Substance Use Disorder

Question 1

Describe Mild Alcohol Abstinence Syndrome

Answer 1

disturbed sleep, weakness, nausea, anxiety, mild tremors

Question 2

Severe Syndrome:

Answer 2

12-72 hours after last drink.

Cramping, vomiting, hallucinations, tremors, increased HR and BP and temp, tonic-clonic seizures

Question 3

What is the main symptom of Severe Alcohol Abstinence Syndrome?

Answer 3

Delirium Tremens- severe hallucinations; cardiovascular collapse and death

Question 4

What does CIWA measure?

Answer 4

Used to determine how aggressive you need to be with withdrawal treatment

Question 5

Most effective drug used for acute withdrawal:

Answer 5

Benzodiazepine

• Most effective
• CNS depression
• Prevents seizures form DTs
• Reduce symptoms, stabilize VS

Question 6

Aside from benzodiazepines, what drugs are used to treat acute withdrawal?

Answer 6

Blood pressure meds
ex. Atenolol, propranolol
-Improve VS, decrease cravings
-Ex. Clonidine (decreases autonomic aspects of withdrawal symptoms)
-Anti-epileptic drugs
Ex. Carbamezapine (tegretol)
-decrease withdrawal symtpoms
-Prevent seizures

Question 7

What is used to maintain abstinence?

Answer 7

Disulfiram (antabuse)

-unpleasant reaction with alcohol is consumed. will persist for 2 weeks after last dose

Question 8

What is Re Via?

Answer 8

Naltrexone, pure opioid antagonist, decreases cravings, blocks pleasure effect. Nausea in 10% of people. Oral daily dose or IM depot once a month. MOST EFFECTIVE

Question 9

What are the SE of Nicotine withdrawal?

Answer 9

cravings, nervousness, restlessness, irritability, impatience, increased hostility, insomnia, impaired concentration, increased appetite, weight gain. Begin 24 hours can last weeks/months

Question 10

What are the First Line Smoking Cessation Aids?

Answer 10

• Nicotine (patch, gum, lozenge, nasal spray, inhaler)

- Non-nicotine (Vareniclin, Chantix. Buproprion SR, Zyban)

Question 11

What are two serious SE of Varenicline (Chantix)?

Answer 11

• neuropsychiatric effects (suicide risk)

- Cardiovascular effects (angina, HTN, MI)

Question 12

What are s&S of abstinence syndrome?

Answer 12

early yawning, rhinorrhea, sweating (10 hours after final dose)

• Anorexia, irritability, tremor, “gooseflesh”
• Worst: Violent sneezing, weakness, N/V/D, abdominal cramps, bone and muscle ache, muscle spasms, kicking movement

Question 13

Remember this two for opioid use disorder

Answer 13

Quitting “cold turkey” and “kicking the habit”

Question 14

How long does opioid withdrawal last?

Answer 14

7-10 days. Unpleasant but not dangerous.

Question 15

What Agonist drug is used for long-term management of opioid addiction?

Answer 15

Methadone

Question 16

What Agonist-Antagonist drug is used for long-term management of opioid addiction?

Answer 16

Buprenorphine (Suboxone)

Question 17

What Antagonist drug is used for long-term management of opioid addiction?

Answer 17

Naltrexone (Re Via)

Question 18

Methadone clinics:

Answer 18

No opioid withdrawal
No opioid induced euphoria
Creates high degree of tolerance- they won’t want street drugs anymore
-Less likely to seek street drugs
-once a day dosing
-has to be delivered by approved treatment program

Question 19

Opioid Agonist-Antagonist:

Answer 19

Suboxone, Buprenorphine

• partial agonist (mu receptor)
• full antagonist (kappa_
• Alleviates cravings, high doses can block opioid induced euphoria, ceiling to resp. depression (safer than methadone)
• buprenorphine + naloxone

Question 20

Opioid Antagonist:

Answer 20

Naltrexone (Re Via)

• used AFTER detox
• blocks euphoria
• prevents opioid use
• oral and IM formulation