Module 5 tobacco, alcohol, benzo Flashcards
tobacco use disorder
most common use disorder
tobacco withdrawal s/s
anxiety anger irritability depression dec. concentration
tobacco non-pharmacologic therapy
counseling
hypnosis
tobacco pharmacologic therapy
over the counter: - nicotine patches - lozenges - gum - inhalers Rx: - bupriopion - varenicline
bupriopion MOA
tobacco withdrawal med
inhibits neuronal uptake of norepi and dopamine
bupriopion AE
Black Box: - suicidality - neuropsychiatric: -- behavior change -- hostility -- aggression -- depression Nausea constipation/diarrhea diaphoresis inc. HR
bupriopion precaution
preg: may cause congenital heart defects
bupriopion administration
7-12 weeks
varenicline MOA
tobacco cessation
agonizes and block a4, B2 nicotinic AcH receptors
varenicline AE
depression suicidality N/V fatigue/malaise sleep disturbance
varenicline precaution
preg: low fetal weight in animals
varenicline administration
11 weeks
alcohol use disorder
ETOH modulates the major inhibitory neurotransmitter (GABA) and major excitatory neurotransmitter (NDMA)
-> dec. anxiety, inc. sedation and CNS depression
Alcohol withdrawal s/s
neuron excitation can occur within 12-48 hours of stopping agitation anxiety termors N/V weakness diaphoresis hallucinations confusion delirium inc. HR HTN fever tonic-clonic seizures
alcohol withdrawal tx nonpharmacologic
support groups
substance use counseling
alcohol withdrawal tx pharmacologic
benzodiazepines
alcohol maintenance tx pharmacologic
naltrexone
disulfiram
acamprosal
naltrexone MOA
alcohol maintenance
ETOH releases opioids in brain
- competitive opioid antagonist
- blocks mu receptor -> prevents high
naltrexone use
1st line therapy for alcohol use disorder: moderate - severe
naltrexone AE
nausea HA dizzy fatigue inc. liver enzymes
naltrexone administration
IM: lasts 4 weeks
oral
naltrexone precautions
preg: teratogenicity, fetal death in animals
naltrexone education
does not alleviate cravings or withdrawal s/s
disulfiram MOA
alcohol use disorder
inhibits aldehyde dehydrogenase metabolism of acetaldehyde
-> flushing, inc. HR, hyperventilation, nausea
- s/s last 30 min to hours
disulfiram AE
BB: never give if intoxicated hepatitis peripheral neuropathy optic neuritis psychotic disorder metallic or garlic after taste dermatitis
disulfiram caution
preg: fetal toxicity in animals
acamprosate MOA
alcohol use disorder
stimulates inhibitory GABA neurotransmission in brain
- antagonizes glutamate effects
acamprosate AE
depression suicidality anxiety diarrhea nausea diaphroesis insomnia pain
acamprosate contraindications
cardiomyopathy HF arterial/venous thrombus shock anxiety/depression suicidal ideation pregnancy
benzodiazepines use
have high risk physical and psychological dependence
- only used short term for alcohol withdrawal or significant anxiety
commonly used benzodiazepines
alprazolam clonazepam diazepam lorazepam temezapam
benzodiazepine withdrawal most severe vs less severe
usually begins within 12 hours of discontinuation
- alprazolam: rapidly eliminated, worse s/s
- diazepam, clonazapam: slowly eliminated, less severe s/s
benzodiazepine withdrawal s/s
anxiety confusion insomnia irritability nausea vomiting seizures
benzodiazepine withdrawal tx
- long acting benzos tapered down over 10 weeks
- buspirinone
