Ott Substance Use Disorder Flashcards
substance use criteria
two of the following in 12 months:
- larger amount /longer period than intended
- desire or no success trying to cut out
- lots time spent obtaining and recovering
- craving, desire, urge to use
- failure to fulfill major role obligations
- use despite it causing problems
- important activities given up/ reduced
- use when it is hazardous (driving)
- using while knowing you have a problem
- tolerance
- withdrawal sx
does a person with a SUD recover?
always recovering
what is the legal limit for alcohol in most states
80 mg/dL
0.08mg%
0.05% presentation
motor function impairment observable
0.08% presentation
moderate impairment
450 mg/dL presentation
respiratory depression
500 mg/dL presentation
LD 50 for alcohol
stage 4 of alcohol withdrawal time of onset
3-5 days
stage 4 of alcohol withdrawal clinical features
DTs in 5% of pts, confusion, hallucinations, illusions, agitation, tachycardia, hyperthermia
risk factor for DTs
prior DTs
number of detoxifications
early withdrawal sx
hepatic dysfunction
consuming 1 pint of whiskey for 10 of 14 days prior to admission
consuming what puts you at higher risk for DTs
equivalent of 1 pint of whiskey for 10 of 14 days leading up to admission
prophylaxis/fixed dosing advantage and disadvantage
advantage: prevent withdrawal
disadvantage: unnecessary benzo dosing
individualized dosing uses what
CIWA-Ar scale
when to use non-pharm
CIWA < 8
when to medicate
CIWA 8+
when do we have risk if we don’t treat
CIWA >15
benefits of individual dosing
reduce treatment duration
decreased benzo dosing
alcohol withdrawal treatmen
good liver: diazepam/chlordiazepoxide
bad liver: lorazepam/oxazepam
lorazepam use in alcohol withdrawl
PRN
what drug is recommended with alchol use
thiamine
which drug does not work for pts with seizures in alcohol disorder?
phenytoin
what is Wenicke’s encephalopathy a result of
thiamine deficiency
high glucose loads
when do we give thiamine?
before dextrose containing fluids
thiamaine is a cofactor in what
glucose metabolism
disulfiram
aversive therapy
unpleasant effects if used
highly motivated person
disulfiram reaction for how many days after discontinuation
14 days
disulfuram dosing
250 mg daily
acamprosate considerations
avoid in severe renal impairment
suicidality warning
acamprosate side effects
diarrhea
constipation
depression
anxiety
naltrexone does what
decreases binge drinking
increase time between drinking days
side effects with naltrexone
elevated LFTs
injection site reactions
what happens if you take opioids with naltrexone
opioids wont work
opioid withdrawl sx
like the flu
muscle aches
abdominal cramping
diarrhea
sweating
treatment of anxiety or agitation with withdrawal
hydroxizine
alpha 2 agonists used in opioid withdrawal sx
clonidine
lofexidine
clonidine side effect
hypotension
lofexidine benefit
less CV hypotension side effects
whats FDA approved for withdrawal FDA approved
lofexidine
pregnant recomendations for OUD
buprenorphine
methadone
what drug must be given in a licensed treatment program?
methadone
buprenorphine must be given how
sublingually with naloxone
methadone CYPs
2B6
3A4
2C19
2D6
qtc med
methadone
when to initiate buprenorphine
clear signs of withdrawal
divided doses on day 1
buprenorphine CYP
3A4 substrate
buprenorphine concern
LFTs
serotonin syndrome
buprenorphine injection can be given to who?
patients on sublingual for at least 7days prior to administration
abstinenece treatment of opioid use disorder
naltrexone
risk of overdose if they discontinue treatment
naltrexone
