SUD med details

Question 1

Naltrexone

1. what does it do
2. route of admin
3. screening prior

Answer 1

1. decr. craving & alcoholic euphoria
   - should be combined with behavioral
2. must be very compliant to PO
   (started on PO, then switched to IM(gluteal))
3. need negative urine screens (7-10 days after last opioid dose)
   - check LFTs

Question 2

Who is naltrexone best for?

Answer 2

• pts with family PMH
• young age of onset
• high cravings

Question 3

Naltrexone AE

Answer 3

• N/V
• headache
• inj site pn

Question 4

Acamprosate

What does it do?

Answer 4

1. block normal glutamate function
   - upreg of receptors in withdrawal
   - incr stress, negative reinforcement –> cravings

Question 5

Acamprosate AE

Answer 5

• N
• diarrhea
• insomnia
• anxiety
• depression
• caution with renal dysfunction

Question 6

Disulfuram

Answer 6

• increases alcetaldehyde levels –> massive hangover feeling
  (if you drink you’ll feel like garbage)
• does nothing for your cravings

ABSTINENCE out of FEAR

need BAC of 0!
- even ETOH mouthwash can cause that feeling

Question 7

Disulfuram AE

Answer 7

• rash
• fatigue
• funny taste
• headache

monitor LFTs

• avoid if 3x ULN (repeat test q1-2 weeks)
• monitor q1-6months

Question 8

Disulfuram CI

Answer 8

• PMH of CV events!

- alcohol use (even ETOH mouthwash) for 2-14 days after stopping

Question 9

Methadone tx requirements

Answer 9

go to federally licensed institution EVERY DAY

• urine sample
• routine EKGs (@ high doses)

primary care keeps track of monitoring & potential interactions

Question 10

Most of the time should we use suboxone or subutex?

When would we use the other?

Answer 10

suboxone > subutex

allergy to naloxone or pregnant = subutex
can cause spontaneous abortion

Question 11

Subutex initiation

Answer 11

must be off opioids for 12-24 hours

provide maintenance dose or wean over 2 weeks

Question 12

What’s the really cool Buprenorphine effect?

Answer 12

it’s a partial agonist!! (of the opioid effect)

there is NO respiratory depression, but pts still get DA increase

(methadone = full agonist)
(naloxone = antagonist)

Question 13

Is a data waiver necessary of buprenorphine or methadone?

Answer 13

ONLY buprenorphine

“X” placed by DEA #

prescribers don’t get bc:

• $$
• high regulatory burden
• most who get it don’t see max amt of pts

30 initially
100 after 1st year
UT 250 with DEA approval thereafter