SUD/Addiction

Question 1

Methadone

Answer 1

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

Question 2

Methadone MOA

Answer 2

Synthetic analgesic, mu-agonist; prevent addicts from going into withdrawal state/sx—dec craving

Question 3

Methadone SE

Answer 3

Lightheaded, hives, chest pain, tachy, hallucinations, confusion

Question 4

Methadone NC

Answer 4

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

Question 5

Buprenorphine and naloxone (Suboxone is them combined)

Answer 5

Buprenorphine—partial opioid antagonist (helps block rec to prevent craving); combination helps pt recover more quickly from addiction

Question 6

Suboxone SE

Answer 6

HA, opioid withdrawal.d sx, anx, insomnia, sweating, depression, constipation, nausea

Question 7

Buprenorphine and naloxone NC

Answer 7

Potential for abuse but less than methadone and Buprenorphine alone; Sublingual and buccal (works quick)

Question 8

Addiction as a disease

Answer 8

Affected by environment and biological function—brain and behavior

Question 9

Dopamine’s role in addiction

Answer 9

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)

Question 10

What part of the brain is associated with deficits with addiction?

Answer 10

Prefrontal cortex

Question 11

DP transporters after stop taking drugs

Answer 11

With meth use; lack Dp transporters so feel depressed but receptors came back after over a year

Question 12

Risk factors for addiction

Answer 12

Poor social, drug availability, aggressive behavior, lack parental supervision

Question 13

Protective factors for addiction

Answer 13

Self-control, parental monitoring, positive relationships, good grades, anti-drug policy, bio protection (D2 receptors)

Question 14

SUD tx

Answer 14

HOLISTIC; CBT, safe housing, 12 step programs, contingency management program, medically assisted detox (rehab)

Question 15

NC for SUD

Answer 15

Most test pt for other diseases associated with SUD like Hep B and C, TB, endocarditis, HIV/AIDS

Question 16

What are most ODs related to?

Answer 16

IV drug use

Question 17

Endocarditis

Answer 17

Bacteria in the blood gets lodged in the heart valves causing heart failure and need new valves

Question 18

Opioid withdrawal timeline

Answer 18

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

Question 19

Opioid withdrawal s/s

Answer 19

Flu-like, N/V, cramps, goosebumps, dep, anxiety, cravings, sweat, muscle ache, fever

Question 20

Opioids tx

Answer 20

Supportive and MAT—Tylenol, anti-diarrheal w/ Buprenorphine and methadone

Question 21

BDZs and alcohol w/d s/s

Answer 21

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

Question 22

What receptors do alc and BDZs work on?

Answer 22

GABA

Question 23

Wernicke’s encephalopathy

Answer 23

Disorientation, inattention, indifference, occulomotor dysfunction (nystagmus and palsy), gait ataxia

Question 24

Delirium tremens

Answer 24

Tachycardia, high BP, hallucinations, disorientation, fever, agitation, diaphoresis, chest pain, seizures, stroke

Question 25

BDZs withdrawal timeline

Answer 25

Begins w/i 24 hours and peaks at 2 weeks

Question 26

Alcohol w/d timeline

Answer 26

Begins at 8h, 1-3 days to peak, taper after a week

Question 27

Alc and BDZ tx

Answer 27

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