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PR - CNS > SUBSTANCE MISUSE > Flashcards

SUBSTANCE MISUSE Flashcards

1
Q

Describe the cycle of change model.

A
  1. Pre-Contemplation
    - No intention of changing behavior
  2. Contemplation
    - Is aware a problem exists
    - BUT has no commitment to action
  3. Preparation/Determination
    - has an INTENTION on taking action to address the problem
  4. Action
    - They are ACTIVELY modifying their behavior
  5. Maintenance
    - New behavior replaces the old one
  6. Relapse
    - Back to old behavior
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2
Q

What are the three types of therapies to aid in stopping smoking?

A
  1. NRT
  2. Bupropion (Zyban)
  3. Varencicline (Champix)
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3
Q

Which drugs may be effected when someone stops smoking?

A
  1. Theophylline
    - Smoking decreases theophylline concentration
  2. Cinacalcet
  3. Ropinorole
  4. Clozapine
  5. Olanzapine
  6. Chlorpromazine
  7. Haloperidol

Need dose reductions

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4
Q

Champix MOA

A

Nicotine receptor blockers. Won’t feel anything from smoking and the receptors are blocked

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5
Q

What is the MHRA warning of champix?

A

Discontinue treatment and seek prompt medical advice if they develop:
1. Agitation
2. Depressed mood
3. Suicidal thought
So caution in those with a history of psychiatric illness (should be monitored closely)

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6
Q

Champix - avoid in

A

epilepsy, CVD and psychiatric illness

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7
Q

Bupropion - avoid in

A
  1. Acute alcohol withdrawal
  2. Acute benzo withdrawal
  3. Bipolar
  4. HISTORY OF SEIZURES
    - Can cause seizures
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8
Q

Bupropion - SE

A
  • SS
  • depression = refer
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9
Q

NRT

A
  • Patch (16H patch if pregnant/ experience nightmares)
    +
  • short term reliever (lozenges, gum, sublingual tabs, inhalator, nasal spray, and oral spray)

Best effects when use together

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10
Q

NRT patch and reliever

A

Patch acts as long term basal fix and short term acts as quick fix

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11
Q

Which drugs are used as opioid substitution therapy?

A
  1. Buprenorphine
  2. Methadone
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12
Q

What are the advantages of
Buprenorphine over methadone?

A
  1. Less sedating than methadone
    - so preferred in employed patients or people who perform skilled tasks e.g. drive
  2. Fewer drug-drug interactions
  3. Dose reduction is easier with buprenorphine than with methadone
  4. Milder withdrawal symptoms
  5. Lower risk of overdose
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13
Q

What are the
disadvantages of Buprenorphine?

A
  1. Increased risk of precipitating withdrawal
    - especially if taken with opioid
    - reduce the risk by starting the dose 6-12 hours after the last use of heroin
    OR 24 - 48 hours after the last use of Methadone
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14
Q

What are the advantages of Methadone over buprenorphine?

A

More sedative effect:
* Probably preferable for those who typically abuse a variety of sedative drugs and alcohol
* And those who suffer from increased anxiety during withdrawal periods from opioids

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15
Q

Opioid dependence - Rx

A
  • FP10MDA
  • Maximum supply of 14 days
  • SUPERVISED consumption is not a LEGAL requirement. It’s GOOD PRACTICE
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16
Q

Methadone - SE

A

QT

17
Q

Methadone SF vs S

A

o If its prescribed as SF must give SF
o S can cause more local irritation if pt decides to inject it. Injecting with substance high in sugar would hurt
o SF won’t hurt
o If pt is at high risk of abusing it, then go for S so it hurts them

18
Q

When should methadone be first initiated after the last heroin use?

A

Initiated at least 8 hours after last heroin use
- provided there is objective evidence of withdrawal symptoms

19
Q

What should you be aware of with regard to titrating the dose of methadone?

A

A dose on the first day may be toxic on the third day
- because of long-half life, plasma concentrations progressively rise during initiation
- It may take 3-10 days for the plasma concentration to reach a steady state
- titration to a stable dose may take several weeks

20
Q

How do you manage opioid substitution in pregnancy?

A
  • Continue Methadone or
    Buprenorphine (unlicensed)
  • Safer than acute withdrawal of opioids
  • Safer than illicit drugs
21
Q

Neonate should be monitored for

A

respiratory depression
- high-pitch,
- rapid breathing
- hungry but ineffective suckling
- excessive wakefulness

22
Q

Can you give opioids during breastfeeding?

A
  • Methadone or Buprenorphine doses MUST be kept to low
  • Mother should report
    URGENTLY any symptoms her baby gets:
    1. Increased sleepiness (sedation)
    2. Breathing difficulties
    3. Limpness
23
Q

What other treatments may be given to opioid dependence?

A
  1. Loperamide - for diarrhea
  2. Mebeverine - For controlling stomach cramps
  3. NSAIDs and paracetamol - for muscular pains and aches
  4. Metoclopramide or prochloperazine - N+V
  5. Topical rubefacients - muscular aches when withdrawal from methadone
  6. Short-acting Benzo or Z-drugs - for insomnia
  7. Lofexidine - For opioid withdrawal symptoms
  8. Naltrexone - to prevent relapse
  9. Naloxone - for overdose
24
Q

What are the signs of opioid withdrawal?

A
  1. Muscle aches
  2. Restlessness
  3. Anxiety
  4. Lacrimaion (eye tearing up)
  5. Excessive sweating
  6. Inability to sleep
  7. Abdominal cramping DNV
25
Q

If someone has strong alcohol dependence and abruptly stops it, what can happen?

A
  • Seizures
  • Delirium tremens
  • Death
    Therefore these people may need assistance in withdrawing alcohol acutely
26
Q
A
27
Q

Alcohol withdrawal symptoms: seizures of moderate AWS treatment

A
  1. Long-acting benzodiazepine
    E.g. Chlordiazepoxide or diazepam
  2. Carbamazepine
  3. Clomethiazole
28
Q

Chlordiazepoxide or diazepam treatment regimes

A
  • First line
  • Fixed-dose reducing regimen (in primary care or inpatient) or
  • Symptom triggered regimen (tailoring the drug regimen according to the severity of the withdrawal)
29
Q

clomethiazole

A
  • ONLY IN an INPATIENT setting
  • should NOT be prescribed if the patient is liable to drink again
  • if the patient has cirrhosis and drinks alcohol whilst on clomethiazole, risk of FATAl respiratory depression
30
Q

What is delirium tremens?

A
  • agitation, confusion, paranoia
  • visual and auditory hallucinations
31
Q

Delirium tremens: first line

A
  1. Oral lorazepam
  2. Parenteral lorazepam or haloperidol
32
Q

How do you manage Alcohol dependence?

A
  1. Psychological
    - e.g. СВТ
  2. Pharmacological
    - if the patient has not responded well to psychological
    - OR has specifically requested pharmacological
33
Q

Which pharmacological
treatments are used in alcohol dependence?

A
  1. Acamprostate calcium
  2. Oral Naltrexone
  3. Disulfiram
  4. Namefene
34
Q

What should patients be counseled on whilst on Disulfiram?

A

THEY HAVE TO NOT DRINK
Also avoid exposure to small amounts of alcohol in:
1. Perfumes
2. Aerosol sprays
3. Low-alcohol or non-alcohol beer and whines

35
Q

Why should they NOT drink whilst on disulfiram?

A

Risk of getting Disulfiram-like reactions:
1. Flushing
2. Throbbing headache
3. Nausea
4. Palpitations and tachycardia
5. Arrythmias
6. HYPOtension
7. Respiratory depression
8. Coma

36
Q

Wernicke’s encephalopathy treatment

A
  1. Thiamine
  2. Pabrinex

PR - CNS (61 decks)

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