Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Roomies Collab Deck 2: Endocrinology and NeuroPsych > Substance Dependence > Flashcards

Substance Dependence Flashcards

1
Q

Untreated heroin dependence shows early withdrawal symptoms within __________, with peak symptoms at ____________; symptoms subside substantially after ________ days

A

8 hours

36–72 hours

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Compared to heroin withdrawal, methadone or buprenorphine withdrawal occurs __________ (earlier/later) with ___________ (longer/shorter)-lasting symptoms

A

Later

Longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Opioid substitution therapy involves using ___________ and ___________ to substitute heroin or other opioids in dependence

A

Methadone

Buprenorphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Opioid substitute medication should be commenced with a short period of stabilisation, followed by either a ____________ regimen or by ___________ treatment.

A

withdrawal

maintenance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the aim of maintenance treatment in patients who are recovering from opioid addiction?

A

Enables patients to achieve stability, reduces drug use and crime, and improves health; it should be regularly reviewed to ensure the patient continues to derive benefit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why is enforced withdrawal from opioids ineffective for sustained abstinence?

A

Increases the risk of patients relapsing and subsequently overdosing because of loss of tolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Complete withdrawal from opioids usually takes up to ____________ in an inpatient or residential setting, and up to ___________ in a community setting.

A

4 weeks

12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If abstinence from opioids is not achieved, illicit drug use is resumed, OR the patient cannot tolerate withdrawal, the ___________ regimen should be stopped and ___________ therapy should be resumed at the optimal dose.

A

withdrawal

maintenance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Following successful withdrawal treatment from opioids, further support and monitoring to maintain abstinence should be provided for a period of at least _____________

A

6 months

*This includes medical, social, and psychological support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Patients who miss _________ or more of their regular prescribed dose of opioid maintenance therapy are at risk of overdose because of loss of tolerance.

A

3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Patients who miss 3 days or more of their regular prescribed dose of opioid maintenance therapy are at risk of ___________ because of loss of tolerance.

A

Overdose

Consider reducing the dose in these patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If the patient misses _____ or more days of opioid maintenance therapy, an assessment of illicit drug use is also recommended before restarting substitution therapy

A

If the patient misses 5 or more days of treatment, an assessment of illicit drug use is also recommended before restarting substitution therapy

*this is particularly important for patients taking buprenorphine because of the risk of precipitated withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If the patient misses 5 or more days of treatment, an assessment of ___________ is also recommended before restarting substitution therapy

A

illicit drug use

*this is particularly important for patients taking buprenorphine because of the risk of precipitated withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Buprenorphine is preferred by some patients because it is less __________ than methadone hydrochloride

A

sedating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the mechanism of action of buprenorphine?

A

Partial agonist at mu receptors (ie partially activates opiate receptors) to cause a potent analgesic effect on the CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

____________ (buprenorphine/methadone) may be more suitable for employed patients or those undertaking other skilled tasks such as driving

A

Buprenorphine (less sedating)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

_____________ (buprenorphine/methadone) is safer than _____________ (buprenorphine/methadone) when used in conjunction with other sedating drugs, and has fewer drug interactions

A

Buprenorphine

Methadone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Dose reductions may be easier than with ______________ (buprenorphine/methadone) because the withdrawal symptoms are milder, and patients generally require fewer adjunctive medications

A

Methadone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

There is a lower risk of overdose with _____________ (buprenorphine/methadone)

A

Methadone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Buprenorphine can be given on alternate days in higher doses and it requires a shorter drug-free period than methadone hydrochloride before induction with _____________ for prevention of relapse.

A

naltrexone hydrochloride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is “precipitated withdrawal” in the context of opioid dependence?

A

When patients are dependent on high doses of opioids, withdrawal can occur if buprenorphine (a partial agonist) is administered when other opioid agonist drugs are in circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Precipitated opioid withdrawal, if it occurs, starts within __________ of the first buprenorphine dose and peaks at around _________.

A

1–3 hours

6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Non-opioid adjunctive therapy, such as ______________, may be required if symptoms of precipitated withdrawal are severe.

A

lofexidine hydrochloride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

To reduce the risk of precipitated withdrawal, the first dose of buprenorphine should be given when _______________, or ___________ after the last use of heroin (or other short-acting opioid), or ___________ after the last dose of methadone hydrochloride.

A

the patient is exhibiting signs of withdrawal

6–12 hours

24–48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Suboxone is a combination preparation containing _____________ and ____________

A

Buprenorphine

Naloxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Where there is a risk of diversion of opioid substitution medicines, or difficulties with adherence to daily supervised opioid substitution medication, buprenorphine _______________ may be an option.

A

prolonged-release injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Methadone is a __________(long/short)-acting opioid agonist

A

Long

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Methadone is usually administered in a ________-daily dose as an _________ of 1 mg/mL

A

Once

Oral solution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Patients with a long history of opioid misuse, those who typically abuse a variety of sedative drugs and alcohol, and those who experience increased anxiety during withdrawal of opioids may prefer ___________ (methadone/buprenorphine) to ____________ (methadone/buprenorphine) because it has a more pronounced sedative effect

A

Methadone

Buprenorphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Methadone hydrochloride is initiated at least ___________ after the last heroin dose

A

8 hours; provided that there is objective evidence of withdrawal symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Because of the ________________ of methadone, a dose that was tolerated on the first day of treatment may become a toxic dose on the third day as cumulative toxicity develops

A

Long half-life; plasma concentrations progressively rise during initial treatment even if the patient remains on the same daily dose (it takes 3–10 days for plasma concentrations to reach steady-state in patients on a stable dose)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Acute withdrawal of opioids should be avoided in pregnancy because it can cause ___________.

A

fetal death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

_____________ is recommended during pregnancy because it carries a lower risk to the fetus than continued use of heroin or other illicit drugs

A

Opioid substitution therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

If a woman who is stabilised on methadone hydrochloride or buprenorphine for treatment of opioid dependence becomes pregnant, what is the recommended management?

A

Therapy should be continued [buprenorphine is not licensed for use in pregnancy]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Many pregnant patients choose a withdrawal regimen but withdrawal during the first trimester should be avoided because it is associated with an increased risk of ______________

A

spontaneous miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Many pregnant patients choose a withdrawal regimen but withdrawal during the _____________ should be avoided because it is associated with an increased risk of spontaneous miscarriage

A

first trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Withdrawal of methadone hydrochloride or buprenorphine should be undertaken gradually during the _____________ trimester, with dose reductions made every _________

A

second

3-5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

If illicit drug use occurs in a pregnant woman undertaking an opioid withdrawal regimen in the second trimester of pregnancy, what is the recommended management?

A

The patient should be re-stabilised at the optimal maintenance dose and consideration should be given to stopping the withdrawal regimen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Further withdrawal of methadone hydrochloride or buprenorphine in the third trimester _____ (is/is not) not recommended

A

Is NOT; maternal withdrawal, even if mild, is associated with fetal distress, stillbirth, and risk of neonatal mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Further withdrawal of methadone hydrochloride or buprenorphine in the third trimester is not recommended because maternal withdrawal, even if mild, is associated with ___________, ___________, and the risk of ____________.

A

fetal distress

stillbirth

neonatal mortality

41
Q

Drug metabolism can be ____________ (increased/decreased) in the third trimester; it may be necessary to either __________ (increase/decrease) the dose of methadone hydrochloride or change to twice-daily consumption (or a combination of both strategies) to prevent withdrawal symptoms from developing.

A

Increased

Increase

42
Q

Drug metabolism can be increased in the third trimester; it may be necessary to either increase the dose of methadone hydrochloride or change to twice-daily consumption (or a combination of both strategies) to prevent ____________ symptoms from developing.

A

withdrawal

43
Q

The neonate should be monitored for ____________ and signs of __________ if the mother is prescribed high doses of opioid substitue.

A

Respiratory depression

Withdrawal

44
Q

Signs of neonatal withdrawal from opioids usually develop ____________ after delivery but symptoms may be delayed for up to ________, so monitoring may be required for several weeks.

A

24–72 hours

14 days

45
Q

Symptoms of neonatal withdrawal from opioids include…? (6)

A
  1. high-pitched cry
  2. rapid breathing
  3. hungry but ineffective suckling
  4. excessive wakefulness

severe, but rare symptoms include:

  1. hypertonicity
  2. convulsions
46
Q

Can breastfeeding be continued while on opioid substitution therapy?

A

Yes, but doses of methadone and buprenorphine should be kept as low as possible

47
Q

________________, _______________, or __________ in breast-fed babies of mothers taking opioid substitutes should be reported urgently to a healthcare professional.

A

Increased sleepiness

breathing difficulties

limpness

48
Q

In the adjunctive treatment of opioid withdrawal, loperamide may be used for ___________

A

Control of diarrhea

49
Q

In the adjunctive treatment of opioid withdrawal, _____________ may be used for the control of diarrhea

A

Loperamide

50
Q

In the adjunctive treatment of opioid withdrawal, mebeverine may be used for ___________

A

Controlling stomach cramps

51
Q

In the adjunctive treatment of opioid withdrawal, ____________ may be used for controlling stomach cramps

A

Mebeverine

52
Q

In the adjunctive treatment of opioid withdrawal, paracetamol and NSAIDs may be used for ______________ and __________

A

Muscular pains

headaches

53
Q

In the adjunctive treatment of opioid withdrawal, ______________ and ____________ may be used for muscle pain and headaches

A

Paracetamol

NSAIDs

54
Q

In the adjunctive treatment of opioid withdrawal, metoclopramide or prochlrperazine may be used for ___________ or ___________

A

Nausea

Vomiting

55
Q

In the adjunctive treatment of opioid withdrawal, ______________ or _____________ may be used for nausea or vomiting

A

Metoclopramide

Prochlorperazine

56
Q

Topical ____________ can be helpful for relieving muscle pain associated with methadone hydrochloride withdrawal

A

rubefacients

57
Q

If a patient is suffering from insomnia associated with opioid withdrawal, short-acting _____________ or ____________ may be prescribed, but because of the potential for abuse, prescriptions should be limited to a short course of a few days only.

A

benzodiazepines

zopiclone

58
Q

Lofexidine hydrochloride may alleviate some of the physical symptoms of opioid withdrawal by attenuating the increase in _______________ that occurs during opioid withdrawal

A

adrenergic neurotransmission

59
Q

__________________ may alleviate some of the physical symptoms of opioid withdrawal by attenuating the increase in adrenergic neurotransmission that occurs during opioid withdrawal

A

Lofexidine hydrochloride

60
Q

______________ can be prescribed as an adjuvant to opioid substitution therapy, initiated either at the same time as the opioid substitute or during withdrawal of the opioid substitute

A

Lofexidine hydrochloride

61
Q

_____________ may be prescribed instead of an opioid substitute in patients who have mild or uncertain dependence (including young people), and those with a short history of illicit drug use

A

Lofexidine hydrochloride

Can also be used as an adjuvant to opioid substitution therapy

62
Q

Lofexidine hydrochloride may be prescribed instead of an opioid substitute in patients who have ____________ or ___________ dependence (including young people), and those with a _________ history of illicit drug use

A

mild

uncertain

short

63
Q

What is the mechanism of action of naloxone?

A

Opioid antagonist; reverses the effects of opioids including respiratory depression, sedation, and hypotension

Can be given to patients in the case of accidental overdose

64
Q

What is the mechanism of action of naltrexone?

A

Mu-opioid receptor antagonist; blocks opioid effects and precipitates withdrawal symptoms in opioid-dependent subjects

Prescribed as an aid to prevent relapse

65
Q

What is the role of naloxone in opioid cessation?

A

Can be given to patient to be used in case of accidental overdose

66
Q

What is the role of naltrexone in opioid cessation?

A

Can be given to formerly opioid-dependent patients to block opioid effect in the case of relapse

67
Q

Why is opioid substitution therapy usually inappropriate in younger patients (under 18 yo)?

A

Drug misuse is more often related to acute intoxication than to dependence; maintenance treatment with opioid substitution therapy is therefore controversial in young people

However, it may be useful for older adolescents who have a history of opioid use to undergo a period of stabilisation with buprenorphine or methadone before starting a withdrawal regimen

68
Q

For opioid substitution therapy, in patients taking methadone who want to switch to buprenorphine, the dose of methadone should be reduced to a maximum of ________ daily before starting buprenorphine treatment

A

30 mg

69
Q

For sublingual tablets of buprenorphine, if the dose of methadone is over 10 mg daily, buprenorphine can be started at a dose of ________ daily and titrated according to requirements

A

4 mg

70
Q

For sublingual tablets, if the dose of methadone is below 10 mg daily, buprenorphine can be started at a dose of _______ daily

A

2 mg

71
Q

The MHRA reminds healthcare professionals that opioids co-prescribed with benzodiazepines and benzodiazepine-like drugs can produce additive CNS depressant effects, thereby increasing the risk of ___________, ___________,
__________, and _________.

A

sedation

respiratory depression

coma

death

72
Q

The MHRA reminds healthcare professionals that opioids co-prescribed with ___________ and ___________-like drugs can produce additive CNS depressant effects, thereby increasing the risk of sedation, respiratory depression, coma, and death.

A

benzodiazepines

benzodiazepine

73
Q

Healthcare professionals are advised to discuss with patients that prolonged use of opioids, even at therapeutic doses, may lead to __________ and __________

A

dependence

addiction

74
Q

Healthcare professionals are advised to agree on a treatment strategy and plan for __________ with the patient before starting opioids

A

end of treatment

75
Q

Healthcare professionals are advised to counsel patients and their carers on the risks of _________ and potentially fatal ____________, as well as signs and symptoms of overdose when taking opioids (eg buprenorphine, methadone)

A

tolerance

unintentional overdose

76
Q

Regarding the use of buprenorphine and methadone, healthcare professionals are advised to provide regular monitoring and support to patients at increased risk, such as those with current or history of ___________ or ____________

A

substance use disorder (including alcohol misuse)

mental health disorders

77
Q

Healthcare professionals are advised to consider _____________ in patients on long-term opioid treatment who present with increased pain sensitivity

A

hyperalgesia

78
Q

Do not confuse the formulations of buprenorphine______________ which are available in 72-hourly, 96-hourly and 7-day forms

A

transdermal patches

79
Q

What are the contraindications to prescribing buprenorphine, methadone, and all opioids? (5)

A
  1. Acute respiratory depression
  2. Comatose patients
  3. Head injury (interfere with pupillary responses vital for neurological assessment)
  4. Raised ICP ( “ “ )
  5. Risk of paralytic ileus
80
Q

Prolonged use of opioid analgesics may lead to drug dependence and addiction, even at therapeutic doses. There is an increased risk in individuals with current or history of _______________ or ____________

A

substance use disorder

mental health disorders

81
Q

Opioids cause a dose-dependent increased risk of _____________, consider total opioid dose reduction

A

central sleep apnoea

82
Q

In the control of pain in terminal illness, the cautions listed _____________ (should/should not) be a deterrent to the use of opioid analgesics

A

Should not

83
Q

In elderly adults, buprenorphine should not be prescribed without concomitant __________

A

Laxatives

84
Q

What are the common or very common side effects of buprenorphine?

A
  1. Anxiety
  2. Decreased appetite
  3. Depression
  4. Diarrhea
  5. Dyspnea
  6. Syncope
  7. Tremor

Many more….

Arthralgia (in adults); asthenia (in adults); asthma (in adults); behaviour abnormal (in adults); chest pain (in adults); chills (in adults); cough (in adults); dysmenorrhoea (in adults); eye disorders (in adults); fever (in adults); gastrointestinal discomfort (in adults); gastrointestinal disorders (in adults); hypersensitivity; hypotension; increased risk of infection (in adults); insomnia (in adults); lymphadenopathy (in adults); malaise (in adults); migraine (in adults); muscle complaints (in adults); muscle tone increased (in adults); pain (in adults); paraesthesia (in adults); peripheral oedema (in adults); speech disorder (in adults); thinking abnormal (in adults); vasodilation (in adults); withdrawal syndrome neonatal; yawning (in adults); asthenia (in adults); gastrointestinal discomfort (in adults); muscle weakness (in adults); oedema (in adults); sleep disorders (in adults)

85
Q

Neonates breastfed by mothers taking buprenorphine should be monitored for ____________, ____________, and _____________

A

Drowsiness

Adequate weight gain

Developmental milestones

86
Q

Can buprenorphine be prescribed in patients with hepatic and/or renal impairment?

A

Avoid in severe hepatic impairment; dose reduction in mild to moderate impairment

Caution and dose reduction in severe renal impairment

87
Q

Documentation of ___________ status is recommended before commencing therapy for opioid dependence.

A

viral hepatitis

88
Q

What monitoring is required for patients taking buprenorphine as opioid substitution therapy?

A

Liver function (baseline before commencing therapy AND regular LFTs throughout treatment)

89
Q

Many preparations of Methadone oral solution are licensed for opioid drug addiction only but some are also licensed for ____________ in _____________.

A

Analgesia

severe pain

90
Q

In addition to contraindications associated with opioid use, what is the main contraindication specific to methadone?

A

Phaeochromocytoma

91
Q

Methadone should be prescribed with caution in patients with _______________ or risk factors for it

A

QT interval prolongation

92
Q

In addition to preventing opioid relapse, naltrexone is also used in patients with _________-dependence

A

Alcohol

93
Q

What are the common or very common side effects of naltrexone? (9)

A
  1. Abdominal pain, diarrhea, constipation, vomiting
  2. Arthralgia
  3. Asthenia
  4. Eye disorders
  5. Altered mood, anxiety
  6. Sexual dysfunction
  7. Palpitations, tachycardia, chest pain
  8. Sleep disorders, headache
  9. Skin reactions, hyperhydrosis
94
Q

Is naltrexone safe to use in breastfeeding?

A

Avoid due to potential toxicity

95
Q

Is naltrexone safe to use in hepatic and/or renal impairment?

A

Caution in mild to moderate hepatic impairment (adjust dose); avoid if severe or acute impairment

Caution in mild to moderate renal impairment (adjust dose)avoid in severe impairment

96
Q

What pre-treatment screening is required before starting naltrexone?

A

Test for opioid dependence with naloxone before treatment.

97
Q

What are the monitoring requirements for patients taking naltrexone?

A

LFTs before and during treatment

98
Q

Patients and carers should be given what additional advice regarding opioid blocking drugs like naltrexone?

A

Attempts to overcome blockade of opioid receptors by overdosing could result in acute opioid intoxication

Roomies Collab Deck 2: Endocrinology and NeuroPsych (49 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions