TUS Flashcards
Quel est le traitement plus efficace pour TUS amphétamines entre
TCC
Entretien motivations
motivationnal incentive
Naltrexone buproprion
Tx remplacement psychostimulant
Topiramate
TCC
Aucun rx efficace
Nouvelle thérapies : contency management (motivationnal incentive : renforcement positif à arrêt d’inspiration d’entretien motivationnel : parfois cash, jeton). On fait ddr pour tester
Intox thc
En combien de temps?
Dure combien temps?
Dépend de la voie
Si inhalé : 5 10 mins intox et dure 2 à 4 h
Si mangé : intox retardé (1 à 4h) et dure 6 8h
Combien de temps un DDR au THC reste positif
quelques jours
1 à 2 semaines
Jusqu’à un mois
Toutes des bonnes réponses selon le contexte
The half-life of THC with infrequent use is 1.3 days.
The half-life for frequent users (weekly use or more) is 5-13 days. This is due to the absorption of THC in fat.
Heavy use of THC can be detectable for up to 30 days in urine.
Indirect THC inhalation or exposure will generally not result in a positive test, however, there have been a few reports of a weak dose-response relation between the THC content of cannabis and effects on those exposed to second-hand smoke, including metabolites found in blood and urine and psychoactive effects; however, this relationship depends on a number of factors including dose and ventilation of the space.2
Perle clinique : Syndrome hyperemesis : intoxication chronique THC marqué par No Vo cyclique surtout am, avec Dlr abdo, perte poids (5kg)soulagé par douche chaude arrêtant avec cessation THC. Tx soutient d’antiémétique (plus ou moins haldol ativan peut aidé)
Quels sont les traitements du TUC THC
TCC
Contengency management
Motivationnal enhancement therapy
REmplacement avec cannabis synthétique
Naltrexone
ISRS
Gabapentin
Les traitements psychologique sont ceux qui ont des évidences
Plusieurs Rx testé dans antidépressuer : étude négative
Remplacement cannabis synthétique : diminue les sevrage
Rx a venir (avec support psychologique) : Naltrexone (contreversé : étude qui diminue d’autres qui dise que ca augmente la conso), gabapentin (1200 DIE x12 semaine, diminue sevrage et abstinence), NAC
TUS mixte : quels sont les indication de traitement
Traiter par pallier, le traitement le plus addictif initialement
Traiter tous en même temps
Un mixte des deux
Key principles
Co-occurring substance use disorders should be treated concurrently, when possible.
Severity of each substance use disorder should guide treatment.
Treatment for co-occurring substance use disorders should be triaged according to which carries the highest risk of mortality (for example, prioritize treating opioid use disorder over cannabis use disorder).
Safety should be prioritized.
Perle clinique :
Poser la question d’arrêt tabagique!!!
Despite assumptions to the contrary, 44-80% of individuals receiving substance use disorder treatment are interested in tobacco cessation.
Traitement TUS ROH et opiacé: quoi proposer (plusieurs réponses possible)
Naltrexone
Gabapentin pour le sevrage et tx maintient
Buprenorphine
Acamprosate
Benzodiazépine pour le sevrage alcool
Tx psychosocial
Tx psychosocial ++ avec Buprenorphine et acamprosate en maintient
Gabapentin pour sevrage ROH
Buprenorphine : Due to its superior safety profile, including causing significantly less respiratory depression, buprenorphine / naloxone may be a safer opioid agonist treatment for those with concurrent alcohol use disorder than methadone or slow-release oral morphine.4,5
Acamprosate should be considered
Naltrexone is not recommended due to coocuring use of opiacé
Gabapentin : recommandé pour tx sevrage (au dessus des benzo!) non recommandé Canadian study found that concomitant use of opioid medications and gabapentin increased the risk of fatal overdose by 49%, with moderate and high daily doses increasing the fatal opioid overdose risk by 60% compared to those with no concomitant gabapentin use.
Benzo : pas contre indiqué mais a plus haut risque de détresse respi. Éviter (pas contre indication absolu)donner benzo à pt avec TUS opiacé : augmente leur risque de développer 2 tus et augmente risque contraction Hep C, VIH et mort
Traitement co tx TUS ROH et tabac
Naltrexone +wellbutrin
Naltrexone + varenicline
Patch+Gabapentin
Patch+naltrexone
Support psychosocial
Tx psychosocial++ avec Naltrexone + varenicline
A 2015 meta-review identified a combination of varenicline and naltrexone as the most promising option for tobacco cessation in individuals who are both smokers and heavy drinkers. Adding nicotine replacement therapy may improve outcomes. However, additional clinical research is needed
Which is the most common diagnosis that is found to occur in co-occurring substance use disorder?
Stimulant use disorder
Alcohol use disorder
Tobacco use disorder
Opioid use disorder
Alcool disorder
Alcohol use disorder was the most common diagnosis in those with co-occuring substance use disorders, followed by tobacco use disorder, and opioid use disorder. Apres cocaine et THC
Perle clinique : Co-occurring substance use is associated with younger age, lower educational attainment, lower socioeconomic status, childhood abuse, and male sex.
Quel est l’objectif du PAWSS et comment l’interpréter
PAWSS : Prediction of alcohol withdrawal severity scale
Objectif : déterminer si haut risque sevrage (hospitalier) ou peut suivi a maison
On regarde : Acloolémie ou Hx ROH dans 30 dernier jour + facteur risque sevrage aigu (Poul plus 120) ou ATCD sevrage (Fréquence conso, Cure fermé, atcd sevrage, blackouts, atcd convulsion, atcd DT)
Score égal ou plus que 4 – va a hopital
What should a provider consider when using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA)?(Select all that apply)
Ask open-ended question for each item on the scale.
Treat withdrawal early, before increased severity develops.
If a person scores less than 10, assess them every 4 hours. Consider prophylactic treatment based on their history.
If a person scores above 10, begin treatment and assess them every hour.
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