Chapter 4 - Substance Dependance

Question 1

List some dangerous alcohol withdrawal symptoms

Answer 1

Seizures
Delerium tremens
Death

Question 2

What is used to treat alcohol withdrawal seizures?

Answer 2

Fast acting benzodiazepines e.g. lorazepam

Question 3

With regards to assisted alcohol withdrawal, what is a fixed dosing reducing regime?

Answer 3

Reducing the dose over 7-10 days

Question 4

With regards to assisted alcohol withdrawal, what is a symptom triggered regime?

Answer 4

The reducing dose is determined by the patients withdrawal symptoms

Question 5

What treatment options are available for assisted alcohol withdrawal?

Answer 5

Long acting benzodiazepines e.g. diazepam, chlordiazepoxide

Carbamazepine

Chlormethiazole

Question 6

Why should chlormethiazole only be used in patients who are not likely to continue to drink alcohol?

Answer 6

There is a risk of fatal respiratory depression when chlormethiazole is combined with alcohol

Question 7

What is delerium tremens and how is it managed?

Answer 7

A medical emergency caused by alcohol withdrawal

It is managed with oral lorazepam

Question 8

What drugs are used to prevent relapse in alcohol dependence?

Answer 8

Acamprostate
Naltrexone
Disulfiram

Question 9

When is nalmefene used to reduce alcohol consumption in alcohol dependence?

Answer 9

When the patient has a high drinking level

When there aren’t any physical withdrawal symptoms

When there isn’t an immediate need for detoxification

Question 10

What should be given to patients with suspected Wernicke’s encephalopathy?

Answer 10

Parenteral thiamine

Followed by oral thiamine

Question 11

Why should oral thiamine be given to dependant drinkers in acute alcohol withdrawal?

Answer 11

To prevent Wernickes encephalopathy

Question 12

If a patient who is taking disilfiram for the maintenance of abstinence in alcohol dependence wants a non-alcoholic beer, can they have it?

Answer 12

No
People taking disulfiram need to abstain from alcohol completely

Even in alcohol free beer, there is still a small amount of alcohol. This is enough to cause a disulfiram-alcohol reaction which may be life threatening

If a patient is still drinking alcohol, naltrexone or acamprostate will be more appropriate

Question 13

Which drugs are usually used for opioid substitution therapy?

Answer 13

Methadone

Buprenorphine

Question 14

If a patient has missed 2 days of their methadone, can they still have their methadone?

Answer 14

Yes

If they have missed 3 or more doses then they can’t continue to have it

Question 15

Why can’t patients who have missed over 3 days of their methadone continue at that dose?

Answer 15

Risk of overdose due to a loss of tolerance

Question 16

What is more sedating, buprenorphine or methadone?

Answer 16

Buprenorphine

Question 17

What is lofexidine used for?

Answer 17

To manage opioid withdrawal symptoms

Question 18

When can the following drugs be taken after heroin:

a) buprenorphine
b) methadone

Answer 18

a) 6-12 hours

b) 8 hours

Question 19

What is preferred in pregnancy, acute opioid withdrawal or opioid substitution therapy?

Answer 19

Opioid substitution therapy

This is safer for the foetus

Question 20

List some symptoms of nicotine withdrawal

Answer 20

Cravings
Weight gain
Irritability 
Sleep disturbances 
Poor concentration

Question 21

What drug treatment is available to help patients stop smoking?

Answer 21

Vareniciline
Bupropion
Nicotine replacement therapy

Question 22

Which formulation is long acting nicotine replacement therapy?

Answer 22

Patch

Apply for 16 hours and leave off overnight

Question 23

Which formulations are short acting nicotine replacement therapy?

Answer 23

Lozenge
Gum
Nasal spray
Oral spray

These are taken when there is a craving