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Pharmacotherapeutics > Substance use disorders > Flashcards

Substance use disorders Flashcards

1
Q

What is the probability after trying heroin that a person will become dependent?

A

25%

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2
Q

Self-administration of any drug in a culturally disapproved manner that causes adverse consequences.

A

Abuse

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3
Q

Behavior pattern of overwhelming involvement in use and securing of drug supply. Also tendency to relapse after discontinuation.

A

Addiction

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4
Q

Physiological state of neuroadaptation due to repeated administration of a drug that requires continued use to prevent withdrawal.

A

Dependence

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5
Q

Decreased effect after repeated administration that requires larger doses to obtain effect seen at the onset of use.

A

Tolerance

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6
Q

Psychological and physiologic reaction to abrupt cessation of a dependence producing drug.

A

Withdrawal

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7
Q

Substance dependence requires at least 12 month period of drug use with frequent negative consequences; at least 3 of what need to be present?

A
  1. tolerance
  2. withdrawal
    3 longer use or larger dose than intended
  3. desire/effort to reduce use
  4. Time spent in seeking, using, or recovery from use
  5. give up/reduce important activities
  6. continue to use despite consequences
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8
Q

Substance abuse requires at least 12 month period of drug use with frequent negative consequences, at least 1 of what need to be present?

A
  1. difficulty meeting obligations
  2. continued use in dangerous situation
  3. legal problems
  4. social problems
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9
Q

What neurotransmitter is stimulate, and what pathway?

A

Mesolimbic reward pathway resulting in an increase release of dopamine.

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10
Q

Slurred speech, poor coordination, blood shot eyes, decreased blood pressure, memory impairment, drowsiness, dizziness are signs of?

A

BZD intoxication

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11
Q

Tremor/muscle twitch, nausea/vomiting, anxiety, yawning, tachycardia, seizures, hallucinations are signs of?

A

BZD withdrawal

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12
Q

How is BZD withdrawal treated?

A

Long acting BZD and slowly taper by 10% every 1-2 weeks as tolerated.

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13
Q

Slurred speech, euphoria, dysphoria, apathy, psychomotor retardation, sedation, attention impairment, miosis are signs of?

A

Opiate intoxication

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14
Q

Bone/muscle pain, anxiety, insomnia, tachycardia, cough, sweating, yawning, mydriasis, piloerection, hypertension are signs of?

A

Opiate withdrawal

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15
Q

How is opiate withdrawal treated?

A 
Symptoms are treated.
NSAIDs - pain
BZD - anxiety
Sleep aids
Antidiarrheal
Antihypertensives
antiemetics
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16
Q

How is opiate dependence treated?

A
  1. motive patient in structured care program

2. methadone, buprenorphine, naltrexone

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17
Q

This drug is a long acting opioid agonist at mu receptors.

A

Methadone

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18
Q

Euphoria, sedation, constipation, increase QT, respiratory depression are side effects of?

A

Methadone

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19
Q

Methadone interacts with?

A

CYP3A4 inhibitor = increase methadone conc.

CYP3A4 inducers: decrease methadone conc

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20
Q

What is the regulatory issue with methadone?

A

Only dispensed for opiate dependence by licensed opiate addiction centers

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21
Q

What is the dosing for methadone?

A

initial 20-30mg. if symptoms persist after 2-4 hours, may give additional 5-10mg.
Maintenance of at least 80mg

22
Q

Which drug is used in pregnant women with opiate dependence?

A

Methadone

23
Q

Which drug is a partial agonist at mu opiate receptor and antagonist at kappa opiate receptor?

A

Buprenorphine

24
Q

What drug and ratio is buprenorphine combined with?

A

Naloxone in a 4:1 ratio

25
Q

constipation, nausea, vomiting, dizziness, precipitation of opiate withdrawal are side effects of?

A

Buprenorphine

26
Q

What interacts occur with buprenorphine?

A

CYP3A4

27
Q

What are the regulatory issues with buprenorphine?

A

Office-based prescribing after 8 hour training course. May treat up to 100 patients

28
Q

What is the dosing of buprenorphine?

A

Wait until symptoms of mild withdrawal.
initial 4mg. if symptoms persist after 2-4 hours, may give an additional 4mg. Total from day 1 given on day 2, and may repeat in 2-4hours if needed. Titration until no signs of withdrawal present.
Maintenance: 4-24mg/day Max 32mg/day

29
Q

Which drug is safer and more accessible? methadone or buprenorphine

A

buprenorphine

30
Q

Which drug is an opioid antagonist at mu receptor?

A

naltrexone

31
Q

Patient should be abstinent from opiates how long? otherwise naltrexone can cause?

A

at least 7 days to prevent precipitation of opiate withdrawal symptoms

32
Q

Alcohol has what 4 physiological effects?

A
  1. Enhance GABA inhibition
  2. Reduce glutamate presence at synapse
  3. Activate opiate receptors
  4. Increase the release of dopamine
33
Q

What questions are asked to screen for alcoholism?

A
  1. Cut back on drinking?
  2. Annoyed by criticizing drinking
  3. guilty about drinking
  4. eye-opener hangover
34
Q

Elevated MCV, AST, ALT, LDH.
Decreased B12, folic acid
Elevated uric acid, triglycerides, amylase,
Bone suppression

A

Alcohol abuse findings

35
Q

Euphoria, mild attention difficulty, mild coordnation, ataxia, confusion, coma, death are signs of?

A

alcohol intoxication

36
Q

anxiety, hypertension, sweating, tachycardia, nausea, vomiting, insomnia, hallucinations, tremor, seizures, confusion, agitation are signs of?

A

alcohol withdrawal

37
Q

Delirium tremens is assoicated with?

A

alcohol withdrawal

38
Q

Treatment of alcohol withdrawal

A
  1. BZD lorazepam 2mg TID

2. Thiamine 100mg IV, 100-200mg po x1 month

39
Q

What is the purpose of giving thiamine during alcohol withdrawal?

A

Prevent wernicke’s encephalopathy (ataxia, nystagmus, mental confusion)

40
Q

Those who survive wernicke’s but do not recover in 48-72hours will get?

A

korsakoff psychosis, chronic amnestic disorder

41
Q

How is alcohol dependence treated?

A

Disulfiram, naltrexone, acamprosate

42
Q

Which drug is an aldehyde dehydrogenase antagonist?

A

disulfiram( Antabuse)

43
Q

How is antabuse dosed?

A

after 12-24hours of last drink.

250mg daily

44
Q

drowsiness, garlic taste, sexual dysfunction, hepatitis, optic neuritis, peripheral neuropathy, nausea, headache are side effects of?

A

disulfiram (Antabuse)

45
Q

Which drug is effective at reducing number of drinks consumed and craving for alcohol?

A

Naltrexone (Revia, Vivitrol)

46
Q

How is naltrexone (Revia, vivitrol) dosed?

A

50mg po daily after 7-10days of opiate free

380mg IM monthly

47
Q

abdominal pain, nausea, anxiety, headache, heptotoxicity are side effects of?

A

naltrexone

48
Q

Which drug is an antagonist at glutamate NMDA receptors?

A

acamprosate (Campral)

49
Q

How is Campral dosed?

A

2x 333mg po tid

50
Q

What caution is their with Campral, what advantage?

A

Caution renal impairment. Advantage over naltrexone and disulfiram is not hepatotoxic

Pharmacotherapeutics (12 decks)

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