Substance Abuse Flashcards
Alcohol Abstinence Syndrome Onset
12-72 hours after last drink
Alcohol Abstinence Syndrome Mild SEs:
disturbed sleep, weakness, nausea, anxiety, mild tremors
Alcohol Abstinence Syndrome Severe SEs:
Can last 5-7 days
Early:
cramping, vomiting, hallucinations, increased HR & BP, tremors, tonic-clonic seizures
Delirium Tremens (DT): severe hallucinations, incontinence, & severe tonic-clonic seizures; can lead to cardiovascular collapse and death!
CIWA:
Clinical Institute Withdrawal Assessment:
Identifies stage and severity of ETOH withdrawal
Assessment includes:
-N/V
-HR and Pulse rate
-Tremors
-Paroxysmal sweats
-Hallucinations (tactile, auditory, & visual)
CIWA score dictates (3):
1) what drug is used
2) the dose needed
3) the need for continued assessments
Goal of ETOH Withdrawal Management
Minimize the S/S of withdrawal
-calm the CNS stimulation
Want drugs with a longer duration of action (lorazepam)
3 Drugs Identified for Management of Sxs (Treatment) of Alcohol Abstinence Syndrome:
1) Benzodiazepines
- Lorazepam (Ativan)
2) Anti-epileptic drugs
- Carbamazepine (Tegretol)
3) BP meds
- Atenolol, Propanolol, clonidine
Alcohol Abstinence Syndrome & Benzodiazepines
MOST EFFECTIVE DRUG for ETOH withdrawal
Benzodiazepines MOA:
CNS Depression; Calm CNS stimulation by working on GABA
-prevent seizures and Delirium Tremens (DT)
Alcohol Abstinence Syndrome & Anti-epileptic Drugs:
Carbamazepine (Tegretol) CNS Depression (same as benzos)
Alcohol Abstinence Syndrome & BP Meds
Atenolol, Propanolol
Used as an Adjunct (PRN) for Sx management
-Improve VS (decrease BP & HR)
-decreased ETOH cravings
Alcohol Abstinence Syndrome & Clonidine
Alpha-agonist BP med used for Sx management
Decrease autonomic aspects of withdrawal
Drugs for ETOH Abstinence:
1) Disulfiram (Antabuse)
2) Naltrexone (Re Via, Vivitrol)
Disulfiram (Antabuse)
Moderately effective for ETOH abstinence
Terrible Sx may occur if ETOH is consumed
Disulfiram (Antabuse) SEs:
If ETOH is consumed: N/V, flushing, palpitations, HA, diaphoresis, polydipsia, weakness, blurred vision, HYPOTENSION
Disulfiram (Antabuse) Patient Teaching:
Stays in system for up to 2 weeks;
AVOID ETOH and ETOH-containing products
(mouth wash, vanilla extract, lotions, colognes, etc.); 7 mLs of ETOH can cause a reaction
Naltrexone (Re Via, Vivitrol) & ETOH
STRONGLY effective for ETOH abstinence
Pure Opioid Antagonist
-Blocks dopamine release, blocking the pleasure from drinking
DECREASES CRAVINGS
Naltrexone (Re Via, Vivitrol) Administration & Considerations:
Dosing: single PO dose, or monthly depot IM injection
Works better in younger populations
Works best in conjunction with supportive therapy
Nicotine Withdrawal Onset & Duration:
onset within 24 hours
Can last for weeks/months
Nicotine Withdrawal S/S
Cravings, nervousness, restlessness, irritability, impatience, increased hostility, insomnia, impaired concentration, increased appetite, and weight gain
1st Line Agents for Nicotine Cessation:
Nicotine Type:
-patch, gum, lozenge, nasal spray, inhaler
Non-nicotine Type:
1) Varenicline (Chantix)
2) Bupropion SR (Zyban)
The 2 Best Methods for Nicotine Cessation Therapy:
1) Varenicline (Chantix) used alone
OR
2) Patch + short-acting nicotine product (gum, nasal spray, lozenge)
Nicotine Replacement Therapy:
Giving nicotine in small doses that are slowly decreased over time
- Less pleasure rec’d than with cigarettes
- Takes away the symptoms of withdrawal
Recommended combo therapy:
1) Patch
2) short-acting product (gum or nasal spray)
Nicotine Gum Special Considerations:
Dosing is dependent on their use from the time they wake up and use nicotine
Patient teaching:
-only use for 6 months
-only chew intermittently to control release of nicotine
Bupropion SR (Zyban) What is it? and SEs?
Atypical antidepressant (same as Welbutrin)
-structurally similar to amphetamines
SEs:
dry mouth, insomnia, weight loss
Bupropion SR (Zyban) & Nicotine Cessation
Lower doses are used for smoking cessation
REDUCES URGE TO SMOKE and decreases withdrawal Sxs
Varenicline (Chantix)
What is it? SEs?
Partial Agonist on nicotinic receptors SEs: Nausea, sleep disturbances, HA; Neuropsychiatric effects (suicide risk!) Cardiovascular effects (angina, HTN, MI)
Varenicline (Chantix) & Nicotine Cessation
MOST EFFECTIVE
-blocks activation of the nicotinic receptors that promote the release of dopamine
Opioid Withdrawal Onset & Duration:
~10 hours after the last dose
Can last 7-10 days
Opioid Withdrawal S/S:
Early: (10 hours after last dose)
Yawning, rhinorrhea, sweating
Anorexia, irritability, tremor, and ”gooseflesh”
At worse:
Violent sneezing, weakness, N/V/D, abdominal cramps, bone and muscle pain, muscle spasms, kicking movements
Is Opioid Withdrawal Dangerous?
NO; Unpleasant but not dangerous
Drugs for LT Management of Opioid Addiction:
1) Opioid Agonist
- Methadone
2) Opioid agonist-antagonist
- Buprenorphine (Suboxone)
3) Opioid Antagonist
- Naltrexone (Re Via, VIvitrol)
Opioid Agonist (Methadone) for Opioid Addiction
Used as “maintenance” for people not ready to come off of opioids completely
No opioid withdrawal or opioid-induced euphoria
Creates a high degree of tolerance;
taking a street drug can’t produce the desired effect (Less likely to seek them)
Once-a-day, low dosing (long half-life)
-Has to be delivered by an approved treatment program
Same patient teaching as with opioids
Buprenorphine (Suboxone) & Opioid Addiction:
Partial agonist (mu receptors); Full antagonist (kappa receptors)
- Suppress opioid cravings
- High doses can block opioid-induced euphoria
- Ceiling to resp. depression (safer than methadone*)
Can be sublingual and buccal
buprenorphine (Suboxone) + Naloxone
buprenorphine + naloxone
Mixed with naloxone to discourage IV drug abuse.
Naltrexone for Opioid Addiction
Pure Opioid Antagonist
Used AFTER detox (can cause withdrawal)
Blocks euphoria and Prevents opioid use
PO and IM (depot) formulations
