebeverine

Question 38

what is the role of lefexidine (2)

Answer 38

• adjuvant to opioid substitution

- in patients whose dependance is uncertain including young people

Question 39

why is opioid substitution therapy usually inapprorapite in younf people

Answer 39

harmful effects are usually due to intoxication than dependance

Question 40

how do eating and drink affect absorption of nicotine

Answer 40

acidic beveragges such as coffee or fruitjuive may decrease oral nicotine absorprion through buccal mucosa. Avoid 15 mins before nicotine therapy.

Question 41

MHRA caution for varenicline

Answer 41

suicidal behaviour -
seek medical advice is depressed mood, agitation and suicidal thoughts occur.
Caution in patient with history of psychiatric illness

Question 42

what is the difference between methadone for dependance and methadone for cough in terminal illness

Answer 42

linctus - 2mg/5mL for cough in terminal illness

oral solution - 1mg/mL used in dependace