drugs used in substance misuse Flashcards
mechanism of methadone and buprenorhphine
mu opioid receptor agonist (buprenorphine is partial)
side effects of methadone and buprenorphine
like all opioids - constipations, sedation, euphoria, nausea.
buprenrophine - less sedating and less euphoric
if over 100mg need to do ECG to check for qtc prolongation
contraindications of methadone and buprenorhphine
acute resp distress head injury raised ICP risk of paralytic ileus phaeochromocytoma take care w qt prolongation - if conduction issue/ on other qt prolonging drugs
cautions for methaone and buprenorphine
- resp disorders
- epilepsy
- hypotension
- hypothyroidism
- adrenocortical insufficeincy
- IBD
disorders of bladder outflow
when is medication not necessary in alcohol withdrawal
if pt drinks less than 15 units/ day or 10/day for women
drug given in alcohol withdrawal to relieve sever symps and reduce the risk of devloping seizures
long acting benzo - chlordiazepoxide, diazepam, lorazempam
oral thiamine supplements can be used when
pt is well noursishes and otherwise phsically well
pabrinex (IV/IM thiamine) should be given if
acutely physically unwell for any reason, if admitted to hosp, if they are malnourished, decompensated liver disease
disulfiram mode of action
blocks acetaldehyde dehydrogenase - accumulation of acetaldehyde which causes anxiety, flushing, palps, hedache and nausea
contraindications for disulfiram
HF, stroke, CHD, hypertension, liver disese, cognitive impairment, psychosis, personailty disorder, suicide risk
acamprosate mode of action
anhances GABA and inhibits glutamate trasnmission - reduced craving - safe to use while cotinuinng to drink
naltrexone/ nalmefene mode of action
block opioid receptors to reduce cravings and reduce the pleasant effect of alcohol
contraindications to naltrexone and nalmefene
recent alc withdrawal, recent or current opioid use
dosage of benzos in alc withdrawal driven by
CIWA - monitors nausea, tremor and sweats
