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Therapeutics > Substance Use Disorders > Flashcards

Substance Use Disorders Flashcards

1
Q

What are the 5 C’s?

A

Craving, impaired Control, use despite Consequences, Chronicity, Compulsive

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2
Q

What increases the rate of alcohol absorption? (3)

A
  1. gastric bypass
  2. fasting state
  3. carbonation
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3
Q

What decreases the rate of alcohol absorption? (3)

A
  1. smoking
  2. anticholinergic agents
  3. carbohydrates/food
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4
Q

Where does alcohol distribute?

A

into total body water

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5
Q

What are two reasons that women experience greater effects from alcohol?

A
  1. males have a larger Vd because females/obese have more adipose and less total body water
  2. women have less efficient pre-hepatic alcohol dehydrogenase
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6
Q

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?

A

minor withdrawal

5-10 hours

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7
Q

What stage of alcohol withdrawal includes hallucinations (tactile/visual) & seizures (generalized tonic clonic)?

How many hours in does this occur?

A

major withdrawal

12-72 hours

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8
Q

What type of metabolism does alcohol undergo?

A

zero order
- removes fixed amount per unit time regardless of dose

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9
Q

What symptom is hallmark of delirium tremens?

How quickly does delirium tremens occur?

A

disordered consciousness

48-96 hours

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10
Q

What is the typical cause of death for a patient with delirium tremens?

A

arrhythmia or secondary complications (pneumonia, liver failure)

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11
Q

What are the components for management of alcohol withdrawal? (4)

A
  • thiamine B1 50-100 mg QD
  • D5W & 1/2 NS
  • multivitamin
  • benzo standing orders
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12
Q

What are the benzo standing order regimens for alcohol withdrawal?

A

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

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13
Q

What agents are used for maintenance of sobriety? (6)

A

FDA approved: naltrexone, acamprosate, disulfiram

Off label: baclofen, gabapentin, topiramate

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14
Q

What are the CI for naltrexone use?

A

current opioid use

LFTs > 5x ULN

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15
Q

What is a patient required to do to start naltrexone?

A

be opioid free for 5-7 days

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16
Q

What alcohol/opiate maintenance agent is also available as a monthly injection?

A

naltrexone

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17
Q

What are the CI for acamprosate?

A

CrCl < 30

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18
Q

What is a patient required to do to start disulfiram?

A

must be abstinent for 12 hours prior

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19
Q

How long after the last dose of disulfiram can a reaction still occur with alcohol consumption?

A

14 days

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20
Q

What are the CI of disulfiram?

A

severe cardiac disease

coronary occlusion

21
Q

What dose adjustments exist for acamprosate?

A

1/2 dose of CrCl 30-50 or body weight < 60 kg

22
Q

What is a patient required to do to start acamprosate?

A

nothing, but ideally they should be abstinent to start

23
Q

What way does the dose response curve shift in the case of sensitization?

A

LEFT

24
Q

What way does the dose response curve shift in the case of tolerance?

A

RIGHT

25
Q

What agent is used for benzo overdose?

A

flumazenil (Romazicon)

26
Q

What is the CI for flumazenil (Romazicon)?

A

seizure disorder

27
Q

What does higher Ki mean for opiates?

A

tighter binding to opiate receptor

28
Q

What agents are used for opiate maintenance? (3)

A
  1. methadone
  2. buprenorphine
  3. naltrexone
29
Q

What agents are used for opiate withdrawal? (3)

A
  1. methadone
  2. clonidine
  3. lofexidine (Lycemyra)
30
Q

How does receiving doses from methadone clinics generally work?

A

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

31
Q

What is a patient required to do to start buprenorphine?

A

must be in withdrawal already

32
Q

Which buprenorphine LAI has a REMS program?

A

Sublocade

33
Q

How is Sublocade given?

A

300 mg x 2 does then 150 mg MONTHLY

34
Q

How is Brixidi given?

A

if not on bup before:
- test dose
- WEEKLY

if transitioning from oral bup:
- WEEKLY or MONTHLY

35
Q

What is needed to start Sublocade?

A

oral buprenorphine has to have been started & adjusted for at least 7 days

36
Q

What is the BBW for Sublocade?

A

harm or death given IV -> forms a solid mass upon contact with bodily fluids

37
Q

What is true of Zubsolv compared to Suboxone?

A

Zubsolv has higher bioavailability, so it is given as a lower dose

38
Q

What is true of Bunavail compared to Suboxone?

A

Bunavail has 2x higher bioavailability, so you can use 1/2 the dose

39
Q

What are the brands for buprenorphine/naloxone sublingual tabs?

A

Suboxone & Zubsolv

40
Q

What is the brand for buprenorphine/naloxone sublingual films?

A

Suboxone

41
Q

What is the brand for buprenorphine sublingual tabs?

A

Subutex

42
Q

What is the brand for buprenorphine/naloxone buccal films?

A

Bunavail

43
Q

What are the brands of buprenorphine LAIs?

A

Sublocade & Brixidi

44
Q

What suggests Xylazine contamination in a opioid overdose?

A

not having an optimal response to Narcan

45
Q

What is the standard for care for opioid use disorder in expectant mothers?

A

METHADONE!!!

46
Q

What BAC is associated with impaired balance, speech, vision, reaction time, and hearing?

A

0.07-0.09

47
Q

What BAC is associated with a need for assistance in walking & total mental confusion?

A

0.25

48
Q

What BAC is associated with a loss of consciousness?

A

0.3

Therapeutics (17 decks)

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