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5. Addictions psychiatry > Treatments for substance misuse > Flashcards

Treatments for substance misuse Flashcards

1
Q

Rate at which IV naloxone can be given

A

0.8mg per 70kg

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2
Q

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

A

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

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3
Q

Concern which limits use of clonidine in opioid withdrawal

A

High rates of hypotension

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4
Q

Dose of methadone usually needed to block cravings for opioids

A

> 60mg/day

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5
Q

Dose of methadone usually needed to block opioid withdrawal symptoms

A

40-60mg/day

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6
Q

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

A

Levo-alpha-acetylmethadol

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7
Q

Drug which contains buprenorphine and naloxone

A

Suboxone

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8
Q

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

A

Naltrexone

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9
Q

Side effect of naltrexone if taken by an active heroin user

A

Significant withdrawal symptoms

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10
Q

NICE suggested first line medication for opioid detoxification

A

Buprenorphine
Methadone

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11
Q

Drug which has shown to be useful in treatment for amphetamine dependence but which was withdrawn due to potential for abuse

A

Amineptine

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12
Q

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

A

5-10%

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13
Q

Contraindications for bupropion

A

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

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14
Q

Total treatment length of bupropion for smoking cessation

A

8 weeks

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15
Q

Psychological intervention for cocaine use with the best evidence base

A

Contingency management

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16
Q

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

A

Levo-alpha-acetylmethadol

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17
Q

Alpha 2 adrenergic agonists used for symptoms of opioid withdrawal

A

Lofexidine
Clonidine

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18
Q

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

A

Methadone

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19
Q

Most common adverse effects of clonidine

A

Dry mouth and eyes
Fatigue
Sedation
Dizziness
Nausea
Hypotension
Constipation

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20
Q

Current state of naltrexone implant license in the UK

A

Not licensed

21
Q

Risk of seizures associated with bupropion extended use

A

1 in 1000

22
Q

Risk of seizures associated with bupropion standard release

A

4 in 1000

23
Q

Length of time nicotine replacement therapy should be used for

A

8-12 weeks

24
Q

First line smoking cessation treatments in the UK

A

Nicotine replacement therapy
Bupropion
Varenicline

25
Q

Common side effects of varenicline

A

Nausea
Sleep disturbance
Vivid dreams

26
Q

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

A

7-14 days

27
Q

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

A

Naltrexone

28
Q

Mechanism of action of naloxone

A

Short acting mu opioid antagonist

29
Q

Mechanism of action of naltrexone

A

Long acting non-selective opioid antagonist

30
Q

Mechanism of action of buprenorphine

A

Mu opioid receptor partial agonist

31
Q

Affinity of buprenorphine for mu receptors compared with morphine

A

Buprenorphine has 5x higher affinity

32
Q

Generic medication in subutex sublingual tabs

A

Buprenorphine

33
Q

Reason for the withdrawal sometimes seen when buprenorphine treatment is started

A

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

34
Q

NICE guidelines on ultra rapid detoxification

A

Should not be offered

35
Q

NICE guidelines on rapid detoxification

A

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

36
Q

Length of time ultra rapid detoxification lasts

A

6-12 hours

37
Q

Method of ultra rapid detoxification

A

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

38
Q

Method of accelerated detoxification

A

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

39
Q

Length of time to complete a normal course of acetylcysteine

A

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

40
Q

Recommended course of treatment of varenicline for smoking cessation

A

12 weeks

41
Q

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

A

7-14 days before the person stops smoking

42
Q

Most common adverse effect of varenicline

A

Nausea

43
Q

Psychiatric adverse effect of varenicline

A

Depression, sometimes with suicidal thoughts

44
Q

Duration of treatment recommended for inpatient opioid withdrawal

A

Up to 4 weeks

45
Q

Duration of treatment recommended for outpatient opioid withdrawal

A

Up to 12 weeks

46
Q

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

A

Alcohol
Metals such as lithium, iron

47
Q

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

A

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

48
Q

Mechanism of action of flumazenil

A

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

5. Addictions psychiatry (10 decks)

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