PHRM845-FINAL EXAM Flashcards
Pharmacotherapy of SUD
What percentage of the population used an illicit substance in the past year?
25%
What was the highest used illicit substance in the past year?
- Marijuana
- Hallucinogens
- Rx pain reliever misuse
The first couple of times for using illicit substances is for ____
To feel good/get high
**then pts start to believe they need it to deal with life
2 biggest sources of pain relievers for misuse
- Prescription from doctor (~40%)
- Given by, bought from, or took from a friend or relative (~44.6%)
**We spend a lot of time focusing on pts that get meds from more than 1 doctor, but that only makes up 2.2%
**<10% of people are buying these meds off the street
____ is associated with substance use
Mental health
Psychiatrists silo mental health and substance use…only focus on ___ aspect
Mental health
40.9% of adults get no tx for their SUD or MHD. What are some reasons for this?
-Access issue and number of providers issue
-Feel stigmatized and don’t want to engage
-Lots of steps/barriers to getting meds
Indiana’s efforts to combat prescription drug misuse
- INSPECT program
- Indiana Medical Licensing Board Rules (certain pts have to agree to toxicology screening)
- Indiana Medicaid
- Improving access to naloxone
- Expanding SUD tx centers/methadone clinics
Which population had the hardest access to substance use treatment?
Pregnant women
Examples of DSM-5, TR substances for substance use disorders
- Alcohol
- Caffeine
- Cannabis
- Hallucinogens
- Inhalants
- Opioids
- Sed/hyp/anxio
- Stimulants (Rx and OTC)
- Tobacco
- Other
DSM-5, TR SUD indications
-Deleted the terms “abuse” and “dependence”
-These were considered to be indicators of severity of illness based on number of criteria met and timeframe of substance misuse
-The DSM-5 combine the criteria into SUD (criteria are applied to 10 different drug classes)
SUD classification (Applies for all substances)
2 of the following must occur in a 12-month period
1. Taken in larger amounts or over a longer period than intended
2. Persistent desire or unsuccessful efforts to cut down or control use
3. Great deal of time spent in activities necessary to obtain substance or recover from use
4. Craving, strong desire, or urge to use
5. Recurrent use results in failure to fulfill major role obligations
6. Continued use despite consistent or recurrent social or interpersonal problems caused or exacerbated by use or effects of use
7. Important activities are given up or reduced
8. Recurrent use in situations in which it is physically dangerous (ex: drunk driving)
9. Continued use despite knowledge of having a persistent or recurrent physical or psychological problem related to use
10. Tolerance (needing increased amounts to achieve effect or diminished effect with continued use of the same amount)
11. Withdrawal (characteristic syndrome OR substance is used to relieve or avoid withdrawal symptoms)
Clinical course of SUD
-Runs in families
-Hard to know if it is environmental or hereditary
-See in younger age (onset late teens/early 20’s) b/c brain is a risk-taker at that age
-Most young people will have a drug of choice eventually
-Younger users are more likely to experiment with different drugs; older users generally have a substance of choice, but don’t limit to that drug
-Chronic course with periods of partial or complete remission (best sustained with formal tx)
Risk of setbacks
(previously referred to as relapse)
-Greatest during the first years of tx
-More likely in first 12 months of abstinence
-Majority will be able to maintain complete or partial remission
-90% of ppl abstinent at 2 years will be abstinent at 10 years
->90% abstinent at 10 years will be abstinent at 20 years
-It takes 2 years to reset the nucleus accumbens
Tx principles
-The person with SUD is ALWAYS RECOVERING
-Long-term tx is necessary to reduce risk of setbacks
-No one is perfect
-Pt MUST be engaged in tx, significant work by both tx providers and pt to maintain abstinence
-Providers must not be judgmental
-Tx includes pharmacotherapy and psychotherapy (includes group and individual tx)
Presentation of pt with BAC 50 mg/dl (0.05mg%)
Motor function impairment is observable
Presentation of pt with BAC 80 mg/dl (0.08mg%)
-Legal limit in most states
-Don’t realize rxn time is slower
-Moderate impairment
Presentation of pt with BAC 450 mg/dl
Respiratory depression
Presentation of pt with BAC 500 mg/dl
Lethal dose for ethanol
Stage 1 of alcohol withdrawal
-Time of onset
-Clinical features
~6-8 hours
~Moderate autonomic hyperactivity (anxiety, tremors, tachycardia, insomnia, N/V, diaphoresis) and a craving for alcohol
Stage 2 of alcohol withdrawal
-Time of onset
-Clinical features
~24 hours
~Autonomic hyperactivity with auditory/visual hallucinations lasting ~1-3 days (most remain lucid and oriented)
