substance dependence

Question 1

alcohol dependence management

Answer 1

mild - don’t need treatment

moderate - treated in community setting - unless high risk of developing withdrawal seizures or delirium

severe - undergo withdrawal in inpatient setting

Question 2

alcohol dependence treatment

Answer 2

dependence - treat with CBT or acamprosate or naltrexone (alternative - disulfiram reaction)

withdrawal - long acting benzo - chlordiazepoxide or diazepam (alternative - carbamazepine or clomethiazole)

delirium - short acting benzo - lorazepam

wernicke’s encephalopathy - thiamine (vit B1)

Question 3

nicotine dependence treatment

Answer 3

varenicline - nicotine receptor partial agonist - helps smoking cessation
- avoid in epilepsy, CVD, psychiatric illness

bupropion - avoid in psychiatric illness, seizures, eating disorders
- can cause Serotonin syndrome

NRT - can buy OTC:
- use patch (16hr patch if pregnant or experiences nightmares)
- AND use short term reliever - lozenges, gum, sublingual tablets, inhalator, nasal/oral spray
- using both is optimal

Question 4

opioid dependence imp points

Answer 4

treatment for opioid dependence - only under supervision of appropriately qualified prescriber

prescribed on FP10MDA (blue script) - MAX supply 14 days

3 or more missed doses - refer back to specialist

treatment continued throughout pregnancy - risk of not taking more harmful to fetus

naloxone can be prescribed as well if pt at high risk of overdose

Question 5

opioid dependence treatment

Answer 5

buprenorphine
- less sedating than methadone
- milder withdrawal symptoms
- lower risk of overdose
- suboxone (buprenorphine with naloxone) when theres a risk of injecting

methadone
- causes QT prolongation
- carefully titrated according to patients needs
- sugar vs sugar free - have to give the correct one - sugar usually acts as deterrent for people injecting/abusing as it hurts