Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

neurology/psychiatry > substance use disorders > Flashcards

substance use disorders Flashcards

1
Q

define illicit drug use

A

anything that is illegal (marijuana, cocaine, heroin) AND misuse of prescription drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

define misuse

A

use in any way not directed by a doctor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

define binge drinking

A

5 or more drinks for males
4 or more drinks for females
(12 oz beer, 5 oz wine, 1.5 oz liquor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

define heavy alcohol use

A

binge drinking on 5 or more days in the past 30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

4 categories that define when substance use becomes a disorder

A

impaired control
social impairment
risky use
physical dependence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

define addiction

A

a chronic, relapsing brain disease characterized by compulsive drug seeking & use, despite harmful consequences

considered a brain disease because drugs change the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

true or false: opioid withdrawal is life threatening

A

false

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

general timeline of opioid withdrawal, depending on which opioids were used

A

short acting opioids: 6-12 hours after last dose
long acting opioids: 30 hours after the last dose
generally peaks at 72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are some symptoms of opioid withdrawal

A

n/v, stomach cramps, diarrhea, goosebumps, depression, drug cravings
can also include sweating/chills, shake/tremor, muscle ache, agitation/anxiety, more.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is special about fentanyl

A

it is highly lipophilic, leading to its concentration in fat tissue and additional considerations during withdrawal management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are some “comfort medications” used for opioid withdrawal

A

Pain: APAP, NSAIDs, diclofenac
anxiety: hydroxyzine
diarrhea: loperamide
insomnia: trazodone, melatonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what do the ASAM national practice guidelines for OUD say about opioid withdrawal management

A
  1. methadone or buprenorphine recommended> abrupt cessation of opioids
  2. detoxification on its own, without treatment, is NOT a treatment method for OUD and is not recommended.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

describe the role of alpha 2 agonists in opioid withdrawal

A

clonidine and lofexidine may be used for symptomatic relief during withdrawal management; they work by reducing sympathetic outflow from CNS, decreasing peripheral resistance/vascular resistance, heart rate, BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the side effects seen from alpha 2 agonists

A

orthostatic hypotension, sedation, dizziness, somnolence, fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

describe which of the following are full or partial agonists, or antagonists:
methadone, buprenorphine, naltrexone, naloxone

A

methadone= FULL agonist
buprenorphine= PARTIAL agonist
naltrexone and naloxone= antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the role of methadone in opioid withdrawal treatment

A

only given in specially licensed methadone clinics, unless
1. inpatient & admitted for something OTHER than opioid withdrawal
2. outpatient for 72 hours max to cover patient until they go to the clinic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the pearls to definitely know about methadone

A
  1. causes QT prolongation
  2. has drug interactions
  3. preferred agent in pregnancy (DOES NOT PRECIPITATE WITHDRAWAL!)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the difference in methadone dosing between withdrawal treatment, and maintenance treatment

A

withdrawal: 20-30 mg (NTE 40)
maintenance: higher; initial 20-30 but titrated 5-10 mgs every few days to 80-120 mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

methadone side effects

A

QT PROLONGATION
hypotension, dizziness, drowsiness, constipation, nausea/vomiting, respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the most important thing to know about buprenorphine in opioid withdrawal treatment

A

given the HIGH BINDING AFFINITY, this drug will displace ANY opioids in the patient’s system causing PRECIPITATED WITHDRAWAL

MUST WAIT UNTIL PATIENT IS IN WITHDRAWAL TO GIVE! very unfortunate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

which drugs are used for opioid withdrawal treatment, and which drugs are used for maintenance

A

withdrawal: methadone, buprenorphine

maintenance: methadone, buprenorphine, naltrexone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is a disadvantage to consider when using methadone as a maintenance treatment?

A

patient has to present to the methadone clinic DAILY to ingest doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

which is the preferred drug in pregnancy and why

A

methadone– withdrawal leads to fetal harm and is not necessary to start methadone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is a good maintenance dose for buprenorphine

A

16-24 mg/day, but 24 is better

lower doses associated with a greater risk of treatment discontinuation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

counseling for buprenorphine

A

typical ADEs associated with opioids; requires proper administration technique (SL/buccal) and mouth should be rinsed after use to prevent long term dental decay.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

true/false: buprenorphine prescribing requires an X waiver?

A

false; it previously did but now you just need a regular DEA number

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

talk about the pros/cons of buprenorphine formulations?

A

1: monoproduct: contains only BUP, may increase risk of diversion/misuse

2: combination: contains BUP and naloxone to act as a deterrent for misuse

3: injectables Sublocade and Brixadi: contain only BUP; increased adherence and decreased diversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is the role of naltrexone in maintenance OUD treatment?

A

the long acting injectable Vivitrol is used (no PO form for OUD)
A must higher risk for opioid relapse & overdose, making it only for super stable patients.

29
Q

how does the combo of buprenorphine/naloxone deter misuse?

A

naloxone is minimally absorbed PO; meaning in the combo product it is not pharmacologically active. It’s purpose in the combination is to discourage injection use because it would then become active and cause withdrawal

30
Q

compare/contrast Sublocade and Brixadi

A

Sublocade: lower tolerability, forms a palpable depot/lump, higher plasma concentrations above what is achieved by SL BUP, not allowed in pregnancy

Brixadi: higher injection tolerability, no lump, lower plasma concentrations/similar levels to SL BUP, weekly formulation is allowed in pregnancy

31
Q

what is the duration of therapy in OUD

A

generally as long as the patient sees benefit or until they desire to discontinue

32
Q

what is the evidence behind higher doses of naloxone?

A

no difference in survival
8 mg products had a significantly higher prevalence of opioid withdrawal signs & symptoms than the 4 mg products

33
Q

naloxone side effects?

A

withdrawal
very safe & effective: very rarely anaphylactic reactions, pulmonary edema is related to the opioid used and not the narcan

34
Q

what is the MOA of alcohol

A

GABA agonist: inhibitory
NMDA antagonist: additional inhibitory
net result being CNS depression

35
Q

what is the kinetic order of alcohol

A

zero order elimination (NOT concentration dependent)
so it takes TIME to clear from the body

36
Q

true or false: alcohol withdrawal is life threatening

A

true!

37
Q

what are some risk factors for complicated alcohol withdrawal

A

heavy use
history of delirium tremens
comorbid conditions
seizure disorder
age 65+
long duration of use

VERY SERIOUS RISK FACTOR: patient is conscious/coherent at a BAC 0.30

38
Q

what is delirium tremens?

A

hallucination, disorientation, tachycardia, fever, hypertension, diaphoresis, agitation

39
Q

risk factors for delirium tremens

A

history of sustained drinking
history of previous DT
age >30
concurrent illness
significant alcohol withdrawal with an elevated alcohol level
LONGER period since last drink

40
Q

patients who present with alcohol withdrawal more than ___ hours after their last drink are more likely to develop DT than those who present sooner.

A

48 hours

41
Q

when is delirium tremens onset?

A

48-72 hours after last drink

42
Q

first line drug of choice for alcohol withdrawal

A

benzodiazepines (because they are GABA agonists similar to alcohol)

43
Q

dosing for benzodiazepines in alcohol withdrawal

A

can be “fixed dose taper” or “symptom triggered”

44
Q

pros/cons of fixed dose taper vs symptom triggered for benzo dosing for alcohol withdrawal

A

symptom triggered: reduces amount of benzo use, reduces length of stay, maybe more appropriate if uncomplicated withdrawal

fixed dose: increased benzo requirement, increased length of stay, but maybe more appropriate if complicated withdrawal

45
Q

which benzos are short acting

A

OLA
oxazepam
lorazepam
alprazolam

46
Q

which benzos are long acting

A

CDC
clonazepam
diazepam
chlordiazepoxide

47
Q

when to choose a short acting benzo for alcohol withdrawal

A

lower amount of alcohol use or lower amount of benzo use/low potency benzo

48
Q

when to choose a long acting benzo for alcohol withdrawal

A

significant use of alcohol, presentation with high BAC, significant use of benzos or high potency benzos or longer acting benzos

49
Q

which drug is reserved for severe withdrawal, failed benzo therapy, or history of complicated withdrawal

A

phenobarbital

50
Q

what are some of the inferior options for treating alcohol withdrawal

A

gabapentin
dexmedetomidine
ketamine
carbamazepine
baclofen

51
Q

what are (4) long term complications of alcohol use

A

wernicke encephalopathy
korsakoff syndrome
liver disease and cirrhosis
depression

52
Q

define wernicke encephalopathy

A

acute, reversible neurologic complication of thiamine (vitamin B1) deficiency that is commonly associated with alcohol use disorder

53
Q

what is the triad of symptoms of wernicke encephalopathy

A

Encephalopathy: altered mental state
oculomotor dysfunction: nystagmus, provoked by horizontal gaze to both sides
gait, ataxia: unsteady when walking

54
Q

dosing of thiamine for alcohol withdrawal vs dosing for suspected wernicke encephalopathy

A

patients being treated for alcohol withdrawal: give thiamine 100 mg IM/IV x 3 days then 100 mg PO daily thereafter

suspect wernicke: thiamine 500 mg IM TID x 2 days, then 500 mg IM daily x 5 days, then 100 mg PO daily thereafter

55
Q

do you wait for confirmation of wernicke encephalopathy diagnosis before giving thiamine

A

NO!! a delay in treatment risks permanent damage. if untreated it can lead to coma, death

56
Q

what is korsakoff syndrome

A

an IRREVERSIBLE neuropsychiatric manifestation of wernicke encephalopathy which develops later if under treated or not treated. prognosis is poor and there is no effective treatment

57
Q

what are some symptoms of korsakoff syndrome

A

confabulation, memory deficits, apathy, intact sensorium and long term memory

58
Q

how is korsakoff syndrome prevented

A

parenteral thiamine

59
Q

what are the 3 main drugs used for alcohol use disorder maintenance treatment

A

naltrexone
acamprosate
disulfiram

60
Q

mechanism of naltrexone

A

mu opioid receptor antagonist

61
Q

adverse effects of naltrexone

A

GI upset, headache, dizziness, insomnia, increased LFTs
improve compliance with vivitrol IM every 4 weeks

62
Q

when is naltrexone contraindicated

A

liver impairment

63
Q

mechanism of acamprosate

A

modulates glutamate transmission

64
Q

when is acamprosate contraindicated

A

CrCL<30

65
Q

mechanism of disulfiram

A

inhibits aldehyde dehydrogenase, causing buildup of acetaldehyde: a disulfiram reaction then ensues
reaction: sweating, headache, dyspnea, hypotension, flushing, palpitations, nausea, vomiting

66
Q

what should you counsel patients about when dispensing disulfiram

A

hidden forms of alcohol (mouthwash, cooking ingredients, etc)

67
Q

side effects of disulfiram

A

besides the intended side effects: severe and sometimes fatal hepatic failure

68
Q

drugs for cocaine use disorder

A

non-psychostimulants: bupropion, topiramate
psychostimulants: modafanil, ER mixed amphetamine salts

69
Q

drugs for amphetamine-type stimulant use disorder

A

non-psychostimulants: bupropion +/- naltrexone, topiramate, mirtazapine
psychostimulants: ER Methylphenidate

neurology/psychiatry (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions