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PHA333 > Substance misuse > Flashcards

Substance misuse Flashcards

1
Q

What complications are involved?

A

Overdose, HIV, hepatitis, homelessness & crime

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1
Q

What is opioid dependence?

A

Dependence which develops after regular use of opioids

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2
Q

What is the key element of opioid dependence?

A

A strong desire/sense to take opioids

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3
Q

What is OST?

A

Opioid substitution therapy
- Pharmacological: buprenorphine/methadone
- Psychosocial support

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4
Q

What is the aim of OST?

A
  • Improve QOL of opioid-dependent patients
  • Reduce illicit opioid use
  • Prevent people dropping out of treatment
  • Reduce crime
  • Reduce risk of BBV transmission
  • Reduce mortality
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5
Q

Is methadone a partial or full agonist and what dose should it be initiated at?

A

Full
10-30mg/day

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6
Q

When is there an increased risk of QT prolongation with methadone?

A

Dose >100mg

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7
Q

Is buprenorphine partial or full?

A

Partial opioid agonist at mu receptors and antagonist at k receptors

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8
Q

Differences between opioid intoxication and acute withdrawal syndrome?

A

Intoxication: lower BP, hypoventilation, constriction of pupils, slower pulse

AWS: dilated pupils, cough, clammy skin, yawning, sneezing, watering eyes, increased pulse, raised BP, runny nose, nausea, diarrhoea

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8
Q

Features of suspected opioid dependency

A
  • Psychiatric: overdose, depression
  • Forensic: probation, community service
  • Social: family problems, unemployment, financial
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9
Q

Physical exam features

A
  • Poor nutrition
  • Dental hygiene
  • Needle tracks
  • Skin abcess
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10
Q

Drug and alcohol assessment

A

Degree of dependence
Medical history
Psychiatric history
Social history
Family history

Urine/drug screen

ECG, U+Es, FBC, LFT, Screen for HIV/Hep B&C

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11
Q

How often to test urine and how long do substances show?

A

3 months

Heroin: up to 48 hours
Methadone: 7-9 days
Buprenorphine: 1-2 weeks

Shorter detection window for mouth swab but can be done

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12
Q

Difference between maintenance and detoxification

A

Maintenance is for patients who wish to reduce but are not ready to completely stop the use of opioids
- Reduce illicit drug use, reduce harm & stabilise life
- Supervised for 3 months

Detoxification for patients who wish to become drug-free
- 28 days as an inpatient and 12 weeks in community
- Minimise withdrawal symptoms

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13
Q

Why is the ultra-rapid detox not recommended?

A

High rate of relapse

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14
Q

What are the symptomatic treatment to manage withdrawal for each?

  • Diarrhoea
  • Nausea/vomiting
  • Stomach pain/cramping
  • Aches/pains
  • Agitation/anxiety
A
  • Loperamide
  • Metoclopramide
  • Mebeverine
  • Paracetamol/ibuprofen
  • Zopiclone/diazepam
15
Q

What is used for relapse prevention?

A

Naltrexone

16
Q

Which treatment is first line and how is it chosen?

A
  • Methadone first line but both equally as effective

Based on
- preference for either drug
- previous benefit
- safety concerns
- drug-drug interactions
- pregnancy (complex as withdrawing the baby)
- severity of dependence

17
Q

How to initiate methadone?

A
  • Start low, go slow (long acting synthetic opioid)
18
Q

What are the risk factors for overdose

A
  • Low opioid tolerance
  • Use of CNS depressant drugs
  • Drug interactions
  • Rapid dose increase
  • Slow methadone clearance (hepatic impairment)
19
Q

What is the increase to methadone usually?

A

60-120mg/day

20
Q

How to initiate buprenorphine

A
  • Ideally wait 6-12hrs after last use of heroin
  • 24-48hrs after last dose of methadone

Safer to initiate than methadone
Less risk of over-sedation, respiratory depression & overdose

21
Q

What to do when initiating methadone/buprenorphine

A

Start low dose & titrate rapidly

22
Q

How many missed doses?

A

3 days

23
Q

What is required?

A

Home office wording

24
Q

What type of agonists are benzodiazepines?

A

GABA receptor agonists

25
Q

How to manage withdrawal?

A
  • Slow tapering
  • Switch to equivalent dose of diazepam
26
Q

How to reduce benzodiazepines?

A

Reduce by 5-10% of total daily dose every 1-2 weeks

27
Q

What not to do on benzodiazepines?

A

Never stop abruptly unless serious medical requirement to do so

PHA333 (4 decks)

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