SUD

Question 1

Benzodiazepine Withdrawal treatment

Answer 1

Taper over 4 to 8 weeks and reduce dose by 10 to 25% q 2 weeks

Question 2

Benzodiazepine Withdrawal symptoms

Answer 2

Insomnia, rebound anxiety, irritability, sensitivity to light and sound
Severe: Hallucinations or seizure

Question 3

Binge drinking definition

Answer 3

5+ drinks in one occasion/15+ drinks a week (male)
4+ drinks in one occasion/8+ drinks a week (female)

Question 4

Heavy alcohol use definition

Answer 4

binge drinking for 5+ days in past month

Question 5

Kindling theory

Answer 5

Repeated episodes of alcohol withdrawal likely to worsen
Positive relationship of alcohol withdrawal seizures to repeated detoxification
Repeated episodes of withdrawal could worsen neuronal damage

Question 6

Risk factors for delirium tremens

Answer 6

Prior history of DTs
Early symptoms of withdrawal
Hepatic dysfunction
Large alcohol consumption

Question 7

Symptoms of delirium tremens

Answer 7

Confusion
Hallucinations
Agitation
Tachycardia
Mydriasis
Fever

Question 8

Treating alcohol use withdrawal

Answer 8

lorazepam
chlordiazepoxide (unless hepatic impairment)

Question 9

disulfiram MoA

Answer 9

Acetaldehyde dehydrogenase (ALDH) inhibitor

Question 10

disulfiram CI

Answer 10

Concurrent use of metronidazole, ethanol or ethanol-containing products, cardiovascular disease, psychosis

Question 11

disulfiram AE

Answer 11

Drowsiness, garlic-like or metallic after taste, dermatitis, nausea, headache, psychosis and hepatitis

Question 12

disulfiram DI

Answer 12

Increase effects of benzodiazepines, phenytoin, theophylline, warfarin
Accidental disulfiram reaction with ethanol-containing pharmaceuticals

Question 13

naltrexone MoA

Answer 13

Blocks opioid receptors
Diminishes positive effects of alcohol to prevent heavy drinking and urge to drink

Question 14

naltrexone CI

Answer 14

Patients receiving or dependent on opioids
Acute hepatitis or liver failure

Question 15

naltrexone AE

Answer 15

Nausea, headache, anxiety, sedation, asthenia, hepatotoxicity (BBW), injection site reaction, depression

Question 16

naltrexone DI

Answer 16

Decreases effects of opioid-containing products

Question 17

When to use disulfiram (LAI)

Answer 17

Patient must be opioid-free for 7 to 10 days prior to initiation of therapy
Urine drug screen should be performed prior to initiation

Question 18

acamprosate MoA

Answer 18

Increases GABA and decreases glutamate activity in the CNS
Combats drink cravings after stopping drinking

Question 19

which alcohol use disorder drug should be adjusted for renal impairment

Answer 19

acamprosate

Question 20

acamprosate AE

Answer 20

Diarrhea, dizziness, headache, nausea, flatulence

Question 21

acamprosate CI

Answer 21

severe renal impairment

Question 22

benefit of naltrexone

Answer 22

no withdrawal symptoms if D/C
if take a drink on naltrexone, will not feel sick (unlike disulfiram)
males respond better

Question 23

treatment of methamphetamine use disorder

Answer 23

bupropion, mirtazapine, topiramate

Question 24

treatment of alcohol use disorder

Answer 24

naltrex > acamprosate > combo

Question 25

treatment of stimulant intoxication disorder

Answer 25

lorazepam/diazepam > FGA/SGA > combo (severe or refractory)

Question 26

treatment of cocaine use disorder

Answer 26

topiramate
bupropion (CI to epilepsy, since lowers seizure threshold)