Substance Abuse Flashcards
mild sxs of alcohol abstinence syndrome
- can manage at home, don’t need hospitalization
- disrupted sleep, weakness, nausea, anxiety, mild tremors
severe sxs of EARLY alcohol abstinence syndrome
how long can it last?
-hospitalized
early sxs: cramping, vomiting, hallucinations, tonic-clonic seizures
can last for 5-7 days: tremors, increase HR, increase BP
onset of severe sxs from alcohol abstinence syndrome
12-72 hours after last drink
What are “Delirium Tremens”
DT
severe form of alcohol withdrawal
-hallucination, CV collapse, death, incontinence, tonic clonic seizure
What is CIWA? Why do I care about it?
Clinical Alcohol Withdrawal Assessment
- used to assess patients withdrawal status
- score indicates med to be given and dose
What kind of things are you assessing on CIWA?
-pulse increase, HR increase, N/v, tremors, sweats, hallucinations (multi-sensory)
Drugs to treat acute alcohol withdrawal (3)?
- Benzodiazapine
- Blood Pressure MEds
- Anti-epileptic
drug of choice for treating alcohol withdrawal?
Benzodiazapine
How does Benzodiazapine work?
- calm CNS by working on GABA
- CNS depression
Benefits of benzodiazapine
- prevent seizure/DT’s
- reduce sxs
- stabilize VS
Brand names of benzodiazpines?
Lorazepam: long acting
Librium
which blood pressure meds are used to treat alcohol withdrawal syndrome?
beta blockers:
Atenolol
Propanolol
alpha agonist:
Clonidine
Do you use BP meds alone to treat alcohol withdrawal?
no, used as an adjunct
Benefits of BP meds like Atenolol an Propanolol to treat alcohol withdrawal syndrome?
decrease:
BP, HR, cravings
How are BP meds like Atenolol and Propanolol ordered to treat alcohol withdrawal syndrome?
PRN
How do BP meds like Atenolol, Propanolol, Clonidine work to treat alcohol withdrawal syndrome work?
decrease autonomic aspects of withdrawal sxs
2 drugs to maintain abstinence from Alcohol?
- Disulfiram (antabuse)
2. Naltrexone (Revia)
how does antabuse work to maintain abstinence?
disrupts way alcohol is metabolized
- -> leads to accumulation of ACETYLALDEHYDE
- —-> gives pt unpleasant effects with alcohol use
how long do sxs last after taking alcohol with Disulfram? How much alcohol can trigger reaction?
- last 30 min - several hours
- sxs can occur with as little as 7 mL
How long do effects of Disulfram last after stop taking it?
-up to 2 weeks after last dose
sxs if use alcohol with Disulfram
- N/V
- Flushing
- Palpitations
- Sweating
- Thirst
- headache
- Blurred Vision
- Hypotension
Patient education for Disulfram
watch for alcohol in sauces, syrups, skin lotion/linaments
How does Naltrexone work with alcohol abuse management?
Pur opioid agonist
-blockade of DOPAMINE that happens SECONDARY to blockade of opioid receptors
benefits of naltrexone for treating alcohol withdrawal?
- decrease cravings
- blocks pleasure effects
side effects of naltrexone?
nausea in 10% of people
Route for naltrexone for alcohol abuse?
-oral daily dose
OR
-IM depot once monthly
what age group does Naltrexone work best in?
younger populations
Sxs of nicotine withdrawal?
you know these- a jittery mean person who can’t sleep and can’t focus
Onset of nitoctine withdrawal sxs ?
w/in 24 hours
duration of nicotine withdrawal sxs?
weeks-months
Options for smoking cessation aids?
nicotine
non nicotine:
-varenicline (chantix)
-buproprion (Zyban)
most effective therapy for stopping smoking?
Chantix
or
Patch + short acting nicotine like nasal/ gum
Considerations for nicotine patch?
- comes in 12 hour or 24 hour
- non hairy area
- change site daily, rotate location
Condiserations for nicotine gum?
-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
fast acting nicotine replacement agents?
lozenge and nasal spray
How is buproprion dosed? what is used for normally?
- antidepressant
- use lower dose for anti smoking then antidepressant
Benefits of Buproprion (zyban)(Buproban)
decrease:
urge to smoke
withdrawl sxs
appetite
How does Buproprion (zyban)(Buproban) work?
- causes CNS stimulation
- similar to amphetamine
Side effects of Buproprion ?
dry mouth, insomnia, weight loss
How does Varenicline (Chantix work)
non nicotine
-partial agonist @ nicotine receptors
Side effects of varenicline?
nausea, sleep disturbance (bad dreams), headache
serious:
- neuropsychiatric effect (suicide risk)
- cardiovascular effects (angina, HTN, MI)
When does opioid withdrawal sxs start?
starts 10 hours after last dose
Early, Middle, and Late stage sxs of opioid withdrawal?
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
when do opioid withdrawal sxs peak and how long can it take to comepletely withdraw?
72 hours, 7-10 days to withdraw
can you die from opioid withdrawal? what about alcohol?
opioid = no alcohol = yes
3 classes of drugs to manage opioid addition long term:
Agonist: Methadone
Agonist/Antagonist: Buprenorphine (suboxone)
Antagonist: Naltrexone (Re Via)
2 uses for methadone (opioid agonist)
- suppresive therapy : use as opioid substitution over 10 days to prevent withdrawal sxs
- maintenance (most common) :
- slowly increase dose to increase euphoria tolerance
- prevent high from other drugs like street drugs
side effects of methadone?
- constipation
- miosis
Who can administer/prescribe methadone?
- has to be delivered by approved treatment program
- most go to clinical DAILY to take pill
How does Buprenorphine (opioid agonist/antagonist) work?
- partial agonist @ Mu
- full antagonist @ KAppa
*opposite of pain medicine
Why would you want to use burprenorphine?
- 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
Suboxone is a combo of what 2 drugs?
buprenorphine + naloxone
Why do you want to use suboxone?
discourages drug abuse : naloxone is antagonist to euphoria from street drugs
-maintenance or facilitate detox
Who can write an Rx for suboxone?
- provider has 8 hours of training to write RX
- limited # of Rx can write
How does naltrexone (opioid agonist) work?
- blocks euphoria
- prevents opioid use
When do you use naltrexone?
after detox
Who can write rx for naltrexone?
all provders b/c it is not a controlled substance
Routes for naltrexone?
oral or IM
