Substance Dependence & Migraines

Question 1

How should you treat moderate/severe alcohol dependence?

Answer 1

Treat with CBT or with Acamprosate or Naltrexone (alternative are drugs that cause disulfram reaction = bad side effects which put them off drinking)

Question 2

Which medication can be used to treat alcohol withdrawal symptoms?

Answer 2

Long-acting benzodiazepine such as chlordiazepoxide or Diazepam.

Alternative - Carbamazepine or Clomethiazole

Question 3

whcih drug should be used to treat Delirium in patients with Alcohol dependence?

Answer 3

Lorazepam

Question 4

What drug should be used to treat Wernicke’s Encephalopathy in patients with alcohol dependence?

Answer 4

Thiamine (Vitamin B1)

Question 5

What are 3 options for patients with Nicotine Dependence?

Answer 5

Varenicline
Bupropion
NRT

Question 6

What is the MOA of Varenicline and which patients should it be avoided in?

Answer 6

MOA: Blocks nicotine receptors making smoking not feel ‘good’

Avoid in epilepsy (may increase risk of seizures), CVD (may increase risk of CVD events) and psychiatric illness

Question 7

Which type of patients should Bupropion be avoided in?

Answer 7

Psychiatric illness
Seizures
Eating disorders

Question 8

What is the MOA of Bupropion and what is a serious side effect of it?

Answer 8

Works by inhibiting dopamine re-uptake which helps to prevent craving and withdrawal effects.

Side Effect = Serotonin Syndrome

Question 9

Which hour long NRT patch should be used for patients who are pregnant or experience nightmares?

Answer 9

16hr patch

Question 10

What should be given alongside a nicotine replacement therapy patch?

Answer 10

Short term relievers such as lozenges, gum, sublingual tablets, nasal/oral spray