Treatment of Substance Abuse

Question 1

Mild symptoms include: insomnia, tremulousness, mild anxiety, GI upset/anorexia, HA, diaphoresis, palpitation

Answer 1

alcohol withdrawal

Question 2

When do mild withdrawal symptoms of alcohol begin and resolve?

Answer 2

within 6 hrs of cessation of drinking. Mild symptoms resolve within 24-48 hours

Question 3

When do withdrawal seizures of alcohol begin and what is their treatment?

Answer 3

within 48 hours after last drink. Treat with benzos

Question 4

Develops within 12-24 hours of last drink. Resolves within 24-48 hours. NOT delirium tremens. Usually visual, but can be auditory or tactile

Answer 4

alcoholic hallucinosis

Question 5

Sx include: hallucinations, disorientation, tachycardia, HTN, low grade fever, agitation, diaphoresis. Begins 48-96 hrs after last drink and lasts 1-5 days

Answer 5

delirium tremens

Question 6

Treatment of ETOH withdrawal

Answer 6

Replace fluids and potassium. Thiamine 100mg IV/IM before glucose. Benzos

Question 7

What happens if you give glucose before thiamine when treating ETOH withdrawal?

Answer 7

can precipitate wernicke’s or korsakoff’s

Question 8

If a patient suffering from ETOH withdrawal has refractory DTs, what can you use for treatment?

Answer 8

DTs—add phenobarbitol or propofol

Question 9

What should you not use for treatment of ETOH withdrawal?

Answer 9

antipsychotics because they lower seizure threshold

Question 10

What should you use in a patient who has status epilepticus due to ETOH withdrawal?

Answer 10

phenobarbital. do not use carbamazepine do to liver metabolism

Question 11

Pure mu-opioid receptor antagonist. Blunts pleasurable effects of alcohol. Reducing craving, use 2-6 months. Causes hepatocellular injury if drink ETOH with it

Answer 11

naltrexon

Question 12

Synthetic derivative of homotaurine—analog of GABA. Used for relapse prevention of alcoholism.

Answer 12

acamprosate

Question 13

Inhibits the activity of acetaldehyde dehydrogenase (ALDH) which results in 5-10 fold increase in acetaldehyde levels after alcohol ingestion

Answer 13

disulfiram (Antabuse)

Question 14

Leads to facial flushing, dyspnea, N & V, HA, blurred vision, vertigo and anxiety if ETOH is consumed

Answer 14

disulfiram (Antabuse)

Question 15

Drug with the greatest addictive potential

Answer 15

heroin

Question 16

When do these symptoms of cessation of opioids occur: Anxiety, restlessness, insomnia, yawning. Rhinorrhea, lacrimation, diaphoresis. Stomach cramps, mydriasis

Answer 16

8-14 hrs after last dose

Question 17

Administered after patient completely detoxed. Antagonist prevents the user from experiencing any beneficial effects w/ subsequent opioid use

Answer 17

naltrexone

Question 18

Method of long term treatment. Administration of single daily dose in a controlled setting w/ counseling and social services

Answer 18

methadone

Question 19

Partial opioid agonist. Sublingual preparation—Subutex. Combined w/ naloxone—Suboxone

Answer 19

buprenorphine

Question 20

Drug of choice to treat opioid addication in pregnancy

Answer 20

methadone

Question 21

alpha-2-adrenergic receptor agonist. May decrease withdrawal symptoms in patients using low doses of opioids. Can be abused with methadone

Answer 21

clonidine

Question 22

Sx of withdrawal include: increased body temperature, HTN, increased RR and HR, aroused level of consciousness, increased reflexes/seizures, psychotic behaviors

Answer 22

benzo withdrawals

Question 23

What do you need to watch for in a serious withdrawal from benzos?

Answer 23

respiratory depression

Question 24

Treatment for serious withdrawal of benzos

Answer 24

carbamazepine or valproate. ICU w/abnormal vital signs