Substance Abuse Drugs

Question 1

Treatments available to reduce cravings in EtOH or benzo dependent patients =

Answer 1

• Acamprosate (GABA agonist)
• Benzos
• Naltrexone

Question 2

Drugs used to cause patients to avoid alcohol and how:

Answer 2

Disulfiram

This inhibits acetaldehyde dehydrogenase, and therefore makes patients become flushed, etc when they drink EtOH.

Question 3

Flumazenil =

Answer 3

Benzo antagonist used in benzo overdose

Question 4

Naltrexone vs Naloxone =

Answer 4

These are both opiate antagonists, but naltrexone is used for the longer term maintenance therapy of opiate dependency whereas naloxone is used in the acute emergency setting.

Question 5

Best management in acutely altered patient rolled into the ED:

Answer 5

• ABCs

- 50% dextrose + Naloxone + Thiamine

Question 6

Give IV flumazenil in acutely altered patient rolled into ED?

Answer 6

No, this can lower seizure threshold, which is not a good idea for a patient who we don’t really know what is going on.

Question 7

Role of clonidine in substance abuse treatment:

Answer 7

It can be used to limit the autonomic symptoms associated with opiate withdrawal, such as the elevated BP, HR, and increased agitation.