Lecture 8 - Substance Use Disorders Flashcards
SUDs DSM-5 Criteria
2-3 = Mild
4-5 = Moderate
6+ = Severe
at least 1 has to be tolerance or withdrawal
Risk factors for SUD
Cultural attitudes
Onset of use at an early age
Early evidence of aggressive behavior
Intra-familial disturbances
Environment (high substance use among peers)
FH of SUD
Psychiatric co-morbidities
Wernicke-Korsakoff Syndrome caused by…
thiamine deficiency, leads to eventual cell death and causes eventual injury to brainstem
Wernicke Syndrome Symptoms
confusion
delirium
Nystagmus (classic)
Ataxia (classic)
Psychosis
Sleep disturbances
Responds rapidly to vit replacement
Korsakoff Psychosis
Later manifestation of Wernicke’s syndrome
Symptoms:
Severe disorientation
Delirium
Memory loss
Confabulation (classic)
Psychosis
Tm for Wernicke-Korsakoff Syndrome
“banana bag” = thiamine + folate + MVI
prophylaxis = Thiamine 100-500mg/daily IV or IM for 3-5 day, then oral
Txm = Thiamine 100-500 IV or IM TID X 5 days, then oral
on-pharm AUD Txm
Cognitive behavioral therapy
Motivational enhancement therapy
Community reinforcement
Cue exposure and relation training
Group therapy, family therapy
Self-help groups
12 step programs
4 FDA approved drugs for AUD
Disulfiram (Antabuse)
Oral naltrexone (ReVia)
Inj naltrexone (Vivitrol)
Acamprosate (Campral)
Disulfiram Dosing
Initial: 500mg QD 1-2 wks
Maintenance: 125mg-500mg QD
** start 12 hours after last drink to start**
Disulfiram monitoring paramaters
efficacy: reduction in alc consumption/cravings
Safety: facial flushing, inc LFTs
Disulfiram ADEs
Dermatitis
Garlic-like or metallic aftertaste
Hepatitis
HA
Fatigue
drowsiness
Disulfiram DDI
Disulfiram metabolite inhibits CYP3A4
Metronidazole n EtOH contains products = disulfiram-like rxn
Disulfiram Counseling
can take up to 14 days for liver enzymes to return to BL after stoping
Avoid metronidazole n all EtOH containing products
Disulfiram duration
indefinite, until pt has fully recovered…can take months to years
Disulfiram Considerations
noncompliance limits utility
most effective in motivated pts or those legally mandated to take it
RCTs haven’t shown advantage over placebo in achieving total abstinence, delaying relapse, or improving employment status
Naltrexone MOA in AUD
Blocks endorphins from activating opioid receptors which lead to reward signal
Naltrexone Counseling
No opioids in past 7-10 days
Review potential AE, ensure pt understands traditional pain meds won’t work in emergency
DDI Naltrexone
Opioids may precipitate withdrawal in opioid dependent patients
ADE Naltrexone
N/V
HA
Anxiety
Insomnia, fatigue, inc ALTs
injection site reactions w/ IM
Naltrexone monitoring parameters
Efficacy: EtOH consumption/craving
Safety: LFTs, nausea, anxiety, dizziness
Naltrexone dosing
Oral: 50mg QD
IM injection = 380mg Q4 weeks in the butt
Acamprosate MOA
seems to inc GABA activity and dec Glutamate
not fully defined
Acamprosate Dosing
666mg TID
** Req renal dosing, and dont use if CrCl <30 **
Lower dose if < 60kg BW
Acamprosate DI
none
