Substance Dependence Flashcards
Without inpatient medical support, alcohol withdrawal in severely dependent patients can lead to what symptoms?
Seizures, delirium tremens, death.
How can moderate alcohol dependence often be treated?
In a community setting.
Which drugs are commonly used to reduce alcohol withdrawal symptoms?
Long-acting benzodiazepines. Carbamazepine (unlicensed) is sometimes used when benzodiazepines are contraindicated or not tolerated or clomethiazole
Patients in alcohol withdrawal with clear agitation or hallucinations or at risk of delirium tremens may be treated with which drugs?
Oral lorazepam then IV haloperidol/lorazepam
Which drugs are the first line for the prevention of relapse in alcohol dependence?
Acamprosate and naltrexone.
If acamprosate and naltrexone are contraindicated or not tolerated, what other drug can be used to prevent relapse in alcohol dependence?
Disulfiram.
Nalmefene is licensed for the reduction of alcohol consumption in which patients?
Patients with alcohol dependence who have a high drinking risk.
Which treatments are effective aids to smoking cessation?
NRT, bupropion, varenicline.
Is nicotine replacement therapy with bupropion and varenicline recommended?
No.
When smoking is stopped, what may need to happen to the patient’s other medication? Why?
The doses may need adjusting due to the reduced induction of CYP1A2 by nicotine.
Patients on varenicline should be advised to discontinue treatment when which symptoms occur?
Agitation, depressed mood, suicidal thoughts.
Which patients should be monitored closely when taking varenicline?
Patients with a history of psychiatric illness.
How long after untreated heroin withdrawal do withdrawal symptoms show? After how long do they subside?
After 8 hours, subsiding after 5 days.
How long after stopping methadone or buprenorphine treatment do withdrawal symptoms occur, in relation to those of heroin?
Withdrawal occurs later with longer lasting symptoms.
Which drugs are used in opioid substitution therapy?
Methadone and buprenorphine.
After how many days missed opioid substitution therapy dose are patients at greater risk of overdose? What should be done in these cases?
Three or more days due to reduced tolerance. Consider reducing next dose.
Why is buprenorphine often preferred to methadone for opioid substitution therapy? Why is this?
It is less sedating due to it being a partial opioid-receptor agonist.
When is methadone usually administered?
Once daily as a methadone 1mg/ml solution.
Why should acute withdrawal of opioids be avoided in pregnancy?
It can cause foetal death.
Should treatment of opioid replacement therapy be continued during pregnancy? Is buprenorphine licensed in pregnancy?
Yes and no.
How should withdrawal of buprenorphine or methadone be handled during the second trimester of pregnancy?
Slowly and gradually.
During the first trimester of pregnancy, there is an increased risk of what adverse effect during opioid withdrawal?
Spontaneous miscarriage.
During the third trimester of pregnancy, there is an increased risk of what adverse effects during opioid withdrawal?
Foetal distress, stillbirth, increased risk of neonatal mortality. The neonate should be monitored for respiratory distress and signs of withdrawal.
How should the dose of methadone be handled in breastfeeding mothers?
It should be kept as low as possible.
How should neonates born to opioid dependent mothers be monitored?
Monitored for drowsiness, adequate weight gain and developmental milestones.
How should adverse effects in babies to opioid dependent mothers who are breastfeeding be reported?
Urgently.
Apart from opioid substitution therapy, what else is methadone licensed for? In what form and strength is this?
Analgesia in severe pain and cough in terminal illness. Methadone linctus 2mg/5ml.
Patients with which risk factors for QT interval prolongation should be monitored whilst taking methadone?
Heart or liver disease, electrolyte abnormalities, concomitant treatment with drugs which can prolong the QT interval. Patients requiring 100mg daily should also be monitored.
Why does methadone overdose require prolonged monitoring?
Due to the long-acting nature of the opioid.
What is the risk of alcohol in combination with Clomethiazole?
can lead to fatal respiratory depression even with short term use
How long is Bupropion treatment for?
7-9 weeks
What are the 3 strengths of the 24 hour patches
7, 14, 21 mg
What conditions are NRT cautioned in
Diabetes (monitor BMs initially), CVD, GI disease, uncontrolled hyperthyroidism
What is smokings affect on theophylline
Smoking increases theophylline clearance, so if stopping, dose reduction may be needed
What is an ADR associated with Nicotine replacement patches?
Nightmares - use the 16 hour patch if this occurs (break overnight)
How long Varenicline treatment for?
12 weeks
First line treatment for Delirium tremens
Lorazepam
What is the medication is used for Wernickes encepthalopathy
Thiamine
How often should patients taking Disulfiram be monitored?
Every 2 weeks for first 2 months then each month follwing 4 months then every 6 months
What should patients on disulfiram be counselled on?
- Risk of Disulfiram related reactions - may occur when exposed to alcohol in perfume, aerosol spray etc/ causes nausea, flushing, palpitations, hypotension and arrhythmias
- reporting signs of hepatoxicity
If patient has nicotine cravings on waking, what NRT patch is most appropriate?
24 hours
Can a patient have a can of coke before using nicotine gum?
No - acidic drinks can decrease absorption of nicotine through the buccal mucosa and should be avoided for 15 mins before use of NRT
