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Psych/Sub abuse/Alcohol Therapeutics > Sub Abuse > Flashcards

Sub Abuse Flashcards

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1
Q

Risk factors for SUDs

A

-dysfunctional childhood
-abuse
-ADHD
-school problems
-conduct disorder
-early onset of sub use (esp before age 14)
-genetics

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2
Q

Hair testing

A

-7 days-3 months (longest detection)
-need 150 strands
-observed

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3
Q

Urine testing

A

-1-30 days depending on drug
-pt can alter sample so Cr normalize

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4
Q

Blood/saliva testing

A

-0-3 days unless long half life
-observed (pt can’t alter)

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5
Q

Chlorazepate metabolites

A

nordiazepam, oxazepam

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6
Q

Chlordiazepoxide metabolites

A

nordiazepam, oxazepam

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7
Q

Diazepam metabolites

A

nordiazepam, oxazepam, temazepam

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8
Q

Nordiazepam metabolites

A

oxazepam

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9
Q

Temazepam metabolites

A

oxazepam

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10
Q

Buprenorphine metabolites

A

norbuprenorphine

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11
Q

Codeine metabolites

A

morphine, norhydrocodone, hydrocodone, hydromorphone

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12
Q

Fentanyl metabolites

A

norfentanyl

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13
Q

heroin metabolites

A

6-acetylmorphine, morphine

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14
Q

hydrocodone metabolites

A

norhydrocodone, hydromorphone

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15
Q

methadone metabolites

A

EDDP

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16
Q

morphine metabolites

A

hydromorphone

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17
Q

oxycodone metabolites

A

oxymorphone, noroxycodone

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18
Q

Benzodiazepines

A

-fast onset
-inhibit GABA
-effect: dec BP, memory impairment, drowsiness, confusion, anterograde amnesia, etc.
-OD: supportive, flumazenil 0.2 mg/min

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19
Q

Flumazenil

A

-used for benzo overdose
-CI: tricyclic seizure or dependent patients
-AE: n/v, benzo withdrawal symptoms

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20
Q

Barbiturates

A

-withdrawal can be life threatening
-taper, change to long acting barb (phenobarbital)

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21
Q

GHB

A

-used for its amnesia effects
-homemade xyrex (CIII)
-treatment of cataplexy and daytime sleepiness in narcoleptics
-withdrawals: agitation, mental changes, elevated BP/HR, tachycardia
-Toxicity: coma, seizures, res. depression, vomiting

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22
Q

Opiates

A

-inhibits pain pathwyas
-Heroin, Morphine, Codeine, Hydrocodone, Hydromorphone, Fentanyl, Oxycodone, Tramadol, Tapentadol, Meperidine
-Effects: euphoria, constipation, sedation
-Withdrawal: restless legs, insomnia, lacrimation

23
Q

Opioid OD

A

-Naloxone 0.4-2 mg q 2-3 min
-1 nasal spray, alternate nostrils
-displaces narcotics

24
Q

Opiate withdrawal

A

methadone, buprenorphine, clonidine, lofexidine

25
Q

Opiate maintenance

A

Methadone, buprenorphine

26
Q

Opiate abstinence

A

Naltrexone

27
Q

Methadone

A

-Major CYP3A4 substrate
-QTc prolongation
-1/2 of each dose remains in the body & is added to the next dose; inc levels without inc dose, so start low go slow.

28
Q

Methadone detox

A

20-80 mg, taper by 5-10 mg daily

29
Q

Methadone maintenance

A

suppress s/s of withdrawal, stop cravings, block reinforcing effects of illicit drugs

30
Q

Buprenorphine

A

-substrate of CYP3A4
-active met: norbup
-need to be in withdrawal before taking

31
Q

Bup induction

A

find minimum dose at which pt d/c or diminishes use of opiates, experiences no withdrawal, minimal or no SE and no cravings

32
Q

Bup stabilization

A

no withdrawal, min to no SE, no cravings

33
Q

Bup maintenance

A

may be indefinite, attention to psychosocial issues, seen/toxed monthly

34
Q

Bup dosing

A

-Subutex (just bup)
-Saboxone (bup/naloxone)
-Zubsolv (bup/naloxone)
-Sublocade (300 mg or 100 mg SQ given monthly)

35
Q

Sublocade

A

-injectable (reduce abuse)
-monthly dose
-BBW: don’t admin IV or Im (serious harm)
-REMs program
-Patient needs to be on >/= 8 mg of bup before starting

36
Q

Clonidine

A

AE: drowsiness, dizziness, dry mouth, HA

37
Q

Lofexidine

A

AE: orthostatic hypotension, bradycardia, hypotension, insomnia, dizziness, drowsiness

38
Q

Withdrawal symptom management

A

-pain: NSAIDs, APAP, muscle relaxants, neuropathic agents (not controls)
-N/V: reglan, zofran
-D: anti-diarrheal drugs
-Anxiety/sleep: insomnia meds, muscle relaxants, hydroxyzine

39
Q

Naltrexone

A

-abstinence maintenance: 25 mg qd for 1 week, then 50 mg/d
-must be opiate free for 7-10 days
-AE: GI upset, withdrawal
-BBW: acute hepatitis, hepatocellular injury
-Injection: 380 mg IM every 4 weeks or 1 month

40
Q

Vivitrol (Naltrexone XR)

A

opiate free for 7 days

41
Q

Dextromethrophan

A

-DM antitussive
-at high doses similar to PCP or ketamine
-Robotripping

42
Q

Cocaine

A

-substrate of CYP3A4 and inhibits 2D6
-OD: supportive, lorazepam, halodol, anti arrhythmic agents prn for cardiovascular complications
-metabolites: ecgonine methyl ester, benzoylecogoine, cocaethyline

43
Q

Cocaine withdrawal

A

Bromocriptine 2.5 mg tid
-used for parkinsons and hyperprolactinemia

44
Q

Amphetamine

A

OD: supportive, haldol, lorazepam

45
Q

Ecstacy MDMA

A

-derivative of amphetamine

46
Q

PCP

A

effect: euphoria, delusion, hostility, hallucinations

47
Q

LSD

A

OD: lorazepam, haldol

48
Q

Weed

A

releases dopamine

49
Q

Weed

A

-releases dopamine
-synthetic cannabinoids: THC, CBD, CBN (herbal products) - effects more pronounced than seen with weed use

50
Q

Krokodil

A

-derived from cocaine (impure, highly contaminated)
-contains gasoline and lighter fluid
-iodine, HCl, red phosphorus
-causes ulcers, skin necrosis, infection

51
Q

Krokodil

A

-derived from cocaine (impure, highly contaminated)
-contains gasoline and lighter fluid
-iodine, HCl, red phosphorus
-causes ulcers, skin necrosis, infection

52
Q

Bath salts

A

-cathinones
-analog of naturally occuring substance
-death cause: arrhythmias, hyperthermina, intracerebral hemorrhage
-Treat: IV benzos, sedation, fluids

53
Q

Kratom

A

-13x more potent than morphine
-Mitragyna speciosa korth: tree in Asia and Africa
-stimulant effects at low doses: altertness, physical activity, talkativeness, social
-opiate effects at higher does plus sedation and euphoria

54
Q

Pregnancy/lactaton

A

-Subutex over Suboxone
-Methadone

Psych/Sub abuse/Alcohol Therapeutics (5 decks)

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