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Pre reg > Substance Dependence > Flashcards

Substance Dependence Flashcards

1
Q

Without inpatient medical support, alcohol withdrawal in severely dependent patients can lead to what symptoms?

A

Seizures, delirium tremens, death.

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2
Q

How can moderate alcohol dependence often be treated?

A

In a community setting.

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3
Q

Which drugs are commonly used to reduce alcohol withdrawal symptoms?

A

Long-acting benzodiazepines. Carbamazepine (unlicensed) is sometimes used when benzodiazepines are contraindicated or not tolerated or clomethiazole

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4
Q

Patients in alcohol withdrawal with clear agitation or hallucinations or at risk of delirium tremens may be treated with which drugs?

A

Oral lorazepam then IV haloperidol/lorazepam

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5
Q

Which drugs are the first line for the prevention of relapse in alcohol dependence?

A

Acamprosate and naltrexone.

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6
Q

If acamprosate and naltrexone are contraindicated or not tolerated, what other drug can be used to prevent relapse in alcohol dependence?

A

Disulfiram.

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7
Q

Nalmefene is licensed for the reduction of alcohol consumption in which patients?

A

Patients with alcohol dependence who have a high drinking risk.

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8
Q

Which treatments are effective aids to smoking cessation?

A

NRT, bupropion, varenicline.

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9
Q

Is nicotine replacement therapy with bupropion and varenicline recommended?

A

No.

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10
Q

When smoking is stopped, what may need to happen to the patient’s other medication? Why?

A

The doses may need adjusting due to the reduced induction of CYP1A2 by nicotine.

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11
Q

Patients on varenicline should be advised to discontinue treatment when which symptoms occur?

A

Agitation, depressed mood, suicidal thoughts.

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12
Q

Which patients should be monitored closely when taking varenicline?

A

Patients with a history of psychiatric illness.

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13
Q

How long after untreated heroin withdrawal do withdrawal symptoms show? After how long do they subside?

A

After 8 hours, subsiding after 5 days.

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14
Q

How long after stopping methadone or buprenorphine treatment do withdrawal symptoms occur, in relation to those of heroin?

A

Withdrawal occurs later with longer lasting symptoms.

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15
Q

Which drugs are used in opioid substitution therapy?

A

Methadone and buprenorphine.

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16
Q

After how many days missed opioid substitution therapy dose are patients at greater risk of overdose? What should be done in these cases?

A

Three or more days due to reduced tolerance. Consider reducing next dose.

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17
Q

Why is buprenorphine often preferred to methadone for opioid substitution therapy? Why is this?

A

It is less sedating due to it being a partial opioid-receptor agonist.

18
Q

When is methadone usually administered?

A

Once daily as a methadone 1mg/ml solution.

19
Q

Why should acute withdrawal of opioids be avoided in pregnancy?

A

It can cause foetal death.

20
Q

Should treatment of opioid replacement therapy be continued during pregnancy? Is buprenorphine licensed in pregnancy?

A

Yes and no.

21
Q

How should withdrawal of buprenorphine or methadone be handled during the second trimester of pregnancy?

A

Slowly and gradually.

22
Q

During the first trimester of pregnancy, there is an increased risk of what adverse effect during opioid withdrawal?

A

Spontaneous miscarriage.

23
Q

During the third trimester of pregnancy, there is an increased risk of what adverse effects during opioid withdrawal?

A

Foetal distress, stillbirth, increased risk of neonatal mortality. The neonate should be monitored for respiratory distress and signs of withdrawal.

24
Q

How should the dose of methadone be handled in breastfeeding mothers?

A

It should be kept as low as possible.

25
Q

How should neonates born to opioid dependent mothers be monitored?

A

Monitored for drowsiness, adequate weight gain and developmental milestones.

26
Q

How should adverse effects in babies to opioid dependent mothers who are breastfeeding be reported?

A

Urgently.

27
Q

Apart from opioid substitution therapy, what else is methadone licensed for? In what form and strength is this?

A

Analgesia in severe pain and cough in terminal illness. Methadone linctus 2mg/5ml.

28
Q

Patients with which risk factors for QT interval prolongation should be monitored whilst taking methadone?

A

Heart or liver disease, electrolyte abnormalities, concomitant treatment with drugs which can prolong the QT interval. Patients requiring 100mg daily should also be monitored.

29
Q

Why does methadone overdose require prolonged monitoring?

A

Due to the long-acting nature of the opioid.

30
Q

What is the risk of alcohol in combination with Clomethiazole?

A

can lead to fatal respiratory depression even with short term use

31
Q

How long is Bupropion treatment for?

A

7-9 weeks

32
Q

What are the 3 strengths of the 24 hour patches

A

7, 14, 21 mg

33
Q

What conditions are NRT cautioned in

A

Diabetes (monitor BMs initially), CVD, GI disease, uncontrolled hyperthyroidism

34
Q

What is smokings affect on theophylline

A

Smoking increases theophylline clearance, so if stopping, dose reduction may be needed

35
Q

What is an ADR associated with Nicotine replacement patches?

A

Nightmares - use the 16 hour patch if this occurs (break overnight)

36
Q

How long Varenicline treatment for?

A

12 weeks

37
Q

First line treatment for Delirium tremens

A

Lorazepam

38
Q

What is the medication is used for Wernickes encepthalopathy

A

Thiamine

39
Q

How often should patients taking Disulfiram be monitored?

A

Every 2 weeks for first 2 months then each month follwing 4 months then every 6 months

40
Q

What should patients on disulfiram be counselled on?

A
  1. Risk of Disulfiram related reactions - may occur when exposed to alcohol in perfume, aerosol spray etc/ causes nausea, flushing, palpitations, hypotension and arrhythmias
  2. reporting signs of hepatoxicity
41
Q

If patient has nicotine cravings on waking, what NRT patch is most appropriate?

A

24 hours

42
Q

Can a patient have a can of coke before using nicotine gum?

A

No - acidic drinks can decrease absorption of nicotine through the buccal mucosa and should be avoided for 15 mins before use of NRT

Pre reg (45 decks)

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