Treatments for substance misuse

Question 1

Rate at which IV naloxone can be given

Answer 1

0.8mg per 70kg

Question 2

Three main types of drugs which can be given for opioid withdrawal

Answer 2

Methadone
Buprenorphine
Alpha 2 adrenergic agonists e.g. clonidine, lofexidine

Question 3

Concern which limits use of clonidine in opioid withdrawal

Answer 3

High rates of hypotension

Question 4

Dose of methadone usually needed to block cravings for opioids

Answer 4

> 60mg/day

Question 5

Dose of methadone usually needed to block opioid withdrawal symptoms

Answer 5

40-60mg/day

Question 6

Long acting methadone like drug which suppresses withdrawal for 48-72 hours

Answer 6

Levo-alpha-acetylmethadol

Question 7

Drug which contains buprenorphine and naloxone

Answer 7

Suboxone

Question 8

Long acting opioid antagonist used to remove the effects of heroin if taken

Answer 8

Naltrexone

Question 9

Side effect of naltrexone if taken by an active heroin user

Answer 9

Significant withdrawal symptoms

Question 10

NICE suggested first line medication for opioid detoxification

Answer 10

Buprenorphine
Methadone

Question 11

Drug which has shown to be useful in treatment for amphetamine dependence but which was withdrawn due to potential for abuse

Answer 11

Amineptine

Question 12

Percentage of smokers attempting to quit who abstain for a year with no treatment

Answer 12

5-10%

Question 13

Contraindications for bupropion

Answer 13

History of seizures
Eating disorders
Adolescent age
Pregnancy
History of bipolar disorder

Question 14

Total treatment length of bupropion for smoking cessation

Answer 14

8 weeks

Question 15

Psychological intervention for cocaine use with the best evidence base

Answer 15

Contingency management

Question 16

Drug used in opioid maintenance therapy which was withdrawn due to QTc prolongation

Answer 16

Levo-alpha-acetylmethadol

Question 17

Alpha 2 adrenergic agonists used for symptoms of opioid withdrawal

Answer 17

Lofexidine
Clonidine

Question 18

First line treatment option for opioid dependence if both methadone and buprenorphine are suitable

Answer 18

Methadone

Question 19

Most common adverse effects of clonidine

Answer 19

Dry mouth and eyes
Fatigue
Sedation
Dizziness
Nausea
Hypotension
Constipation

Question 20

Current state of naltrexone implant license in the UK

Answer 20

Not licensed

Question 21

Risk of seizures associated with bupropion extended use

Answer 21

1 in 1000

Question 22

Risk of seizures associated with bupropion standard release

Answer 22

4 in 1000

Question 23

Length of time nicotine replacement therapy should be used for

Answer 23

8-12 weeks

Question 24

First line smoking cessation treatments in the UK

Answer 24

Nicotine replacement therapy
Bupropion
Varenicline

Question 25

Common side effects of varenicline

Answer 25

Nausea Sleep disturbance Vivid dreams

Question 26

Length of time opioid detoxification with bupropion as an inpatient usually lasts

Answer 26

7-14 days

Question 27

Opioid treatment most appropriate for someone who is highly motivated to stay abstinent and has social support

Answer 27

Naltrexone

Question 28

Mechanism of action of naloxone

Answer 28

Short acting mu opioid antagonist

Question 29

Mechanism of action of naltrexone

Answer 29

Long acting non-selective opioid antagonist

Question 30

Mechanism of action of buprenorphine

Answer 30

Mu opioid receptor partial agonist

Question 31

Affinity of buprenorphine for mu receptors compared with morphine

Answer 31

Buprenorphine has 5x higher affinity

Question 32

Generic medication in subutex sublingual tabs

Answer 32

Buprenorphine

Question 33

Reason for the withdrawal sometimes seen when buprenorphine treatment is started

Answer 33

It displaces full agonists from mu receptors due to its higher affinity

Question 34

NICE guidelines on ultra rapid detoxification

Answer 34

Should not be offered

Question 35

NICE guidelines on rapid detoxification

Answer 35

Should only be considered for patients who specifically request it and understand the risks

Question 36

Length of time ultra rapid detoxification lasts

Answer 36

6-12 hours

Question 37

Method of ultra rapid detoxification

Answer 37

Uses opioid antagonists Patient is under GA or heavily sedated Patient is then maintained on naltrexone

Question 38

Method of accelerated detoxification

Answer 38

Naloxone/naltrexone are used in addition to clonidine, lofexidine, or buprenorphine to speed up detoxification without causing full withdrawal

Question 39

Length of time to complete a normal course of acetylcysteine

Answer 39

21 hours First infusion 1 hour Second infusion 4 hours Third infusion 16 hours

Question 40

Recommended course of treatment of varenicline for smoking cessation

Answer 40

12 weeks

Question 41

Recommended time to start bupropion and varenicline when used for smoking cessation

Answer 41

7-14 days before the person stops smoking

Question 42

Most common adverse effect of varenicline

Answer 42

Nausea

Question 43

Psychiatric adverse effect of varenicline

Answer 43

Depression, sometimes with suicidal thoughts

Question 44

Duration of treatment recommended for inpatient opioid withdrawal

Answer 44

Up to 4 weeks

Question 45

Duration of treatment recommended for outpatient opioid withdrawal

Answer 45

Up to 12 weeks

Question 46

Overdoses which should not be treated with activated charcoal as there will be no effect

Answer 46

Alcohol Metals such as lithium, iron

Question 47

Patient groups where flumazenil should be avoided in benzodiazepine overdose due to the risk of seizures

Answer 47

Patients with epilepsy Patients who are dependent on benzodiazepines Patients who may have ingested pro-convulsants e.g. TCAs

Question 48

Mechanism of action of flumazenil

Answer 48

Competitive inhibition at the benzodiazepine binding site on the GABA-A receptor