Substance Abuse Flashcards by Kol Giessel

mild sxs of alcohol abstinence syndrome

can manage at home, don’t need hospitalization

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

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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

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onset of severe sxs from alcohol abstinence syndrome

12-72 hours after last drink

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What are “Delirium Tremens”

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

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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

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What kind of things are you assessing on CIWA?

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

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Drugs to treat acute alcohol withdrawal (3)?

Benzodiazapine
Blood Pressure MEds
Anti-epileptic

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drug of choice for treating alcohol withdrawal?

Benzodiazapine

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How does Benzodiazapine work?

calm CNS by working on GABA

- CNS depression

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Benefits of benzodiazapine

prevent seizure/DT’s
reduce sxs
stabilize VS

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Brand names of benzodiazpines?

Lorazepam: long acting

Librium

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

beta blockers:
Atenolol
Propanolol

alpha agonist:
Clonidine

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Do you use BP meds alone to treat alcohol withdrawal?

no, used as an adjunct

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

decrease:

BP, HR, cravings

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

PRN

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

decrease autonomic aspects of withdrawal sxs

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2 drugs to maintain abstinence from Alcohol?

Disulfiram (antabuse)

2. Naltrexone (Revia)

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how does antabuse work to maintain abstinence?

disrupts way alcohol is metabolized

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

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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

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

-up to 2 weeks after last dose

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sxs if use alcohol with Disulfram

N/V
Flushing
Palpitations
Sweating
Thirst
headache
Blurred Vision
Hypotension

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Patient education for Disulfram

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

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How does Naltrexone work with alcohol abuse management?

Pur opioid agonist

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

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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)

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

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