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Pharm 313 > Substance Abuse > Flashcards

Substance Abuse Flashcards

1
Q

mild sxs of alcohol abstinence syndrome

A
  • can manage at home, don’t need hospitalization

- disrupted sleep, weakness, nausea, anxiety, mild tremors

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2
Q

severe sxs of EARLY alcohol abstinence syndrome

how long can it last?

A

-hospitalized
early sxs: cramping, vomiting, hallucinations, tonic-clonic seizures
can last for 5-7 days: tremors, increase HR, increase BP

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3
Q

onset of severe sxs from alcohol abstinence syndrome

A

12-72 hours after last drink

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4
Q

What are “Delirium Tremens”

A

DT
severe form of alcohol withdrawal
-hallucination, CV collapse, death, incontinence, tonic clonic seizure

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5
Q

What is CIWA? Why do I care about it?

A

Clinical Alcohol Withdrawal Assessment

  • used to assess patients withdrawal status
  • score indicates med to be given and dose
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6
Q

What kind of things are you assessing on CIWA?

A

-pulse increase, HR increase, N/v, tremors, sweats, hallucinations (multi-sensory)

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7
Q

Drugs to treat acute alcohol withdrawal (3)?

A
  1. Benzodiazapine
  2. Blood Pressure MEds
  3. Anti-epileptic
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8
Q

drug of choice for treating alcohol withdrawal?

A

Benzodiazapine

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9
Q

How does Benzodiazapine work?

A
  • calm CNS by working on GABA

- CNS depression

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10
Q

Benefits of benzodiazapine

A
  • prevent seizure/DT’s
  • reduce sxs
  • stabilize VS
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11
Q

Brand names of benzodiazpines?

A

Lorazepam: long acting

Librium

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12
Q

which blood pressure meds are used to treat alcohol withdrawal syndrome?

A

beta blockers:
Atenolol
Propanolol

alpha agonist:
Clonidine

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13
Q

Do you use BP meds alone to treat alcohol withdrawal?

A

no, used as an adjunct

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14
Q

Benefits of BP meds like Atenolol an Propanolol to treat alcohol withdrawal syndrome?

A

decrease:

BP, HR, cravings

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15
Q

How are BP meds like Atenolol and Propanolol ordered to treat alcohol withdrawal syndrome?

A

PRN

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16
Q

How do BP meds like Atenolol, Propanolol, Clonidine work to treat alcohol withdrawal syndrome work?

A

decrease autonomic aspects of withdrawal sxs

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17
Q

2 drugs to maintain abstinence from Alcohol?

A
  1. Disulfiram (antabuse)

2. Naltrexone (Revia)

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18
Q

how does antabuse work to maintain abstinence?

A

disrupts way alcohol is metabolized

  • -> leads to accumulation of ACETYLALDEHYDE
  • —-> gives pt unpleasant effects with alcohol use
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19
Q

how long do sxs last after taking alcohol with Disulfram? How much alcohol can trigger reaction?

A
  • last 30 min - several hours

- sxs can occur with as little as 7 mL

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20
Q

How long do effects of Disulfram last after stop taking it?

A

-up to 2 weeks after last dose

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21
Q

sxs if use alcohol with Disulfram

A
  • N/V
  • Flushing
  • Palpitations
  • Sweating
  • Thirst
  • headache
  • Blurred Vision
  • Hypotension
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22
Q

Patient education for Disulfram

A

watch for alcohol in sauces, syrups, skin lotion/linaments

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23
Q

How does Naltrexone work with alcohol abuse management?

A

Pur opioid agonist

-blockade of DOPAMINE that happens SECONDARY to blockade of opioid receptors

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24
Q

benefits of naltrexone for treating alcohol withdrawal?

A
  • decrease cravings

- blocks pleasure effects

25
Q

side effects of naltrexone?

A

nausea in 10% of people

26
Q

Route for naltrexone for alcohol abuse?

A

-oral daily dose
OR
-IM depot once monthly

27
Q

what age group does Naltrexone work best in?

A

younger populations

28
Q

Sxs of nicotine withdrawal?

A

you know these- a jittery mean person who can’t sleep and can’t focus

29
Q

Onset of nitoctine withdrawal sxs ?

A

w/in 24 hours

30
Q

duration of nicotine withdrawal sxs?

A

weeks-months

31
Q

Options for smoking cessation aids?

A

nicotine
non nicotine:
-varenicline (chantix)
-buproprion (Zyban)

32
Q

most effective therapy for stopping smoking?

A

Chantix
or
Patch + short acting nicotine like nasal/ gum

33
Q

Considerations for nicotine patch?

A
  • comes in 12 hour or 24 hour
  • non hairy area
  • change site daily, rotate location
34
Q

Condiserations for nicotine gum?

A

-dosing dependent on amt of tobacco used w/in 30 min of waking up
-do not use longer then 6 mo
-every time chomp down get dose of nicotine
patient education: chomp down intermittntly

35
Q

fast acting nicotine replacement agents?

A

lozenge and nasal spray

36
Q

How is buproprion dosed? what is used for normally?

A
  • antidepressant

- use lower dose for anti smoking then antidepressant

37
Q

Benefits of Buproprion (zyban)(Buproban)

A

decrease:
urge to smoke
withdrawl sxs
appetite

38
Q

How does Buproprion (zyban)(Buproban) work?

A
  • causes CNS stimulation

- similar to amphetamine

39
Q

Side effects of Buproprion ?

A

dry mouth, insomnia, weight loss

40
Q

How does Varenicline (Chantix work)

A

non nicotine

-partial agonist @ nicotine receptors

41
Q

Side effects of varenicline?

A

nausea, sleep disturbance (bad dreams), headache

serious:

  • neuropsychiatric effect (suicide risk)
  • cardiovascular effects (angina, HTN, MI)
42
Q

When does opioid withdrawal sxs start?

A

starts 10 hours after last dose

43
Q

Early, Middle, and Late stage sxs of opioid withdrawal?

A

early: rest. n digest: yawning, rhinorrhea, sweating
middle: anorexia, irritability, tremor, goosflesh
at worst (72 hours sxs peak): violent sneezing, weakness, N/v, diarrhea, abd cramps, bone/muscle pain, muscle spasms, kicking movements

44
Q

when do opioid withdrawal sxs peak and how long can it take to comepletely withdraw?

A

72 hours, 7-10 days to withdraw

45
Q

can you die from opioid withdrawal? what about alcohol?

A 
opioid = no 
alcohol = yes
46
Q

3 classes of drugs to manage opioid addition long term:

A

Agonist: Methadone
Agonist/Antagonist: Buprenorphine (suboxone)
Antagonist: Naltrexone (Re Via)

47
Q

2 uses for methadone (opioid agonist)

A
  1. suppresive therapy : use as opioid substitution over 10 days to prevent withdrawal sxs
  2. maintenance (most common) :
    - slowly increase dose to increase euphoria tolerance
    - prevent high from other drugs like street drugs
48
Q

side effects of methadone?

A
  • constipation

- miosis

49
Q

Who can administer/prescribe methadone?

A
  • has to be delivered by approved treatment program

- most go to clinical DAILY to take pill

50
Q

How does Buprenorphine (opioid agonist/antagonist) work?

A
  • partial agonist @ Mu
  • full antagonist @ KAppa

*opposite of pain medicine

51
Q

Why would you want to use burprenorphine?

A
  • suppress cravings
  • high dose = block opioid euphoria
  • has ceiling for suppressing Resp. Depression = safer then methadone
  • take for 1st couple of days of withdrawal then switch to suboxone
52
Q

Suboxone is a combo of what 2 drugs?

A

buprenorphine + naloxone

53
Q

Why do you want to use suboxone?

A

discourages drug abuse : naloxone is antagonist to euphoria from street drugs
-maintenance or facilitate detox

54
Q

Who can write an Rx for suboxone?

A
  • provider has 8 hours of training to write RX

- limited # of Rx can write

55
Q

How does naltrexone (opioid agonist) work?

A
  • blocks euphoria

- prevents opioid use

56
Q

When do you use naltrexone?

A

after detox

57
Q

Who can write rx for naltrexone?

A

all provders b/c it is not a controlled substance

58
Q

Routes for naltrexone?

A

oral or IM

Pharm 313 (26 decks)

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