Substance Abuse

Question 1

Opioid Receptors

Answer 1

mu- major receptor involved in opioid pain relief & respiratory depressant effects
kappa- sedative actions
delta- multiple actions

Question 2

Opioid withdrawal

Answer 2

<8 hours- anxiety, craving
8-24- anxiety, insomnia, GI disturbance, Rhinorrhea, Mydriasis, Diaphoresis
1-7 days- HTN, Tachy, GI N/V/D, fever/chills, tremors, muscle spasms, seizures

Question 3

Methadone

Answer 3

Synthetic opioid.

Used: analgesia, withdrawal from other opioids

Question 4

Naloxone

Answer 4

Narcan
Effects within seconds, short duration of action.
SE: increased BP, precipitation of WD, irritability, anxiety, seizure, N/V/D, pulmonary edema.

Question 5

Naltrexone

Answer 5

Injection-Vivitrol long acting (monthly)

Similar to naloxone, longer duration. Blocks effects of heroin for up to 48 hours.

Question 6

Buprenorphine

Answer 6

Buprenex, Subutex
Partial agonist at mu receptors.
Less sedation, rest depression & CV effects

Question 7

Suboxone

Answer 7

Buprenorphine/Nalaxone

SL strip

Question 8

Clonidine

Answer 8

Catapress.
Alpha 2 adrenergic agonist. Activated inhibitory neurons, decreased sympathetic outflow = decreased peripheral resistance; renal vascular resistance, HR, BP.
Unlabeled use: Heroin or nicotine WD, severe pain. ADD/ADHD
AE: HypoTN, Drowsiness, dizziness, xerostomia, HA

Question 9

Pentazocine

Answer 9

Talwin

Agonist/Antagonist: Some antagonist activity of Mu receptors. Less euphoria than morphine

Question 10

Pentazocine/Naloxone

Answer 10

Talwin Nx.

Abuse deterrent

Question 11

Tx of Alcohol Abuse

Answer 11

BZD for acute WD.
Naltrexone- decrease reinforcing effects of EtOH
Disulfram- Discourage use

Question 12

Acute EtOH WD

Answer 12

Chlordiazepoxide (Librium)
Lorazepam (Ativan)
Seizures- Emergency
IV BZD- Diazepam (Valium) ro Lorazepam (Ativan)
IV Mg Sulfate, IV/IM Thiamine
DTs- IV BZD

Question 13

Disulfram

Answer 13

Antabuse

Blocks oxidation of acetaldehyde to acetic acid. Accumulation = flushing, tacky, hyperventilation, N/V

Question 14

Acomprosate

Answer 14

Campral
Restores balance of GABA/glutamate activities.
Decreased alcohol intake

Question 15

Topiramate

Answer 15

Topamax

Seems to reduce cravings

Question 16

Smoking cessation Tx

Answer 16

Nicotine replacement
Buproprion:
MC AEs- insomnia, dry mouth, increased BP
Varenicline (Chantix)- Blocks nicotine binding to receptors.
MC AEs: N, HA, sleep disturbance. BBW possible suicidal ideations