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Multisystems > Treatment of SUD > Flashcards

Treatment of SUD Flashcards

1
Q

3 Treatment Goals

A
  1. Treatment of acute overdose.
  2. Detoxification - controlled withdrawal.
  3. Maintenance of abstinent state; prevent relapse.
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2
Q

Opiates

  1. Acute Overdose
A

Overdose –> respiratory depression.

(+) opiate antagonist - naloxone (IV, nasal spray).

Available to IV drug users and their families.

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3
Q

Opiates

  1. Four Approaches of Detoxification
A
  1. “Cold Turkey”
  2. Methadone Detox
  3. Clonidine Treatment
  4. Antagonist-Accelerated Withdrawal
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4
Q

Opiates

Detox - Cold Turkey

A

Can be accelerated by administration of naloxone. Symptom relief with diazepam (sedative) and anti-diarrheal agents. (Gooseflesh withdrawal symptom.)

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5
Q

Opiates

Detox - Methadone

A

Administer oral methadone (cross dependence) to relieve symptoms; reduce dose on pre-determined regimen. Symptoms mild but intense craving is still present.

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6
Q

Opiates

Detox - Clonidine Treatment

A

Administer clonidine (centrally acting adrenergic alpha2-R agonist) to reduce symtoms of withdrawal from low - moderate opioid use. Inhibits firing of locus ceruleus neurons. Recall - The alpha2-R is present on pre-synaptic neurons and inhibits NE release. No longer used.

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7
Q

Opiates

Detox - Antagonist-Accelerated Withdrawal

A
  1. Administer naltrexone (opiate antagonist) for a rapid but severe withdrawal. (Used by some wealthy opiate addicts to reduce tolerance and begin using again.)
  2. Can also administer an anesthetic (midazolam) to induce a sedated state.
  3. Can also administer a partial opiate agonist (buprenorphine) to assist in detox.
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8
Q

Opiates

  1. Two Methods of Maintenance
A

Relapse is common during following days and months; relapse after one year drug free is < 20%.

  1. Methadone Maintenance - opioid agonist
  2. Antagonist or Partial Agonist Therapy
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9
Q

Opiates

Methadone Maintenance

A

Over a year+, legally supplied daily dose of oral methadone (opioid agonist) induces a high level of tolerance to other opiates. If you go out and shoot heroin, no high will result. Gives you time to break drug-seeking and using habits. Methadone is used bc its long 1/2-life gives stable levels of the drug.

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10
Q

Opiates

Antagonist or Partial Agonist Therapy

A
  • After complete detox, give long-term oral naltrexone (antagonist, longer 1/2-life than naloxone) to block the effects of any self-administered opiate drug. Retention of patients is low because they will stop taking naltrexone during cravings to get high.
  • Buprenorphine (partial agonist, mixed agonist-antagonist effects) block self-administered opiate effects but also produces a mild “high” that is different than a true heroin high.
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11
Q

Describe the logic behind combination buprenorphine/naloxone tablets.

A

Available via prescription for maintenance treatment of heroin and prescription opioid addiction. BUT people were starting to seek the medication for IV abuse.

  • Sublingual - buprenorphine (partial agonist) is absorbed but naloxone (antagonist) is not; buprenorphine produces mild euphoria but also blocks the mu-R from any additional heroin.
  • IV - naloxone (antagonist) is fully available and blocks all mu-R; prevents both the co-administered buprenorphine or heroin from having any euphoric effect.

Note - no studies of naloxone during pregnancy. Use buprenorphine alone.

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12
Q

Stimulants - Cocaine and Amphetamines

Review Mechanism and Toxicity

A

Cocaine - inhibits DAT, NET, SERT

Amphetamines - releases DA, NE, 5HT

Acute Toxicity

  • Sympathetic Stimulation - cardiac arrythmias, HTN
  • Central Stimulation - agitation, anxiety, decreased appetite

Chronic Toxicity

  • Withdrawal Symptoms - depression, anhedonia, weight gain
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13
Q

Stimulants - Cocaine & Amphetamines

Acute Overdose and Withdrawal

A

NO specific treatments. Treat symptoms as needed.

Diazepam - controls agitation and seizures.

Beta-blockers - prevents arrhythmias.

Hydralazine - decreases BP.

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14
Q

Stimulants - Cocaine & Amphetamines

Maintenance

A

Nothing available to prevent cravings, which many report never go away. Investigating behavioral modification treatment.

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15
Q

Nicotine

A

Alternative sources - chewing gum, inhalers, patches.

Varenicline (Chantix) - partial agonist; reduces central stimulation by nicotine and reduces DA release.

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16
Q

Hallucinogens

Acute Overdose and Withdrawal

A
  1. Protect patient and others from psychotic behavior; “talk down” or quite reassurance is often best treatment but may not work with PCP.
  2. Symptomatic
  • Diazepam - prevents convulsions.
  • Haloperidol - treats psychotic episodes; avoid anticholinergic phenothiazines due to risk of anticholinergic-induced psychotic symptoms.
  • Hydalazine - treat HTN.
17
Q

Ethanol

  1. Acute Overdose
A
  1. Gastric lavage - prevents further absorption.
  2. Maintain cardiopulmonary function, temperature, acid-base balance.
  3. Give fluids to reverse dehydration.
  4. Give antacid to reduce gastric acid secretion (ranitidine, omeprazole, etc).
18
Q

Treatment of Methanol and Ethylene Glycol Poisoning

A
  • methanol –> formaldehyde
  • ethylene glycol (antifreeze) –> glycoaldehyde, glycolic acid, oxalic acid
  • give ethanol or fomepizole – compete for alcohol dehydrogenase, reduce formation of toxic metabolites
19
Q

Alcoholism

  1. Withdrawal
A
  • Fluids, electrolytes, thiamine, other vitamins.
  • Seizures? Diazepam
  • Hallucinations? Haloperidol
  • Acid Secretion? Omeprazole, Ranitidine
20
Q

Alcoholism

  1. Maintenance
A
  • Social, psychotherapy (AA, etc.)
  • Phamacologic Treatments
  1. Disulfiram (Antabuse) - aversion therapy, inhibits aldehyde dehydrogenase –> acetaldehyde builds up and causes unpleasant symptoms.
  2. Naltrexone - opiate antagonist, reduces reinforcing effects of ethanol; shown to decrease cravings and relapses.
  3. Acamprosate - unknown mechanism (inc GABA, dec Glu); reduces cravings and relapses.

Multisystems (5 decks)

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