SUD/Addiction Flashcards
Methadone
Medication-assisted tx; reduces sx of w/d assoc with opioids (and heroin—opioid derivative); proven to help people stay clean by blocking opioid receptors
Methadone MOA
Synthetic analgesic, mu-agonist; prevent addicts from going into withdrawal state/sx—dec craving
Methadone SE
Lightheaded, hives, chest pain, tachy, hallucinations, confusion
Methadone NC
Pt can be addicted to methadone and it can be abused but potential is lower; often just dependent so get w/d sx if stop; often get daily dose from methadone clinic—difficult bc need access to clinic
Buprenorphine and naloxone (Suboxone is them combined)
Buprenorphine—partial opioid antagonist (helps block rec to prevent craving); combination helps pt recover more quickly from addiction
Suboxone SE
HA, opioid withdrawal.d sx, anx, insomnia, sweating, depression, constipation, nausea
Buprenorphine and naloxone NC
Potential for abuse but less than methadone and Buprenorphine alone; Sublingual and buccal (works quick)
Addiction as a disease
Affected by environment and biological function—brain and behavior
Dopamine’s role in addiction
Get Dopmaine surge from drug; mimics usual pleasure response but amplified; many Dp surges disturb normal Dp pattern and cause receptor downregulation to compensate (fewer receptors leads to anhedonia and impulsive behavior—takes more drugs to get the effect; reward path in VTA and NAc)
What part of the brain is associated with deficits with addiction?
Prefrontal cortex
DP transporters after stop taking drugs
With meth use; lack Dp transporters so feel depressed but receptors came back after over a year
Risk factors for addiction
Poor social, drug availability, aggressive behavior, lack parental supervision
Protective factors for addiction
Self-control, parental monitoring, positive relationships, good grades, anti-drug policy, bio protection (D2 receptors)
SUD tx
HOLISTIC; CBT, safe housing, 12 step programs, contingency management program, medically assisted detox (rehab)
NC for SUD
Most test pt for other diseases associated with SUD like Hep B and C, TB, endocarditis, HIV/AIDS
What are most ODs related to?
IV drug use
Endocarditis
Bacteria in the blood gets lodged in the heart valves causing heart failure and need new valves
Opioid withdrawal timeline
Begins 12-24h after last dose; peak at 72h; usually lasts 5-10 days—physical sx lessen at 1 week, psych and emo sx at 2 weeks (dep/anx, irritable, sleep prob), cravings and dep at 1 month lingering for weeks or months
Opioid withdrawal s/s
Flu-like, N/V, cramps, goosebumps, dep, anxiety, cravings, sweat, muscle ache, fever
Opioids tx
Supportive and MAT—Tylenol, anti-diarrheal w/ Buprenorphine and methadone
BDZs and alcohol w/d s/s
Dangerous; can lead to death; sleep prob, retching, irritable, nausea, inc muscle tension, weight loss, anx, palpitations, panic attach, anx, HA, muscle ache, sweat, concentration probs, perceptual changes
Dangerous sx: seize, hallucinate, delirium tremens, Wernicke’s encephalopathy
What receptors do alc and BDZs work on?
GABA
Wernicke’s encephalopathy
Disorientation, inattention, indifference, occulomotor dysfunction (nystagmus and palsy), gait ataxia
Delirium tremens
Tachycardia, high BP, hallucinations, disorientation, fever, agitation, diaphoresis, chest pain, seizures, stroke
BDZs withdrawal timeline
Begins w/i 24 hours and peaks at 2 weeks
Alcohol w/d timeline
Begins at 8h, 1-3 days to peak, taper after a week
Alc and BDZ tx
BDZ taper (helps prevent seizure and DT severity), 12 step program, therapy, alcohol withdrawal—need vitamin supplement esp B1 (thiamine) bc Dec abs of bit from long term stomach inflammation from alcohol consumption
