Substance dependence Flashcards
What 2 medications are used in opioid substitution therapy
Buprenorphine and Methadone
How long does compelte withdrawal from opioids takw?
12 weeks in community, 4 weeks in rehab facility
How many mised doses puts a patient at risk of overdose due to tolerance?
3 missed doses
What is suboxone
Buprenorphine and Naloxone
Symptoms of neonatal withdrawl syndrome
High pitched cry, hypertonicity, convulsions, ineffective suckling, excesive wakefullness
What drug can be used in combination with opioid substitution therapy or alone for people with mild or uncertain dependence?
Lofexidine
What medication precipitates opioid withdrawl in opioid dependent subjects?
Naltrexone
what medicastions are used in fixed dosing egimes for alcohol withdrawl?
Long acting benzo e.g. Chlordiazepoxide reducing doses over 7 to 10 days
What is the risk of alcohol in combination with Clomethiazole?
can lead to fatal respiratory depression even with short term use
Symptoms of Delirium tremens
agitation, confusion, paranoia, visual and auditory hallucinations
First line treatment for Delirium tremens
Lorazepam
Indication of use of Acamprostate calcium
relapse prevention in patients with moderate - severe alchol dependence
What drug can be used to treat patients who have alchohol dependence without physial withdrawl symptoms
Nalmefene
What can be given to alcohol dependent patients who have severe alcohol related hepatitis with a discriminant function of 32 or more?
Corticosteroids
What is the medication is used for Wernickes encepthalopathy
Thiamine (IV) followed by PO
How often should patients taking Disulfiram be monitored?
Every 2 weeks for first 2 months then each month follwing 4 months then every 6 months
What should patients on disulfiram be counselled on?
- Risk of Disulfiram related reactions - may pccur when exposed to alcoho in perfume, aerol spray etc/ causes nausea, flushing, palpitations, htypotension and arrhythmias
- reporting signs of hepatoxicity
How old do you have to be to have Acamprosate
> 16
If patient has nicotine cravings on waking, what NRT patch is most appropriate?
24 hour patch
Side effects of NRT patches
Mild local reactions due to irritant effects of nicotone, nightmares
How long is Bupropion treatment for?
7-9 weeks
Pharmacotherpay options ofr smoking cessastion
NRT, Varenicline, Bupropion
What is an ADR associated with Nicotine replacement patches?
Nightmares - use the 16 hour patch if this occurs (break overnight)
Side effects of nicotine chewing gum
GI disturbance, N&V, dyspepsia, hiccup
What are the 3 strengths of the 24 hour patches
21mg, 14mg, 7mg
hat are the 2 strengths of the 16 hour patches
15mg, 10mg
What conditions are NRT cautioned in?
Diabetes (monitor BMs initially), CVD, GI disease, uncontrolled hyperthyroidism –> although NRT is also betterthan smoking
What is smokings affect on theophylline
Smoking increases theophylline clearance, so if stopping, dose reduction may be needed
Can a patient have a can of coke before using nicotine gum?
No - acidic drinks can decrease absorption of nicotine through the buccal mucosa and should be avoided for 15 mins before use of NRT
What conditions is Varenicline and Bupropion contraindciated in?
<18 years and pregnant/breastfeeding
How long Varenicline treatment for?
12 weeks (start 1-2 weeks before stop date)
What conditions is Varenicline and Bupropion cautioned in?
Mental health (risk of suicial ideation), Seizures and CVD
