Module 11. Substance abuse

Question 1

What are canada’s low risk alcohol drinking guidelines safe limits?

Answer 1

women 10 drinks per week, 2/day
men 15 drinks per week 3/day

Question 2

if you drink _____ drinks per week or less, you are likely to avoid alcohol related consequences for yourself or others at this level

Answer 2

2 standard drinks or less

Question 3

True or false?

7 standard drinks or more per week— Your risk of heart disease or stroke increases significantly at this level.

Answer 3

True

Question 4

What are some biomechanical markers of prolonged alcohol use?

Answer 4

elevated LFT, AST ALT GGT, MCV and Carbohydrate deficient transferrin

is AST:ALT ratio is >2:1 and GGT is elevated, then this is suggestive of alcohol use

Question 5

What is the one question screen? and how do you proceed after this?

Answer 5

One question screen is

How many times in the past year have you had more than 5 drinks (for men) or 4 drinks (for women) in one day?

If the answer is more then one, you need to proceed with the AUDIT

Question 6

what are some of the nonpharm

Question 7

Naltrexone is contraindicated in which patients?

Answer 7

Naltrexone is contraindicated in patients on opioid therapy due to precipitation of opioid withdrawal
please use with caution with those in hepatic dysfunction

Question 8

How many days opiod free must a patient be to start Naltrexone?

Answer 8

; a patient must be opioid-free for ≥7 days prior to naltrexone initiation.

Question 9

if your patient has alcohol use disorder and they have hepatic impairment, what would be your first line pharmacological treatment?

Answer 9

Acamprosate instead of Naltrexone, as Acamprostate is renally excreted

Its more effective when combined with psychosocial therapy, however if the patients goal is alcohol abstinence this is also more effective

Question 10

What drug would you prescribe your patient who is looking for alcohol reduction vs. alcohol abstinence?

Answer 10

reduction = Naltrexone

Abstinence= acamprostate

Question 11

What are second line options to treat Alcohol use disorder?

Answer 11

1. Disulfiramin, it creates a reaction like nausea, flushing, vertigo, and rarely death. Its an aversive therapy, that makes the patient fear drinking due to its unpleasant reaction. Contraindicated in hepatotoxicity
2. Anticonvulsants, Topiramate, Gabapentin. Reduces cravings and helps with withdrawl. May cause cognitive dysfunction

Question 12

What are all the drugs used to treat alcohol use disorder?

Answer 12

1. Naltrexone
2. Acamprosate
3. Disulfiram
4. Anticonvulants like topiramate, gababentin

Question 13

What medication do you give all patients going through alcohol withdrawl?

Answer 13

All patients should receive Thiamine B1 to prevent/treat Wernicke-Korsakoff syndrome

daily during their withdrawl

Question 14

What class of medications can be used during alcohol withdrawl?

Answer 14

Benzodiaxepines

Question 15

If a patient has been taking lorazepam 2mg several times daily, what could you do to help them taper?

Answer 15

switch them over to a long-half life benzo such as diazepam or clonazepam

Question 16

When do withdrawl symptoms from benzos occur when you abruptly stop, and what are they?

Answer 16

If its a short life benzo the symptoms will start after 2 days
if its long acting it can be 5-10 days

symptoms include HTN, tachycardia, hyperreflexia, seizures

Question 17

How does the COWS scale work?

Answer 17

COWS scale is used to determine a patients opiod withdrawl score

5-12 = mild
13-24= moderate
36 + = severe

Question 18

what is the most effective treatment for opiod use disorder?

Answer 18

The most effective treatment for opioid use disorder continues to be maintenance therapy with a long-acting agonist like methadone or the partial agonist buprenorphine

Question 19

How would you treat a patient with mild opiod use disorder?

Answer 19

Taper and discontinue the opiod while starting psychosocial support

To taper, lower the drug 5-10% every 2-4 weeks

Question 20

How would you treat a patient with moderate-severe opiod use disorder?

Answer 20

Initiate pharmacotherapy- maintenance therapy with opioid agonist

Concurrently begin outpatient/inpatient psychosocial treatment

Question 21

what are the two maintenance therapies for moderate-severe opioid use disorder?

Answer 21

First line: Buprenorphine/nalaxone
second line: Methadone

Question 22

How long do patients with opioid disorders stay on maintenance treatment?

Answer 22

often at least 12 months, and starting patient at a higher dose is associated with better outcomes

Question 23

What information would be included in an opioid use contract with a patient?

Answer 23

1. Agree not to see out other prescribers
2. Agree to do urine drug screen at each visit
3. Educate on symptoms of overdose
4. Only use one pharmacy, dispense daily,weekly
5. No refills

Question 24

what is the standard of care for opioid use disorder during pregnancy?

Answer 24

Maintenance therapy

ideally Buprenorphine without nalaxone

Question 25

What is neonatal Abstinence Syndrome and how do we treat it?

Answer 25

NAS is neonatal withdraw from maternal opiod use, symptoms usually present 48-72 hours after birth or 4-14 days if on methadone

Question 26

How can you assess for neonatal abstinence syndrome?

Answer 26

Use the finnegan score ever y2 hours

Question 27

What is the first line treatment for Neonatal Abstience syndrome?

Answer 27

Nonpharmacologic treatment is the standard of care for babies with NAS,

and includes swaddling, holding, gentle rocking, pacifier use, frequent small feeds with hypercaloric formula, frequent diaper changes with barrier ointment, and most importantly an environment that is quiet, has low light and white noise.

Question 28

how do you determine if a patient is in opiod withdrawl? and if they are in withdrawl what do you do?

Answer 28

You use the COWS scale to determine the severity of the withdrawal, but typically you will continue their maintenance therapy

(methadone or buprenorphine)

Clonidine can also be used

Question 29

What tools can you use to determine if a patient is in :

alcohol withdrawl
Opioid withdrawl

Answer 29

CIWA-ar is used for alcohol withdrawl
COWS is used for opiod withdrawl

Question 30

true or false opiod Detoxification in pregnancy should be avoided due to risk of spontaneous abortion.

Answer 30

true

Question 31

What are the symptoms of Alcohol Withdrawl?

Answer 31

Autonomic hyperactivity, e.g., sweating or pulse rate greater than 100 bpm
Increased hand tremor
Insomnia
Nausea or vomiting
Transient visual, tactile, or auditory hallucinations or illusions
Psychomotor agitation
Anxiety
Generalized tonic-clonic seizures

Question 32

What are the symptoms of Opioid withdrawl

Answer 32

Dysphoric mood
Nausea or vomiting
Muscle aches
Lacrimation or rhinorrhea
Pupillary dilation, piloerection or sweating
Diarrhea
Yawning
Fever
Insomnia

Question 33

List the medications used to treat Opioid withdrawl

Answer 33

Methadone
Buprenophine/naloxone
Clonidine

Question 34

List the medications used in in maitenance therapy for Opioid use disorder

Answer 34

Methadone
Buprenophine/Naloxone
Naltrexone