Module 5 tobacco, alcohol, benzo

Question 1

tobacco use disorder

Answer 1

most common use disorder

Question 2

tobacco withdrawal s/s

Answer 2

anxiety
anger
irritability
depression
dec. concentration

Question 3

tobacco non-pharmacologic therapy

Answer 3

counseling

hypnosis

Question 4

tobacco pharmacologic therapy

Answer 4

over the counter: 
- nicotine patches
- lozenges
- gum
- inhalers
Rx: 
- bupriopion 
- varenicline

Question 5

bupriopion MOA

Answer 5

tobacco withdrawal med

inhibits neuronal uptake of norepi and dopamine

Question 6

bupriopion AE

Answer 6

Black Box: 
- suicidality
- neuropsychiatric: 
-- behavior change
-- hostility
-- aggression 
-- depression 
Nausea
constipation/diarrhea
diaphoresis
inc. HR

Question 7

bupriopion precaution

Answer 7

preg: may cause congenital heart defects

Question 8

bupriopion administration

Answer 8

7-12 weeks

Question 9

varenicline MOA

Answer 9

tobacco cessation

agonizes and block a4, B2 nicotinic AcH receptors

Question 10

varenicline AE

Answer 10

depression 
suicidality
 N/V
fatigue/malaise
sleep disturbance

Question 11

varenicline precaution

Answer 11

preg: low fetal weight in animals

Question 12

varenicline administration

Answer 12

11 weeks

Question 13

alcohol use disorder

Answer 13

ETOH modulates the major inhibitory neurotransmitter (GABA) and major excitatory neurotransmitter (NDMA)
-> dec. anxiety, inc. sedation and CNS depression

Question 14

Alcohol withdrawal s/s

Answer 14

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

Question 15

alcohol withdrawal tx nonpharmacologic

Answer 15

support groups

substance use counseling

Question 16

alcohol withdrawal tx pharmacologic

Answer 16

benzodiazepines

Question 17

alcohol maintenance tx pharmacologic

Answer 17

naltrexone
disulfiram
acamprosal

Question 18

naltrexone MOA

Answer 18

alcohol maintenance
ETOH releases opioids in brain
- competitive opioid antagonist
- blocks mu receptor -> prevents high

Question 19

naltrexone use

Answer 19

1st line therapy for alcohol use disorder: moderate - severe

Question 20

naltrexone AE

Answer 20

nausea
HA
dizzy 
fatigue 
inc. liver enzymes

Question 21

naltrexone administration

Answer 21

IM: lasts 4 weeks

oral

Question 22

naltrexone precautions

Answer 22

preg: teratogenicity, fetal death in animals

Question 23

naltrexone education

Answer 23

does not alleviate cravings or withdrawal s/s

Question 24

disulfiram MOA

Answer 24

alcohol use disorder
inhibits aldehyde dehydrogenase metabolism of acetaldehyde
-> flushing, inc. HR, hyperventilation, nausea
- s/s last 30 min to hours

Question 25

disulfiram AE

Answer 25

BB: never give if intoxicated
hepatitis
peripheral neuropathy
optic neuritis
psychotic disorder
metallic or garlic after taste
dermatitis

Question 26

disulfiram caution

Answer 26

preg: fetal toxicity in animals

Question 27

acamprosate MOA

Answer 27

alcohol use disorder
stimulates inhibitory GABA neurotransmission in brain
- antagonizes glutamate effects

Question 28

acamprosate AE

Answer 28

depression 
suicidality
anxiety
diarrhea
nausea
diaphroesis
insomnia
pain

Question 29

acamprosate contraindications

Answer 29

cardiomyopathy
HF
arterial/venous thrombus
shock 
anxiety/depression
suicidal ideation 
pregnancy

Question 30

benzodiazepines use

Answer 30

have high risk physical and psychological dependence

- only used short term for alcohol withdrawal or significant anxiety

Question 31

commonly used benzodiazepines

Answer 31

alprazolam 
clonazepam
diazepam
lorazepam
temezapam

Question 32

benzodiazepine withdrawal most severe vs less severe

Answer 32

usually begins within 12 hours of discontinuation

• alprazolam: rapidly eliminated, worse s/s
• diazepam, clonazapam: slowly eliminated, less severe s/s

Question 33

benzodiazepine withdrawal s/s

Answer 33

anxiety
confusion
insomnia
irritability
nausea
vomiting
seizures

Question 34

benzodiazepine withdrawal tx

Answer 34

• long acting benzos tapered down over 10 weeks

- buspirinone