Insomnia & substance dependance Flashcards
why have BZ superseded barbituates?
less s/e & interactions
less dangerous in overdose
How long are BZs indicated for anxiety for
short term 2-4 weeks
Should be use BZs for insomnia
only when severe and disabling or causing extreme distress
BZ withdrawl may occur when
1 day - 3 weeks after stoppping
depending on how long acting the BZ is
For withdrawl what BZ would we switch to?
Would you switch one BZ at a time or all at once?
When is it given?
Switch to diazepam one at a time
At night
How much can you reduce a BZ by when withdrawing per 1-2 weeks?
usually 1-2mg every 1-2 weeks but up to one tenth
When are short acting hyponotics most apprpriate (3)
for people with trouble getting to sleep - sleep onset insomnia.
To minimise hangover effects the next day
And
for elderly patients
Two antidepressants that can help sleep if the underlying cause is depression
mirtazipine
clomipramine
Which z drug is short acting
zolpidem
Which 2 BZ are most suitable for dentistry
diazepam and temazepam
Temazepam if short acting is desirable
Which BZs are short acting (3)
loprazolam
temazepam
lormatazepam
why is clomethiazole a useful hypnotic in the elderly ?
free from handover effects
When is melatonin liscenced
what age
short term treament of insomnia in over 55
what is the problem with antihistamines for insomnia
headache
psychomotor impairment
antimuscurinic effects
what is the purpose of beta blockers in anxiety
reduce autonomic symptoms like palpitation and tremor
do short acting or long acting BZs have more withdrawl effect
short acting
why is meprobamate not recommended
less effective than BZs and more hazardous in overdoseage
still causes dependance
does buspirone aleviate symptoms of BZ withdrawl
no - it is specific to 5HT1A
therefore taper down BZ before starting
Two alternatives to chlordiazepoxide for alcohol withdrawl
carbemazepine
clomethiazole
what is the role of antispyschotics in alcohol withdrawl
should not be used alone - may lower seizure threshold
may be used as an adjuvant to BZs for agitation/halucinations
Nalmefene is licensed for which type of patients
only those with high drinking level but no physical alcohol withdrawl
Which medication for alcohol dependance gives an unpleasant systemic reaction when alcohol is ingested
disulfaram
acamprostate and naltrexone are used for
alcohol dependance
1st line
Toiletries and mouthwashes containing alcohol should be avoided on this medicaiton
disulfuram
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
acamprostate
Which alcohol depandance treatment is not appropriate if the patient is aiming for immediate abstiance
Nalmefene
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
Naltrexone (opiate receptor antagonist)
Drugs whose doses may need to be changed when smoking is stopped (4)
Ropinerole
Some antipsychotics
theophylline
cinacalcet (wtf is dis?)
when is a 24 hour nicotine patch more appripriate
if the pt has cravings in the morning
missing over …. doses of methadone requires retitrating
3
why is buprenorphine preferred to methadone
less sedating and lower risk of over dose
what is percipitate withdrawl
when buprenorphine which is a partial antagonist is given with a stronger opioid and causes withdrawl
why is there naloxone in some buprenorphine preparations
for pt at risk of diverting for injection (the naloxone prevents the effects of the buprenorphine)
during pregnancy is it safe to withdraw
no - particularly in first trimester (spntaneous mischarrige)
what adjuvants to opioid withdrawl are recommended for nausea
metoclopramide or prochlorperazine
what adjuvants to opioid withdrawl are recommended for diarrhoea
loperimide
what adjuvants to opioid withdrawl are recommended for abdo cramps
mebeverine
what is the role of lefexidine (2)
- adjuvant to opioid substitution
- in patients whose dependance is uncertain including young people
why is opioid substitution therapy usually inapprorapite in younf people
harmful effects are usually due to intoxication than dependance
how do eating and drink affect absorption of nicotine
acidic beveragges such as coffee or fruitjuive may decrease oral nicotine absorprion through buccal mucosa. Avoid 15 mins before nicotine therapy.
MHRA caution for varenicline
suicidal behaviour -
seek medical advice is depressed mood, agitation and suicidal thoughts occur.
Caution in patient with history of psychiatric illness
what is the difference between methadone for dependance and methadone for cough in terminal illness
linctus - 2mg/5mL for cough in terminal illness
oral solution - 1mg/mL used in dependace
