Week 13 - Substance abuse

Question 1

What is medication assisted therapy (MAT)?

Answer 1

Approved to treat opioid addiction and alcohol dependence

• Relieve withdrawal symptoms and psychological cravings that cause chemical imbalances in the body
• Provide a safe and controlled level of medication
• No adverse effects on a person’s intelligence, mental capability, physical functioning, employment

Question 2

What three medications are used to treat opioid dependence and addiction to heroin, morphine, codeine, oxycodone, and hydrocodone?

Answer 2

• Methadone
• Buprenorphine
• Naltrexone

Question 3

Methadone: MOA

Answer 3

Mu opioid receptors block the effects of opioids while suppressing withdrawal symptoms

• Tricks the brain into thinking it’s still getting the abused drug
• Person is not getting high and feels normal, so withdrawal doesn’t occur

Question 4

True/False: Methadone is ONLY available through opioid treatment programs certified by SAMHSA and registered by the DEA

Answer 4

True

• Most effective in highly dependent patients and should be combined w/ non pharmacological services

Question 5

Buprenorphine: MOA

Answer 5

Partial agonist of mu opioid receptors - supresses and reduces cravings for the abused drug

• Naloxone component is poorly absorbed via sublingual route
  
  • Only present to prevent misuse of medication by crushing and injecting the combined product
  • Because of this safety feature, buprenorphine/naloxone is the preferred formulation

Question 6

Naltrexone: MOA

Answer 6

Blocks mu receptors so they cannot be stimulated

Question 7

Naltrexone: patient education

Answer 7

• Blocks euphoric effects of opioids, so regular administration can help patients overcome psychological addiction
• Taken daily - requires patients to actively participate in their own treatment

Question 8

What is the difference between naloxone and naltrexone?

Answer 8

Naloxone has the same pharmacological effects as naltrexone, but naloxone is shorter acting

• Useful “revival” drug administered to patients who have intentionally or unintentionally overdosed on narcotics

Question 9

What three medications are the most common drugs used to treat alcohol use disorder?

Answer 9

• Disulfiram
• Acamprosate
• Naltrexone

Question 10

Disulfiram (Antabuse): MOA

Answer 10

Aversion therapy

• Treats chronic alcoholism
• Most effective in people who have already gone through detoxification or are in the initial stage of abstinence

Question 11

How soon after taking disulfiram can side effects appear?

Answer 11

10 minutes

• Side effects: N/V, HA, chest pains, difficulty breathing

Question 12

Disulfiram: patient education

Answer 12

Avoid alcohol during therapy

• When alcohol is consumed, patient will feel flushing, tachycardia, N/V
  
  • Helps with aversive therapy (negative conditioning) - patient will abstain from alcohol to avoid unpleasant side effects

Question 13

Acamprosate (Campral): MOA

Answer 13

Helps decrease cravings, referred to as “artificial alcohol”

• For people in recovery who have already stopped drinking alcohol and want to avoid drinking
• Does not prevent withdrawal symptoms after people drink alcohol
• Has NOT been shown to work in people who continue drinking or consume illicit drugs

Question 14

When does acamprosate therapy usually begin?

Answer 14

On the 5th day of abstinence, reaching full effectiveness in 5-8 days

Question 15

Can naltrexone be used to treat alcohol dependency?

Answer 15

Yes - blocks euphoric effects and feelings of intoxication

• Reduces drinking behaviors enough to remain motivated to stay in treatment, avoid relapses, take medications