Substance Dependence

Question 1

Alcohol dependence:
(Mild,moderate, high)

Answer 1

Mild- usually don’t assist, patients own will to withdraw
Moderate- in community but if at high risk of seizures and delirium, then in patient setting
High- In patient setting

Question 2

Treating alcohol dependence - which non drug treatment? And which treatment medication??? and an alternative( think metronidazole like symptoms)

Answer 2

Treat dependence with cognitive behavioural therapy or with Acamprosate and or Naltrexone (alternative: disulfram)

Question 3

Withdrawal symptoms can be treated using what? Give an example of 2 and alternatives?

Answer 3

: Use long acting benzodiazepine such as chlordiazepoxide or diazepam(alternative carbamazepine or clomethiazole)

Question 4

Delirium

Answer 4

Lorazepam

Question 5

Wernicke’s encephalopathy

Answer 5

Thiamine(vitamin B1)

Question 6

Nicotine dependence( 3 kinds)Varenicline,Bupropion,NRT - what are they and what are the cautions???

Answer 6

Varenicline:
- Nictotine receptor blocker, blocks the receptors to avoid feeling from smoking
- Avoid in epilepsy, cardiovascular disease and psychiatric illness

Bupropion:
- Avoid in psychiatric illness,seizures and eating disorders
- Can cause serotonin syndrome

Nicotine replacement therapy(NRT):
- Use a patch (16 hour patch if pregnant or experiencing nightmares) AND
- Use short term reliever:lozenges,gum,sublingual tablets,inhalator,nasal sprays and oral sprays
- Need basal and short term together

Question 7

Opioid dependence treatment must be initiated under what… by a qualified…

Answer 7

Treatment for opioid dependence has to be initiated under supervision of an appropriately qualified prescriber

Question 8

Prescribed on FP10MDA -

Answer 8

Maximum supply of 14 days
Three or more missed doses= refer patient back to a specialist
Treatment should be continued throughout pregnancy
Naloxone can be prescribed alongside of patient is at high risk of overdose

Question 9

Buprenorphine- What is suboxone?- Buprenorphine is less what than methadone and there is less risk of what .. and less what symptoms

Answer 9

• Less sedating than methadone
  
  • Milder withdrawal symptoms
  • Lower risk of overdose
  • Suboxone(buprenophrine with naloxone)when there is a risk of injecting

Question 10

Methadone can cause what??

Answer 10

-causes QT prolongation risk
Carefully treated according to patients need

Question 11

Sugar vs sugar free:

Answer 11

The injecting, it hurts more to inject the sugar version- can cause more irritation