Quiznar 1 Flashcards
What is the initial dose for methadone for a patient with substance misuse issues?
Typically - 10-30mg daily, inc by max 5-10mg increments in 1 day/max 30mg inc over a week.
In exceptional cases 40mg daily.
Patient overdoses on opioid. What is the emergency treatment and what needs to be monitored following?
Tx with naloxone
Monitoring parameters - respiratory rate, spO2, pulse, BP + consciousness levels
(Respiratory depression therefore unconsciousness big thing with opioid overdose)
What are the risk factors for QT prolongation?
- females
- over 65yrs
- cardiac history
- recently converted back to sinus rhythm after period of AF
- impaired kidney or liver function
- certain drugs!!
Which drugs can cause QT prolongation?
- methadone over 100mg dose (moderate effect)
- other SSRIs to a small extent but citalopram to a large extent
- anti psychotics (quetiapine, pimozide, sertindole) have a high effect
What are physical signs of opioid withdrawal?
- tachycardia
- diarrhoea
- hypertension
- pupil dilation
- rhinorrhoea
Why is methadone used for opioid withdrawal therapy?
Methadone has a long duration of action/ long half life
What is buprenorphines MoA in opioid misuse management?
Partial agonist for Mu receptor
(Note that most other opioids are full agonists)
What happens to receptors in alcohol use disorder?
- GABA receptors are downregulated
- NMDA receptors increase because of chronic alc consumption
How are NDMA receptors inhibited/blocked?
- Acamprosate blocks and NMDA receptors
- Acute ingestion of ethanol inhibits the activity of NMDA receptors
What is alcohol?
An anti-convulsant with diuretic effects
Which conditions are associated with chronic alcohol abuse?
Wernickes encephalopathy - caused by thiamine deficiency due to inc alc
Hepatic encephalopathy - caused by liver cirrhosis / build up of toxins that can’t be excreted therefore cross blood-brain barrier causing similar sx as WE
What is the first tool used for identifying alcohol related problems?
1st - AUDIT-C to identify if someone is drinking harmfully/is dependent (three questions then do full AUDIT)
When would you give chlordiazopoxide?
When you’ve done the CIWA assessment (first AUDIT, then SADQ, then CIWA) if patient requires treatment.
Give long acting benzodiazepine
What is chlordiazepoxide used for?
It is a long acting benzodiazepine
Used to prevent complications of alcohol withdrawal for example seizures
What is haloperidol used for?
Delirium tremens
(1st line though is oral lorazepam)
Give examples of antiepileptics
Carbamazepine
Phenytoin
Why do seizures occur with alcohol withdrawal?
Imbalance between GABA and NMDA receptor activity
How is Wernickes encephalopathy treated?
Using IV pabrinex (which is high dose thiamine)
How does delirium tremens present?
- hallucinations which accompany tremors and agitation
What is the treatment for maintenance of abstinence for alcohol withdrawal?
1st line is acamprosate or naltrexone
2nd line disulfuram - pt has to choose themselves because of SE if pt drinks
When would you not give naltrexone for maintenance of alcohol abstinence?
If patient is already taking an opioid
Because naltrexone is an opioid receptor antagonist
