Substance Use Disorders (No benzos... too overwhelmed haha)

Question 1

What is addiction?

Answer 1

Compulsions to continue the destructive behavior despite the impact on oneself and others.

There is cravings, relapse, and preoccupation!

Question 2

What is the 3 stage cycle in the addiction process?

Answer 2

binge/intoxication

withdrawal/negative effects

preoccupation/anticipation

Question 3

What 3 areas of the brain are particularly relevant in substance use disorder and how are those parts of the brain involved?

Answer 3

Basil ganglia: reward/pleasure center and habitual features

extended amygdala: stress/anxiety/withdrawal

Prefrontal Cortex: executive function/ control to not do substance

Question 4

What is incentive salience?

Answer 4

when people/places/things remind your brain of the drug or activity you are/were addicted to and it releases dopamine and makes you crave whatever that might be

Question 5

Repeated activation of what brain structure contributes to developing compulsivity?

Answer 5

dorsal striatum of the basil ganglia

Question 6

Most of the time overdose patients will have constricted pupils, when might they be dilated though?

Answer 6

severe OD with anoxia

Question 7

After naloxone or narcan has been administered what non-FDA approved drug might you use and has a side effect of low blood pressure?

Answer 7

clonidine/clonipin

Question 8

Why would you prescribe zofran for nausea over phenergan?

Answer 8

phenergan can give some people a “buzz”

Question 9

Nalotrexone

MOA:
Indicated for:

2 key facts?

Answer 9

MOA: FULL Mu antagonist

Indicated for blocking opioids and blocking cravings for opioid and alcohol

NO ABUSE LIABILITY
SERIOUSLY DECREASES TOLERNCE - YOU WILL DIE IF YOU GO OUT AND USE WHAT YOU USED TO USE

Question 10

BUPRENORPHINE

MOA
When can you use it?

Answer 10

Partial opiod AGONIST and mixed opioid agonist/antagonist??? LOL

Wait until the pt is in mild/mod withdrawal >12 on CIWAS

and should occur at least 6-12 hours after short acting opioid and/or 24-72 hours after long acting

OR THEY WILL GET VERY SICK

Question 11

What is considered binge drinking and what is considered heavy drinking?

Answer 11

Binge >= 5/occasion

heavy >=5/occasion for >=5 days in a row

Question 12

What two supplements should you give someone suffering from alcohol intoxication after they are safe and their airway is supported?

Answer 12

thiamine and then glucose

Question 13

When does alcohol withdrawal peak?

Answer 13

24-36 hours

Question 14

When might delirium present in alcohol withdrawal?

Answer 14

48-96 hours after and can occur without any other symptoms

Question 15

What two methods can you use benzos in alcohol withdrawal to prevent seizures?

Answer 15

Symptom triggered Benz coverage- using CIWAs

Fixed Dosing - where you probably over medicate to just avoid seizures no matter the symptoms

Question 16

What anticonvulsants can help alcohol withdrawal symptoms? What adrenergic medications can also help?

Answer 16

anticonvulsants: carbamazepine and gabapentin
adrenergic: clonadine and propranolol

Question 17

What medication inhibits aldehyde dehydrogenase and makes you very ill if alcohol is consumed?

Answer 17

Disulfiram/antabuse

Question 18

What drug works best for alcoholism when the patient is highly motivated and has someone to keep them accountable for alcohol consumption/taking the pill?

Answer 18

disulfiram/antabuse

Question 19

What is FDA approved for alcohol abuse disorder and is also effective in combination with gabapentin?

Answer 19

Naltrexone - opioid antagonist

Question 20

Aacamprosate

MOA:
Used for?

Answer 20

MOA: amino acid derived, increases GABA neurotransmission and has effects on glutamate

for alcoholism and reduces heavy drinking

Question 21

What is a potential side effect and drug interaction with topiramate? What is topiramate used for?

Answer 21

Topiramate is used for alcohol use disorder

s/e: slowed cognition
DI: birth control

Question 22

What 2 prescription drugs and used in smoking cessation?

Answer 22

Zyban/wellbutrin

chantix

Question 23

What population should chantix not be used in?

Answer 23

people with history of mental illness or suicidal ideations

Question 24

Can Wellbutrin and chantix be used together?

Answer 24

yes, highly effective

Question 25

What are two huge side effects that Dr. DeRhodes mentioned with marijuana detox?

Answer 25

sleep difficulties and depressed mood

Question 26

What 3 drugs can be used to manage cannaboid withdrawal?

Answer 26

dronabinol - cannaboid receptor antagonist
gabapentin
buspirone