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PHRM 845 > Substance Use Disorder > Flashcards

Substance Use Disorder Flashcards

1
Q

DSM-5, TR substance use disorders

  • the DSM-5 deletes the terms “ ___ “ and “ ___ “
  • criteria are applied to 10 different drugs/drug classes
A
  • abuse
  • dependence
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2
Q

DSM-5, TR SUD

__ of the following, occuring in a 12 month period

A

2

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3
Q

risk of setbacks

  • greatest during the ___ years of treatment
  • more than likely in first ___ months of abstinence
  • majority will be able to maintain complete or partial remission
  • 15-20% pattern of chronic relapse
  • 90% of those abstinent at ___ years
  • > 90% of those abstinent at 10 years will be abstinent at 20 years
A
  • first
  • 12
  • 10
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4
Q

treatment principles

  • a person with SUD is ___ recovering, never recovered
  • long term treatment is necessary to reduce risk of setback
  • no one is perfect, setbacks are possible, have to work on ___
  • patient must be engaged in treatment, significant work by both treatment providers and patient to maintain abstinence
  • treatment providers must be non-judgemental
  • treatment includes pharmacotherapy and psychotherapy
  • individual or group treatment
A
  • always
  • self-esteem
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5
Q

Blood Alcohol Concentration

___ mg/dL ( ___ mg%)
- moderate impairment, legal definition of intoxication in most states

A

80, 0.08

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6
Q

stages of alcohol withdrawal

stage 1: 6-8 hours
- moderate autonomic hyperactivity

stage 2: 24 hours
- autonomic hyperactivity with ___ and ___ hallucinations

stage 3: 1-2 days
- 4% of those untreated develop grand mal seizures 7-48 hours after drop in BAC

stage 4: 3-5 days
- ___ (DTs) in 5% of patients (confusion, illusions, hallucinations, agitation, tachycardia, hyperthermia)

A
  • auditory, visual
  • delirium tremens
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7
Q

risk factors for delirium tremens

  • prior history of DTs = higher risk of developing DT again (kindling)
  • number of detoxifications
  • consuming equivalent of 1 ___ of whiskey per day for 10-14 days prior to admission
  • early symptoms of withdrawal
  • ___ dysfunction
A
  • pint
  • hepatic
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8
Q

CIWA-AR

clinical institute withdrawal assessment

A
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9
Q

treating alcohol withdrawal

BZDs
no liver dysfunction: ___ / ___
- long t1/2 and decrease risk of breakthrough symptoms
- may also use ___ and ___ without liver dysfunction

liver dysfunction
- ___ and ___

A

diazepam, chlordiazepoxide
- lorazepam, oxazepam
- lorazepam, oxazepam

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10
Q

other treatment considerations

___ !!!
- always recommend if any suspicion of alcohol use
- dose: 100 mg daily, usually for duration of hospital stay, may be given after discharge, not considered long term-treatment

carbamazepine
- may be effective for mild/moderate symptoms
- unclear if prevents seizures of DT

valproic acid
- may reduce severity of alcohol withdrawal symtoms, including seizures

phenytoin
- not effective to treat withdrawal seizures, but will see patients taking months or years out from withdrawal seizures - d/c??

A

Thiamine

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11
Q

Wernicke’s encephalopathy

  • result of ___ deficiency - co-factor in glucose metabolism
  • wernicke can be precipitated by high ___ loads
  • give before ___ containing fluids

korsakoff;s psychosis
- chronic
- treat with antipsychotics

A
  • thiamine
  • glucose
  • dextrose
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12
Q

Disulfiram (Antabuse)

  • ___ therapy
  • unpleasant effects if alcohol is used (flushing, nausea, vomiting, tachycardia)
  • potential for cardiovascular collapse, death
  • must have highly ___ person
  • monitor LFTs
  • ___ mg daily usual maintenance dose
  • disulfiram reaction for up to ___ days after d/c
A
  • aversivemotivated
  • 250 mg
  • 14

so sensitive that hand sanitizer could set off topical reaction

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13
Q

Acamprosate (Capral)

  • maintenance of ___
  • ___ elimination, monitor function, avoid in severe impairment
  • ___ warning, SE also include diarrhea, nausea, depression, anxiety
  • ___ mg tabs - 2 tabs, TID
  • is safe to take is person uses alcohol
  • clinical effectiveness is limited by the number of tablets and doses per day
A
  • abstinence
  • renal
  • suicidal
  • 333
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14
Q

Naltrexone

  • clinical trails show best response to naltrexone over acamprosate in combination with psychotherapy
  • available in oral in IM doses
  • decreases ___ drinking, helps to increase ___ between drinking days
  • elevated ___ common, must monitor at baseline and routinely
  • need to evaluate ___ management needs, patient should have wallet card or be able to tell emergency providers that they are taking this
  • oral dose - 50 mg once daily
  • IM dose = 380 mg IM every 4 weeks, brand only, so very expensive
  • warning for injection site reactions
A
  • binge, time
  • LFTs
  • pain
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15
Q

treating opioid withdrawal

symptoms/treatment
- muscle aches/tension = ___ or ___
- ___ = hydroxyzine/BZDs
- abdominal cramping/N/V = ___
- ___ = loperamide
- sweating, yawning, tearing, runny nose = ___ or ___

A
  • acetaminophen or NSAIDs
  • agitation, anxiety, insomnia
  • ondansetron
  • diarrhea
  • clonidine, lofexidine

lofexidine is FDA approved for treating opioid withdrawal

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16
Q

treating opioid withdrawal

  • short-term tapering doses of opioids or buprenorphine may be used in the ___ period
  • buprenorphine should not be initiated until ___ - ___ hours after the last use of short-acting opioid (heroin or oxycodone) and ___ - ___ hours after the last use of methadone
A
  • withdrawals
  • 12-18, 24-48
17
Q

use of a2 agonists for opioid withdrawal symptoms

  • noradrenergic ___ causes many of the opioid withdrawal symptoms, leading to an increased risk of setback
  • treating noradrenergic symptoms can serve as an entry to longer-term treatment with MOUD and psychosocial treatment
  • craving is thought to be mediated by the mesolimbic reward pathway; physical withdrawal symptoms mediated by the locus coerulus
A
  • ## hyperactivity
18
Q

use of a2 agonists for opioid withdrawal symptoms

clonidine
___ - ___ mg/day (mild withdrawal)
up to ___ mg/day (severe withdrawal)
divided doses (0.1-0.2 mg/dose) given hourly

SE
- hypotension, less likely with ___

A

0.3-0.6
1.2
0.1-0.2

lofexidine

19
Q

use of a2 agonists for opioid withdrawal symptoms

lofexidine (0.18 mg tabs)
dosing: ___ mg (3 tabs) QID x 5-7 days
- max dose: ___ mg/day (16 tabs)
- no single dose above __ mg (4 tabs)
- may continue for up to ___ days
- dosing adjustmnt in renal and hepatic impairment

A
  • 0.54
  • 2.88
  • 0.72
  • 14
20
Q

ASAM - american society of addiction medicine

  • pregnant women should be screened for OUD in prenatal care and offered ___ or ___ ; limited data for naltrexone
  • incarcerated people of OUD shoud be screened and offered treatment; should NOT be required to switch meds if entering incarceration in meds
  • combo treatment with opioids and ___ is not recommended due to increased risk of fatal overdose
A
  • methadone, buprenorphine
  • BZDs
21
Q

maintenance treatment of opioid use disorders

  • methadone and buprenorphine are the oral drugs used for ___ treatment
  • ___ must be given in a licensed treatment program
  • ___ is usually given in combination with naloxone in a sublingual tablet/film strip dosage form; poor bioavailability when swallowed, must be ___
  • X-waiver removed
A
  • maintenance
  • methadone
  • ## buprenorphine, sublingual
22
Q

methadone treatment pearls

  • ___ t 1/2 - once daily dosing is appropriate for use in methadone clinical or opioid treatment programs
  • ___ slowly to dose that minimizes withdrawal symptoms, but does not provide euphoric effect
  • witnessed dosing, patients must “earn” take-home bottles
  • urine tox screen should be positive for methadone, generally negative for everything else
  • CYP 2B6, ___ , 2C19, 2D6 substrate; use in caution in patients also taking moderate to strong inhibitors/inducers
  • ___ prolongation is a serious concern - ECG monitoing is recommended
A
  • long
  • titrate
  • 3A4
  • QTc
23
Q

buprenorphine clinical pearls

  • given with ___ in same dosage form to decrease ___ - naloxone is not absorbed through the GI tract, so no effect if taken sublingually, but if injected, it will block effected of buprenorphine
  • to avoid precipitating withdrawal, initiaite therapy when there are clear signs of withdrawal; adminiter in divided doses on day 1
  • available in ___ films and tabs, must be dosed this way due to lack of gastric absorption
  • ___ substrate - monitor closely when used with inducers.inhibitors
  • monitor ___; use with serotonergic drugs may cause ___ syndrome
  • risk of ___ depression in overdose is musch less than with opioids, including methadone, due to partial ___ effect
A
  • naloxone, misuse
  • sublingual
  • 3A4
  • LFTs, serotonin
  • respiratory
  • agonist
24
Q

buprenorphine extended-release injections

  • ER injection (Sublocade, Brixadi)
  • moderate-severe OUD, patients initiated on sublingual buprenorphine and dose adjustment for at least __ days prior to first injection
  • monitor for use with ___ drugs; risk for ___ syndrome
  • 300 mg abdominal subQ injection every 4 weeks x 2 doses, then 100 mg every 4 weeks maintenance dose
  • REMS
  • ___ substrate - watch inducers/inhibitors
A
  • 7
  • serotonergic, serotonin
  • 3A4
25
Q

which to choose?

methadone
- clinical proof of efficacy
- FDA-approved for use in ___
- treatment program requires daily ___ unless patient graduates to “take-home” bottles
- must give urine samples and attend programming
- indiana ___ covers under medical billing
- stigma of program
- is there a program in the area?
- transportation?

A
  • pregnancy
  • attendance
  • medicaid
26
Q

which to choose?

buprenorphine
- effective treatment over ___ -term, longer-term clinical trials lacking
- office-based, can get __ -day Rx
- less stigma
- less ___ potential over methadone
- indiana ___ covers
- removal of X-waiver prescribing requirement may increase access

A
  • short
  • 30
  • misuse
  • medicaid
27
Q

naltrexone long-acting injection (Vivitrol)

  • given in same dose as that used for ___ use disorder
  • is the “___ “ treatment, patients must be ready for this, discuss with patient about readiness to encourange
  • risk for ___ if patient d/c treatment, must inform pt of this risk
  • concern in OUD for patients trying to “overcome” opioid receptor blockade with ___ doses of opioids
  • must inform pt about pain management issues - need to let providers know if injured or in need of acute pain management
A
  • alcohol
  • abstinence
  • overdose
  • higher
28
Q

naloxone kits

  • pharmacies allowed to dispense naloxone kits without prescription
  • FDA approved OTC naloxone ( ___ , 4 mg)
A

Narcan

29
Q

other substances - treatment

  • no FDA approved drug therpies to treat addiction of cocaine, amphetamines, bath salts, K2, maijuana, etc
  • psychosis that results from either K2/spice or bath salts intoxication is not generally responsive to treatment with ___
  • K2/Spice or bath salt deaths caused by cardiovascular collapse, hypokalemia, and seizures
  • use of ___ to treat hypertenition in cocaine intoxication is controversial
  • ___ due to substance withdrawal is common - may last for months after d/c use of cocain - treat like clinical depression
A
  • antipsychotics
  • BB
  • depression
30
Q

therapies under investigation

  • ____ has a growing body of clinical literature that supports use in SUD involving many different substances
  • ondansetron, baclofen, topiramate, olanzapine, gabapentin, and sodium oxybate may be useful for ___ use disorder
  • bupropion, topiramate, amphetamin-based stimulants (as replacement therapy) have been studied for ___ and ___ misuse
  • ___ for heroin dependence
A
  • N-acetyl cysteine
  • alcohol
  • amphetamine, cocaine
  • scopolamine

PHRM 845 (62 decks)

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