Substance Misuse and Dependence Flashcards
Two alternative nicotine replacement therapy drugs
Varenicline
Bupropion Hydrochloride
Cautions with NRT
Depressed mood and other psychiatric disturbances - suicidal thoughts
Smoking induces CYP so other drug levels may rise (buproprion also inhibits) once smoking stops
Reduced seizure threshold
Smoking reduces appetite so may gain weight
Mechanism Varenicline
Partial agonist at nAChR - also provides antagonistic role if exposed to nicotine
Confusion, ataxia and issues with gaze describes…
Wernicke’s encephalopathy
Features of Korsakoff’s psychosis
Memory issues
Aphasia/apraxia/agnosia
Indications for thiamine (3)
Chronic ETOH XS (Wernicke-Korsakoff)
High carb diet
High dose diuretics
Role of thiamine
Metabolism and recycling of neurotransmitters and nerve conduction
Drug indicated for ETOH withdrawal
Chlordiazepoxide - reducing regimen for 7-10 days
Alternative(s) to chlordiazepoxide for ETOH withdrawal
Diazepam - esp if co-existing benzo dependence, carbamazepine, clomethiazole
3 drugs to use in opioid dependence and indications
Methadone - similar opioid action without same ‘high’
Buprenorphine - partial agonist/antagonist that minimises effect on exogenous opioid
Naltrexone - competitively antagonises u-opioid with minimal agonism
Acamprosate mechanism
Stimulates GABAergic inhibitory neurons to reduce stimulation after ETOH intake. Used to maintain abstinence
1-3 line ETOH dependence treatment
- Acamprosate - maintain abstinence in patient
- Disulfiram - avoid consumption
- Naltrexone - negates effect
Contents and indication of pabrinex
Vitamins B and C - used in ?deficiency, IV or IM depending on acuity.
Alcoholism, acute infection, post-op
Mechanism of Disulfiram (antabuse)
Acetaldehyde dehydrogenase inhibitor induces hangover-like symptoms immediately after ETOH consumption
Signs of Ecstasy Toxicity
Neuro: Agitation, anxiety, confusion, ataxia Cardio: tachycardia, hypertension Hyponatraemia Hyperthermia Rhabdomyolysis
