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PSYCH Therapeutics > Substance Use Disorder > Flashcards

Substance Use Disorder Flashcards

1
Q

Goals of TX :
1. Treat __ and __ where possible
2. reduce ___
3. Reduce ___ disorders (secondary illnesses)
4. Prevent ____
5. Improve ____
6. Minimize ____
7. Prevent or reduce ___ and ___ of ___

A
  1. Intoxication, withdrawal
  2. innapropriate use
  3. substance induced
  4. death from the substance
  5. QOL
  6. Ae’s of tx
  7. severity, frequency , relapse
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2
Q

Opioid Physio Effects : Intoxication
1. D, S, I, C, I, E or A

TOXICITY:
2. S, B, H , E , C, F

WITHDRAWAL
3. D, N or V, M, L or R, P, P, or S, D, Y, F, I , A, R , A

A
  1. Drowsiness, slurred speech , impairment in attention or memory , constricted pupils (miosis), itching, euphoria, agitation
  2. Shallow, slow respirations,
    Bradycardia , hypothermia, excessive drowsiness, coma, FATAL OVERDOSE
  3. Dysphoric mood, N/V, Muscle aches, lacrimation , rhinorrhea, pupillary dilation, piloerection , sweating, diarrhea, yawning, fever , insomnia, autonomic hyperactivity , restlessness, anxiety
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3
Q

TX ALGORITHM :
1. If they’re intoxicated/experiencing toxicity … whats first line?
2. If they’re experiencing withdrawal/use disorder, whats first line? and whats supportive therapy ?

A
  1. Naloxone
  2. Buprenorphine +/- naloxone, Methadone, Naltrexone –> CLonidine Or lofexidine
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4
Q

Naloxone :
1. MOA?
2. Onset ?
3. Dose? IM/Nasal spray
4. Administration?

  1. What formulations are available of naloxone? (4)
  2. WHich version is FDA approved for OTC?

Kim , know how to give narcan

A
  1. Opioid receptor antag
  2. < 5 mins
  3. IM 0.4-2mg
    Nasal spray : 2-8 mg (depends on product)
  4. Can repeat eevry 2-3 mins PRN (IM has longest duration)
    -Continue dosing until patient is breathing or max dose is reached
  5. IM injections (vials), IM injections (Zimhi) which are prefilled syringes, Intranasal spray , Intrananasal spray (atomizer)
  6. Narcan 4mg
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5
Q

Symptomatic Management of Opioid Withdrawal:
1. Insomnia
2. HA, muscle aches, pain :
3. Abdom cramps
4. Diarrhea
5. N/V
6. Noradrenergic Hyperactivity

A
  1. trazodone prn
  2. tylenol and or ibuprofen
  3. dicyclomine
  4. loperamide PRN
  5. Zofran PRN
  6. CLonidine , Lofexidine
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6
Q

Clonidine :
1. MOA?
2. Off label for management of ?
3. Onset ? duration ?
4. Monitor for?
5. Precautions ? (2)

Lofexidine :
1. MOA?
2. FDA approved indications?
3. Onset?
4. Duration ?
5. warnings/precautions? Discontinue agent over? (4)

A
  1. alpha 2 agonist
  2. autonomic hyperactivity secondary to opioid withdrawal
  3. 0.5-1hr, until withdrawal sx’s resolve
  4. withdrawal sx’s and BP/HR, QTc interval
  5. CNS depression, avoid abrupt discontinuation after 6-10 days of use
  6. alpha 2 agonist
  7. opioid withdrawal sx’s in adults
  8. 3-5 hrs
  9. 5-7 days after last opioid use (up to 14days)
  10. Hypotension, syncope, dizzy , sedation
    -QT prolongation
    -CNS depression
    -Discontinue agent over 2-4 days
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7
Q

Medications for Opioid Use Disorder (MOUD) :
1. Buprenorphine +/- Naloxone
-MOA?
2. Formulations?
3. Onset ?
4. Metab?
5. Can precipitate ___, dosing is typically started when ?

A
  1. Partial mu opioid R agonist.
    -COmbined w/naloxone to decr misuse if crushed/injected
  2. PO/SL (w. and w/o naloxone)
    -SQ (weekly-Brixadi and monthly-Brixadi+Sublocade)
  3. 20-40 mins (po), 24 hrs SQ
  4. Hepatic, CYP3a4 and UGT
  5. opioid withdrawal
    -after withdrawal starts
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8
Q

Buprenorphine AE”s:
1. Warnings and Precautions for :
-C, Use in pre existing ___, H, H, H, Q, REMS REQUIREMENTS !

  1. Adverse effects:
    -With SL formulation ?
    -Oral ___
    -C, N
    -___ depression
    -____ syndrome
    -S
A
  1. CNS depression
    -Hepatic dysfunction
    -Hepatic events (hepatitis)
    -Hypersensitivity events
    -Hypotension
    -QTc prolongation
  2. Dental ae’s such as dental carries, tooth decay
    -Hypoesthesia
    -Constipation , nausea
    -Respiratory
    -Withdrawal
    -Sweating
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9
Q

MOUD : Methadone
1. MOA?
2. Peak onset ?
3. Dosed how often for OUD?
4. Metab through ?
5. CI’s ? (4)
6. Warnings/Precautions BOXED warnings ?
7. AE’s (5)

A
  1. Full mu opioid receptor agonist
  2. 2-4 hrs
  3. daily
  4. Hepatic via CYP enzymes (So be weary of patients who have hepatic impairment)
  5. Respiratory depression , bronchial asthma, GI obstruction, hypersensitivity
  6. Abuse, misuse
    -Respiratory depression
    * QT prolongation (avoid in QTc
    > 500msec)
    * Neonatal opioid withdrawal
    syndrome
    * CYP interactions 3A4, 2B6, 2C19, 2C9, or
    2D6
    * Risk with concomitant CNS depressants
    * Medication errors with oral solution (1mg/ml, 2mg/ml)
    * Serotonin Syndrome
    * Severe hypotension
  7. Sweating , orthostasis, constipation , cns depression, pruritis, rash, urticaria
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10
Q

Naltrexone :
1. MOA
2. Indication ?
3. Biphasic release pattern so onset is?
4. Duration
5. Contraindications:
H, P, F, C, P, Patient must be off all opioids for ?
In ___

  1. Warnings :
    -__ thoughts/depression
    -__ disorders
    -___ impairment (Avoid in this state or __)
    -___ impairment (use w/caution in mod to severe )
  2. AE’s :
    Accidental ___ after naltrexone discontinuation
    H
    I
    Naltrexone precipitated ___
    S
    GI upset (such as)
    A, D, H, I , M
A
  1. Full opioid receptor antag
  2. prevention of relapse to opioid dependence following withdrawal
  3. 2hrs and 2-3 days
  4. 4 weeks
  5. Hypersensitivity , physiologic dependence on opioids, failure to pass naloxone challenge, , current use of opioid analgesics (including buprenorphine) , positive Urine tox for opioids,
    7-10 days
    -Acute opioid withdrawal
  6. SUicidal
    -Bleeding
    -hepatic (failure)
    -renal
  7. opioid OD .
    Hepatotoxic, inj site rxns , opioid withdrawal, syncope, (Abdom pain, decr appetite, diarrhea, N/V)
    Anxiety, Dizzy, HA, Insomnia, Muscle aches
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11
Q

Special Populations :
1. Adolescents : What drug is approved?
What drug can be used w/parental approval?
Should incorporate ???

  1. Elderly : what 2 drugs can u use?
  2. Pregnancy/Lactation : What drugs can u use? (2)

NON pharm :
4. Psychosocial support such as?
5. Harm reduction supplies such as?

A
  1. Burprenorphine (18), used in those as young as 16
    - Methadone
    -Non pharm approaches
  2. Buprenorphine and Methadone (monitor closely)
  3. Buprenorphine
    -Easier admin and initiation. Lower risk of OD. Potentially milder neonatal abstinence syndrome (NAS)

Methadone : is standard of care. Admin IN CLINIC! Many CYP interactions. OD potential.

  1. Recovery support services, case management, specific social needs assistance. CBT.
  2. Narcan, fentanyl test strips , syringe exchange
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12
Q

Sedative Hypnotics :
1. Intoxication sx’s?
M, I, A, I, D, V, C, S, U, U, I ,S or C

  1. Withdrawal sx’s:
    A. Behavioral and Psych ?
    A,A,S,R,D,I,P,D,D,C,P,C

B. Pyshical sx’s?
T, S, N/V, S, Incr __, H, I or T, S, P, F

A
  1. Mood changes and lability
    Impaired decision making
    aggression
    innaprop sexual behaviors
    Drowsy
    visual disturbances
    confusion
    Slurred speech
    uncoord movements
    unsteady gait
    invol eye movement
    stupor or coma
  2. anxiety
    * agitation
    * sleep disturbances
    * restlessness
    * depression
    * irritability
    * psychosis
    * delirium
    * derealization
    * confusion
    * perceptual disturbances
    * cognitive disturbances

B. tremors
* sweating
* Nausea/vomiting
* shortness of breath
* increased BP/HR
* headache
* involuntary muscle movements or twitching
* Seizures  common, particularly in the setting of abrupt cessation
* psychomotor agitation
* “flu-like” symptoms

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13
Q

CANNABIS :
3. Acute effects?
4. Chronic ?
5. Withdrawal?

STIMULANTS :
1. Acute ?
2. Chronic?
3. WIthdrawal ?

A
  1. Well being feeling, relaxed, friendly, slowed cognition, panic, delirium and psychosis (highdose)
  2. Amotivation . Poor attention span, judgemnt, and communication . Distractibility, Loss of insight, Hyperemesis syndrome
  3. Anxiety, dysphoria, sleep changes, anorexia, HA, tremors, chills, irritability
  4. Euphoria, alertness, incr energy, Decr appetite, weight loss, Bruxism, tremor, anger, grandiosity
  5. Malnutrition, paranoia, dental carries, cardio effects /fatal OD
  6. Fatigue, vivid dreams, intense cravings, anxiety and agitation, anhedonia, hypersomnolence
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14
Q

Dissociatives (Ketamine): Effects
1. Acute
2. Chronic (2)
3. OD

Hallucinogens : Effects
1. ACute V.H.D.A.B.I, F, B
2. Chronic

A
  1. Euphoria, altered time perception, dissociation
    -Hallucinations, delusions, paranoia
    -Delirium, amnesia
    -Autonomic hyperactivity
    -Analgesia
    Vertical nystagmus
  2. Prolonged delirium/amnesia
    -Isolation
  3. Coma, extremely high temp, seizures, muscle breakdown
  4. Visual trails, heightened sensations , depersonalization, derealization, autonomic hyperactivity , bruxism, impaired judgement, feeling of losing one’s mind
    bad trip (panic attack)
  5. Flashbacks
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PSYCH Therapeutics (11 decks)

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