Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Therapeutics III > Ott Pharmacotherapy of Substance Use Disorders > Flashcards

Ott Pharmacotherapy of Substance Use Disorders Flashcards

1
Q

DSM-5 definition of substance use disorder

A

Two of the following is true in a 12-month period:
-Taken in larger amounts or over a longer period of time
-Persistent desire or unsuccessful efforts to cut down or control use
-Great deal of time spent in activities necessary to obtain substance or recover from use
-Craving, strong desire, or urge to use
-Recurrent use results in failure to fulfill major role obligations
-Continued use despite consistent or recurrent social or interpersonal problems caused or exacerbated by use or effects of use
-Important activities are given up or reduced
-Recurrent use in situations which it is physically hazardous
-Continued use despite knowledge of having persistent or recurrent physical or psychological problem related to use
-Tolerance (needing increased amounts to achieve effect or diminished effect with continued use of the same amount)
-Withdrawal (characteristic syndrome OR substance is used to relieve or avoid withdrawal symptoms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clinical presentation of people with a blood alcohol concentration of 80mg/dL or 0.08mg%

A

-Moderate impairment
-Legal definition of intoxication in most states

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Stage 1 alcohol withdrawal clinical features

A

-Onset ~6-8hrs
-Moderate autonomic hyperactivity
-Anxiety
-tachycardia
-Insomnia
-Nausea
-Vomiting
-Diaphoresis
-Craving for alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Stage 2 alcohol withdrawal clinical features

A

-Onset ~24hrs
-Autonomic hyperactivity with auditory or visual hallucinations lasting ~1-3 days - most remain lucid and oriented

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Stage 3 alcohol withdrawal clinical features

A

-Onset ~1-2 days
-~4% of those untreated develop grand mal seizures ~7-48 hours after drop in BAC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Stage 4 alcohol withdrawal clinical features

A

-Onset 96 hours
-Delirium tremens in ~5% of patients
-Confusion
-Illusions
-Hallucinations
-Agitation
-Tachycardia
-Hyperthermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What attributes to mortality in delirium tremens?

A

-~5-15% mortality rate
-Arrhythmias
-SHock
-Infection
-Trauma
-Aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Risk factors for delirium tremens

A

-Prior history of DTs (#1 predictor) (kindling - repeated withdrawal episodes increases the severity of subsequent withdrawal symptoms)
-Number of detoxifications
-Consuming the equivalent of 1 pint of whiskey per day for 10 of 14 days before admission
-Early symptoms of withdrawal
-Hepatic dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you treat alcohol withdrawal when there is no liver dysfunction?

A

-Diazepam/chlordiazepoxide
-Long half-life and decreased risk of breakthrough symptoms
-May also use lorazepam and oxazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you treat alcohol withdrawal when there is liver dysfunction

A

Lorazepam and oxazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the advantages of prophylaxis/fixed dosing when treating alcohol withdrawal?

A

Prevents withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the disadvantages of prophylaxis/fixed dosing when treating alcohol withdrawal?

A

Unnecessary BZD dosing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you treat alcohol withdrawal using individualized dosing?

A

Use CIWA-Ar Scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you treat alcohol withdrawal with a CIWA of less than 8-10?

A

Nonpharmacologic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you treat alcohol withdrawal with a CIWA of 8-15?

A

Medicate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do you treat alcohol withdrawal with a CIWA of over 15?

A

Risk of complications if untreated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Advantages of individualized dosing for the treatment of alcohol withdrawal

A

-Reduces treatment duration
-Decreased benzodiazepine dosing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are other commonly seen treatment options for alcohol withdrawal besides benzodiazepines?

A

-Thiamine
-Phenytoin - Not effective in treating withdrawal seizures, but many patients are on it anyway, possibly dc

19
Q

What causes Wernicke’s encephalopathy?

A

Thiamine deficiency

20
Q

Why should thiamine be given before dextrose-containing fluids?

A

Thiamine is a co-factor in glucose metabolism, Wernicke’s can be precipitated by high glucose loads

21
Q

What two drugs are used to treat alcohol use disorder?

A

-Disulfiram
-Acamprosate
-Naltrexone

22
Q

Acamprosate clinical pearls

A

-Renal elimination, monitor renal function, avoid in severe renal impairment
-Suicidality warning, side effects also include diarrhea, nausea, depression, anxiety

23
Q

Naltrexone clinical pearls

A

-Decreases binge drinking, helps to increase time between drinking days
-Elevated LFTs common, must monitor at baseline and routinely
-Need to evaluate pain management needs, patient should have wallet or card available to tell emergency providers that they are taking this
-Warning for injection site reactions

24
Q

Symptoms of opioid withdrawal

A

-Muscle aches/tension
-Agitation/anxiety/insomnia
-Abdominal cramping/nausea/vomiting
-Diarrhea
-Sweating/yawning/increased tearing/runny nose

25
How to treat muscle aches/tension associated with opioid withdrawal
Acetaminophen or NSAID
26
How to treat agitation/anxiety/insomnia associated with opioid withdrawal
Hydroxyzine/benzodiazepines
27
How to treat abdominal cramping/nausea/vomiting associated with opioid withdrawal
Ondansetron
28
How to treat diarrhea associated with opioid withdrawal
Loperamide
29
How to treat Sweating/yawning/increased tearing/runny nose associated with opioid withdrawal
Clonidine or lofexidine
30
Clonidine dosing
-0.3-0.6mg/day (mild withdrawal) -Up to 1.2mg/day (severe withdrawal) -Divided doses (0.1-0.2mg/dose given up to hourly)
31
Clonidine side effects
-Hypotension is the most common side effect -Less likely with lofexidine; lofexidine is more expensive
32
Lofexidine dosing
-0.18mg tablets -0.54mg (3 tablets) four times daily x 5-7 days -Maximum dose = 2.88mg/day (16 tablets) -No single dose > 0.72mg (4 tablets) -May continue for up to 14 days -Dosing adjustments in renal and hepatic impairment
33
Why are alpha-2 agonists used for opioid withdrawal symptoms?
Treating noradrenergic symptoms can serve as an entry to longer-term treatment with MOUD and psychosocial treatment
34
American society of addiction medicine guidance
-Patients should be offered all forms of MOUD where possible and available -Psychotherapy should be offered, but prescribing MOUD should not be contingent on the patient agreeing psychotherapy or other types of therapy -Pregnant women should be screened for OUD in prenatal care and offered either buprenorphine or methadone; limited data regarding use of naltrexone in pregnancy; if a pregnant woman is taking naltrexone, provide education about risks/benefits -Incarcerated people with OUD should be screened for OUD and offered treatment in the jail/prison setting; should NOT be required to switch medications if entering incarceration on medication; opioid withdrawal should be treated medically -Combination treatment with opioids and benzodiazepines is not recommended due to increased risk of fatal overdose
35
Maintenance treatment of opioid use disorders
-Methadone must be given in a licensed treatment program -Buprenorphine is usually given in combination with naloxone in a sublingual tablet or film strip dosage form; poor bioavailability when swallowed, must be sublingual
36
Methadone clinical pearls
-P450 2B6, 2C19, 3A4, 2D6 substrate - use with caution in patients also taking moderate to strong inhibitors or inducers -QTc prolongation is a serious concern - ECG monitoring is recommended
37
Buprenorphine clinical pearls
-Given with naloxone in the same dosage form to decrease misuse - naloxone is not absorbed through the GI tract, so no effect if taken sublingually; but if injected, will block opiate effect of buprenorphine -To avoid precipitating withdrawal, initiate therapy when there are clear signs of withdrawal; administer in divided doses on day 1 -Available in sublingual films and tablets, must be dosed sublingually due to lack of gastric absorption -3A4 substrate - monitor closely when used with 3A4 inducers or inhibitors -Monitor LFTs; use with serotonergic drugs may cause serotonin syndrome - monitor -Risk of respiratory depression in overdose is much less than opioids, including methadone, due to partial agonist effect
38
When can patients be started on buprenorphine extended-release injection?
Moderate-severe opioid use disorder, patients initiated on sublingual buprenorphine and dose adjustment for at least 7 days before first injection
39
Buprenorphine extended-release injection side effects
Monitor for use with serotonergic drugs - risk for serotonin syndrome
40
Considerations for methadone prescribing
-Clinical proof of efficacy -FDA-approved for use in pregnancy -Treatment program requires daily attendance unless patient graduates to "take-home bottles" -Must give urine samples and attend programming -Indiana Medicaid covers under medical billing -Stigma of program -Is there a program in the area? -Transportation?
41
Considerations for buprenorphine prescribing
-Effective treatment over short-term, long-term clinical trials lacking -Office-based, can get 30-day Rx -Less stigma than methadone -Less misuse potential over methadone -Indiana Medicaid covers -Removal of X-waiver prescribing requirement may increase access
42
Naltrexone long-acting injection clinical pearls
-Given same dose as that used for alcohol use disorder -Is the "abstinence" treatment, patients must be ready for this, discuss with patient about readiness to encourage adherence with ongoing dosing -Risk for overdose if patient discontinues treatment, must tell patient of this risk
43
When was naloxone approved for OTC spray
March 30, 2023
44
What is a common withdrawal symptom of cocaine?
Depression

Therapeutics III (42 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions