Substance dependence

Question 1

Assisted alcohol withdrawal tx 1st line

Answer 1

~ Chlordiazepoxide or Diazepam
— Primary care: fixed-dose reducing regimen
— Inpatient/Residential setting: fixed-dose or symptom triggered regimen

Question 2

Assisted alcohol withdrawal tx alternative

Answer 2

~ carbamazepine
~ Clomethiazole (inpatient setting, with alcohol = respiratory depression)

Question 3

Alcohol withdrawal seizures tx

Answer 3

~ Lorazepam (fast-acting benzodiazepine)

Question 4

Delirium tremens in alcohol withdrawal

Answer 4

1st line = oral lorazepam
~ persistent / if pt declines oral tx = parenteral lorazepam / halpoeridol

Question 5

Alcohol dependence tx 1st line

Answer 5

~ Acamprostate
~ Naltrexone

Question 6

Alcohol dependence tx

Answer 6

Disulfiram (unpleasant systemic reaction to alcohol = flushing, throbbing headache, palpitations, tachycardia, N, V)

Question 7

Reduction of alcohol consumption in pt without physical withdrawal symptoms

Answer 7

Nalmefene ~ for pt with high risk drinking level, but do not require immediate detoxification

Question 8

Wernickes encephalopathy

Answer 8

THIAMINE (B1)
~ pt with alcohol dependence at risk of malnourishment or decompensated liver disease

Question 9

NRT formulations

Answer 9

~ Prolonged-release = 16 hours / 24 hours
—- use 24h patch if strong craving for cigarette on waking

~ Immediate-release = urge to smoke / prevent craving
—gum, lozenges, nasal spray, oral spray, sublingual tab, inhalator

Question 10

NRT side effects

Answer 10

~ Mild local reactions = irritants effects of nicotine

~ GI = N, V, dyspepsia, hiccup

Question 11

Nicotine dependence tx options

Answer 11

~ NRT
~ Bupropion
~ Varenicline

Question 12

Varenicline for nicotine dependence

Answer 12

selective nicotine receptor partial agonist
~ in conjunct with behavioural therapy

MHRA = suicidal behaviour and varenicline

Question 13

Opioid dependence tx missed days

Answer 13

3 or more = risk of overdose due to reduced tolerance
5 or more = check for misuse

Question 14

Tx for opioid dependence

Answer 14

~ Methadone
~ Buprenorphine

Question 15

Methadone profile

Answer 15

~ dose = OD
~ More sedating
— long hx of opioid miuse
— increased anxiety during withdrawal
— abuses sedative drugs/alcohol

~ LONG half-life
accumulates = toxicity
~ SE = QT prolongation

Question 16

Buprenorphine profile

Answer 16

dose = OD
~ less sedating (better if pt has job/drives)
~ SAFER with used with others and less interactions
~ lower risk of overdose

SE = partial agonist
- precipitate withdrawal reaction
– take 1st dose on withdrawal signs
– take 1st dose 6-12 hours after heroin (24-48h after methadone)