Substance-Related Disorders 1 Flashcards
What is the most important modifiable
risk factor in the US for health prevention?
Smoking
What does nicotine withdrawal present as?
-Restlessness
-Anxiety
-Irritability
-Sleep abnormalities
- HA
-Depression
-Increased appetite
-Weight gain
-Chest tightness
-Nicotine craving
_____ after nicotine abstinence is common
Relapse
What are the three main treatment options for smoking cessation?
- Nicotine tapering therapy
- Bupropion
- Varenicline
What options are available for nicotine tapering therapy?
-Gum
-Nasal sprays
-Transdermal patches
-Inhaler
-Lozanges
What is the MOA of Bupropion?
Dopamine and norepinephrine reuptake inhibitor
What is the MOA of Varenicline?
Blocks nicotine receptors, reducing nicotine activity, mimic effects thereby reducing the reward effect and preventing withdrawal
What is the timeline of Varenicline administration?
Begin one week prior to quit date an dcontinue four months after quit date
What are the AEs of Varenicline?
Suicidality
-HA
-Nausea
-Insomnia
-Neuropsychiatric conditions
What are the opioids?
- Heroin
- Hydrocodone
- Codeine
- Morphine
- Dextromethorphan
- Meperidine
- Methadone
How does opioid intoxication present?
Euphoria and sedation
(drowsiness, impaired social functioning, impaired memory, slow or slurred speech)
Opioid intoxication may progress to ____
N/V, seizures and coma
What are the hallmarks of opioid intoxication on physical exam?
-Pupillary constriction
-AMS
-Respiratory depression
-Bradycardia
-Hypotension
Opioid withdrawal may cause ___ breathing
Biot’s (groups of quick, shallow breaths followed by regular or irregular periods of apnea)
What is the classic GI effect of long term opioids?
Constipation
What are the symptoms of opioid withdrawal?
-Piloerections
-Pupil dilations
-Flu-like symptoms
-Rhinorrhea
-HTN
-Lacrimation
-Priritis
-Tachycardia
-N/V/D
Is opioid withdrawal life threatening?
No
How do you treat opioid intoxication/overdose?
Naloxone
What is naloxone?
Opioid antagonist
What is the onset of action of naloxone?
2 minutes IV (5 minutes IM)
How long does naloxone work?
30-60 minutes
How is opioid withdrawal managed?
Symptomatic withdrawal
What is the main medication used in opioid withdrawal?
Clonidine (decreases sympathetic symptoms)
Opioid withdrawal use _______ for diarrhea
Loperamide
Opioid withdrawal use _______ for abdominal cramps
Dicyclomine
Opioid withdrawal use _______ for joint and muscle pain/cramps
NSAIDs
Opioid withdrawal use _______ for mild withdrawal
Benzos
Opioid withdrawal use _______ for severe symptoms
Detox with methadone or Buprenorphine + Naloxone
What are the three options for longterm management of opioid dependence?
- Methadone
- Suboxone
- Naltrexone
What is the MOA of methadone?
Long-acting opioid agonist to control withdrawal
____ can be used in pregnant opioid dependent women
methadone
What is the adverse effect of methadone?
Can cause QT prolongation
What is the MOA of buprenorphine?
Partial opioid agonist
What is suboxone?
Buprenorphine + Naloxone
Why is Naloxone in Suboxone?
Prevents intoxication from IV injection
What is naltrexone?
Competitive opioid antagonist
What is the main concern with naltrexone?
Precipitates withdrawal if used within seven days of heroin use
How is naltrexone administered?
oral or monthly injections
When does alcohol withdrawal onset?
6-36 hours after last drink
What is the main category of alcohol w/d symptoms?
Increased CNS activity (tremors, anxiety, irritability, diaphoresis, palpitations, HTN, insomnia and GI
What is “uncomplicated” withdrawal?
No seizures, hallucinations or delirium tremens
When do alcohol withdrawal seizures usually start?
6-48 hours after last drink
What type of seizures usually occur during alcohol withdrawal?
Tonic-clonic
When do alcoholic hallucinosis usually start in alcohol withdrawal?
12-48 hours after last drink
What does alcoholic hallucinosis present as?
-Visual or tactile hallucinations
-Clear sensorium
-Normal vital signs
When do delirium tremens usually onset?
2-5 days after last drink
How does delirium tremens usually present?
-Delirium (altered sensorium)
-Hallucinations
-Agitation
-Abnormal vital signs
-Diaphoresis
Can alcohol withdrawal be fatal?
Yes
How is alcohol withdrawal treated?
-IV benzos
-IV fluids
-IV thiamine (B1)
-Magnesium
-Multivitamins (including B12 and folate)
-Electrolyte repletion
What is the MOA of benzos in alcohol withdrawal?
Potentiates GABA-mediated CNS inhibition (because alcohol mimics GABA and withdrawal causes excessive CNS activity)
What benzos are preferred in alcohol withdrawal for patients with cirrhosis or alcoholic hepatitis?
Lorazepam or Axazepam
