Substance use disorders Flashcards
What is the probability after trying heroin that a person will become dependent?
25%
Self-administration of any drug in a culturally disapproved manner that causes adverse consequences.
Abuse
Behavior pattern of overwhelming involvement in use and securing of drug supply. Also tendency to relapse after discontinuation.
Addiction
Physiological state of neuroadaptation due to repeated administration of a drug that requires continued use to prevent withdrawal.
Dependence
Decreased effect after repeated administration that requires larger doses to obtain effect seen at the onset of use.
Tolerance
Psychological and physiologic reaction to abrupt cessation of a dependence producing drug.
Withdrawal
Substance dependence requires at least 12 month period of drug use with frequent negative consequences; at least 3 of what need to be present?
- tolerance
- withdrawal
3 longer use or larger dose than intended - desire/effort to reduce use
- Time spent in seeking, using, or recovery from use
- give up/reduce important activities
- continue to use despite consequences
Substance abuse requires at least 12 month period of drug use with frequent negative consequences, at least 1 of what need to be present?
- difficulty meeting obligations
- continued use in dangerous situation
- legal problems
- social problems
What neurotransmitter is stimulate, and what pathway?
Mesolimbic reward pathway resulting in an increase release of dopamine.
Slurred speech, poor coordination, blood shot eyes, decreased blood pressure, memory impairment, drowsiness, dizziness are signs of?
BZD intoxication
Tremor/muscle twitch, nausea/vomiting, anxiety, yawning, tachycardia, seizures, hallucinations are signs of?
BZD withdrawal
How is BZD withdrawal treated?
Long acting BZD and slowly taper by 10% every 1-2 weeks as tolerated.
Slurred speech, euphoria, dysphoria, apathy, psychomotor retardation, sedation, attention impairment, miosis are signs of?
Opiate intoxication
Bone/muscle pain, anxiety, insomnia, tachycardia, cough, sweating, yawning, mydriasis, piloerection, hypertension are signs of?
Opiate withdrawal
How is opiate withdrawal treated?
Symptoms are treated. NSAIDs - pain BZD - anxiety Sleep aids Antidiarrheal Antihypertensives antiemetics
How is opiate dependence treated?
- motive patient in structured care program
2. methadone, buprenorphine, naltrexone
This drug is a long acting opioid agonist at mu receptors.
Methadone
Euphoria, sedation, constipation, increase QT, respiratory depression are side effects of?
Methadone
Methadone interacts with?
CYP3A4 inhibitor = increase methadone conc.
CYP3A4 inducers: decrease methadone conc
What is the regulatory issue with methadone?
Only dispensed for opiate dependence by licensed opiate addiction centers
What is the dosing for methadone?
initial 20-30mg. if symptoms persist after 2-4 hours, may give additional 5-10mg.
Maintenance of at least 80mg
Which drug is used in pregnant women with opiate dependence?
Methadone
Which drug is a partial agonist at mu opiate receptor and antagonist at kappa opiate receptor?
Buprenorphine
What drug and ratio is buprenorphine combined with?
Naloxone in a 4:1 ratio
constipation, nausea, vomiting, dizziness, precipitation of opiate withdrawal are side effects of?
Buprenorphine
What interacts occur with buprenorphine?
CYP3A4
What are the regulatory issues with buprenorphine?
Office-based prescribing after 8 hour training course. May treat up to 100 patients
What is the dosing of buprenorphine?
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
Which drug is safer and more accessible? methadone or buprenorphine
buprenorphine
Which drug is an opioid antagonist at mu receptor?
naltrexone
Patient should be abstinent from opiates how long? otherwise naltrexone can cause?
at least 7 days to prevent precipitation of opiate withdrawal symptoms
Alcohol has what 4 physiological effects?
- Enhance GABA inhibition
- Reduce glutamate presence at synapse
- Activate opiate receptors
- Increase the release of dopamine
What questions are asked to screen for alcoholism?
- Cut back on drinking?
- Annoyed by criticizing drinking
- guilty about drinking
- eye-opener hangover
Elevated MCV, AST, ALT, LDH.
Decreased B12, folic acid
Elevated uric acid, triglycerides, amylase,
Bone suppression
Alcohol abuse findings
Euphoria, mild attention difficulty, mild coordnation, ataxia, confusion, coma, death are signs of?
alcohol intoxication
anxiety, hypertension, sweating, tachycardia, nausea, vomiting, insomnia, hallucinations, tremor, seizures, confusion, agitation are signs of?
alcohol withdrawal
Delirium tremens is assoicated with?
alcohol withdrawal
Treatment of alcohol withdrawal
- BZD lorazepam 2mg TID
2. Thiamine 100mg IV, 100-200mg po x1 month
What is the purpose of giving thiamine during alcohol withdrawal?
Prevent wernicke’s encephalopathy (ataxia, nystagmus, mental confusion)
Those who survive wernicke’s but do not recover in 48-72hours will get?
korsakoff psychosis, chronic amnestic disorder
How is alcohol dependence treated?
Disulfiram, naltrexone, acamprosate
Which drug is an aldehyde dehydrogenase antagonist?
disulfiram( Antabuse)
How is antabuse dosed?
after 12-24hours of last drink.
250mg daily
drowsiness, garlic taste, sexual dysfunction, hepatitis, optic neuritis, peripheral neuropathy, nausea, headache are side effects of?
disulfiram (Antabuse)
Which drug is effective at reducing number of drinks consumed and craving for alcohol?
Naltrexone (Revia, Vivitrol)
How is naltrexone (Revia, vivitrol) dosed?
50mg po daily after 7-10days of opiate free
380mg IM monthly
abdominal pain, nausea, anxiety, headache, heptotoxicity are side effects of?
naltrexone
Which drug is an antagonist at glutamate NMDA receptors?
acamprosate (Campral)
How is Campral dosed?
2x 333mg po tid
What caution is their with Campral, what advantage?
Caution renal impairment. Advantage over naltrexone and disulfiram is not hepatotoxic
