Substance Use Disorders Flashcards
What are the 5 C’s?
Craving, impaired Control, use despite Consequences, Chronicity, Compulsive
What increases the rate of alcohol absorption? (3)
- gastric bypass
- fasting state
- carbonation
What decreases the rate of alcohol absorption? (3)
- smoking
- anticholinergic agents
- carbohydrates/food
Where does alcohol distribute?
into total body water
What are two reasons that women experience greater effects from alcohol?
- males have a larger Vd because females/obese have more adipose and less total body water
- women have less efficient pre-hepatic alcohol dehydrogenase
What stage of alcohol withdrawal includes autonomic hyperactivity, tremors, hyperhidrosis, tachycardia, HTN, GI upset, anxiety, insomnia & vivid dreams?
How many hours in does this occur?
minor withdrawal
5-10 hours
What stage of alcohol withdrawal includes hallucinations (tactile/visual) & seizures (generalized tonic clonic)?
How many hours in does this occur?
major withdrawal
12-72 hours
What type of metabolism does alcohol undergo?
zero order
- removes fixed amount per unit time regardless of dose
What symptom is hallmark of delirium tremens?
How quickly does delirium tremens occur?
disordered consciousness
48-96 hours
What is the typical cause of death for a patient with delirium tremens?
arrhythmia or secondary complications (pneumonia, liver failure)
What are the components for management of alcohol withdrawal? (4)
- thiamine B1 50-100 mg QD
- D5W & 1/2 NS
- multivitamin
- benzo standing orders
What are the benzo standing order regimens for alcohol withdrawal?
symptom triggered
- one dose EVERY HOUR if CIWA Ar = 8-10
fixed schedule
- benzo taper
- Diazepam: 10 mg q6h x 4, 5mg q6h x8
- Lorazepam: 2mg q6h x4, 1mg q6h x 8
What agents are used for maintenance of sobriety? (6)
FDA approved: naltrexone, acamprosate, disulfiram
Off label: baclofen, gabapentin, topiramate
What are the CI for naltrexone use?
current opioid use
LFTs > 5x ULN
What is a patient required to do to start naltrexone?
be opioid free for 5-7 days
What alcohol/opiate maintenance agent is also available as a monthly injection?
naltrexone
What are the CI for acamprosate?
CrCl < 30
What is a patient required to do to start disulfiram?
must be abstinent for 12 hours prior
How long after the last dose of disulfiram can a reaction still occur with alcohol consumption?
14 days
What are the CI of disulfiram?
severe cardiac disease
coronary occlusion
What dose adjustments exist for acamprosate?
1/2 dose of CrCl 30-50 or body weight < 60 kg
What is a patient required to do to start acamprosate?
nothing, but ideally they should be abstinent to start
What way does the dose response curve shift in the case of sensitization?
LEFT
What way does the dose response curve shift in the case of tolerance?
RIGHT
What agent is used for benzo overdose?
flumazenil (Romazicon)
What is the CI for flumazenil (Romazicon)?
seizure disorder
What does higher Ki mean for opiates?
tighter binding to opiate receptor
What agents are used for opiate maintenance? (3)
- methadone
- buprenorphine
- naltrexone
What agents are used for opiate withdrawal? (3)
- methadone
- clonidine
- lofexidine (Lycemyra)
How does receiving doses from methadone clinics generally work?
initially have to go every day for dose
after ~ 90 days you can get 2 days/week take home
after ~2 years you can get 1 month take home at a time
What is a patient required to do to start buprenorphine?
must be in withdrawal already
Which buprenorphine LAI has a REMS program?
Sublocade
How is Sublocade given?
300 mg x 2 does then 150 mg MONTHLY
How is Brixidi given?
if not on bup before:
- test dose
- WEEKLY
if transitioning from oral bup:
- WEEKLY or MONTHLY
What is needed to start Sublocade?
oral buprenorphine has to have been started & adjusted for at least 7 days
What is the BBW for Sublocade?
harm or death given IV -> forms a solid mass upon contact with bodily fluids
What is true of Zubsolv compared to Suboxone?
Zubsolv has higher bioavailability, so it is given as a lower dose
What is true of Bunavail compared to Suboxone?
Bunavail has 2x higher bioavailability, so you can use 1/2 the dose
What are the brands for buprenorphine/naloxone sublingual tabs?
Suboxone & Zubsolv
What is the brand for buprenorphine/naloxone sublingual films?
Suboxone
What is the brand for buprenorphine sublingual tabs?
Subutex
What is the brand for buprenorphine/naloxone buccal films?
Bunavail
What are the brands of buprenorphine LAIs?
Sublocade & Brixidi
What suggests Xylazine contamination in a opioid overdose?
not having an optimal response to Narcan
What is the standard for care for opioid use disorder in expectant mothers?
METHADONE!!!
What BAC is associated with impaired balance, speech, vision, reaction time, and hearing?
0.07-0.09
What BAC is associated with a need for assistance in walking & total mental confusion?
0.25
What BAC is associated with a loss of consciousness?
0.3
