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Question 1

What are the FDA approved treatments for alcohol dependence?

Answer 1

• Disulfuram
• Acamprosate
• Naltrexone PO
• Naltrexone IM monthly

Question 2

Compared to number of people with alcohol use disorder, about how many are receiving medications treatment

Answer 2

-less than 100,000

Question 3

What is the recommendation by NIAA regarding medication treatment for severe alcohol use disorder>

Answer 3

-medication treatment is the GOLD STANDARD given the relatively high relapse rates associated with psycho social support alone (50% at 12 months, 90% at 48 months)

Question 4

Which enzyme is inhibited by disulfiram?

Answer 4

ALDEHYDE Dehydrogenase

Question 5

Name the potentially serious side effects of disulfiram

Answer 5

• hepatitis
• peripheral neuropathy
• optic neuritis
• depression or psychotic disorder or exascerbation

Question 6

What are necessary precautions when prescribing disulfiram

Answer 6

• ALWAYS check LFT’s
• use in motivated and reliable pts only
• warn pts regarding cologne, use of alcohol swipes, mouthwashes

Question 7

Contraindications to Disulfiram

Answer 7

• use of alcohol-containing products or paraldehyde within 14 days
• recent use of metronidazole (also inhibits aldhyde dehydrogenase)
• severe CAD
• psychosis

Question 8

The symptoms of acute alcohol withdrawal are related to overactivity of:

Answer 8

GLUTAMATE

Question 9

Which of the medications used for treatment of alcohol use disorder is CONTRAINDICATED in pts with advanced renal disease (CrCl < 30)?

Answer 9

ACAMPROSATE

Question 10

Most common side effect of acamprosate?

Answer 10

GI upset

Question 11

Describe the mechanism of action of acamprosate

Answer 11

• decrease presynaptic release of glutamate

- block post synaptic NMDA receptors

Question 12

Main metabolic advantage of acamprosate

Answer 12

• renally cleared

- therefore, safe for use in pts with liver disease and no significant drug-drug interactions

Question 13

Naltrexone exerts its mechanism of action by acting primarily as

Answer 13

OPIOID ANTAGONIST

-blocks rewarding effects of alcohol

Question 14

Adverse effects of Naltrexone

Answer 14

-nausea, headaches, dizziness and fatigue, sleepiness (all less than 10% in studies)

Question 15

Name the contraindications for Naltrexone

Answer 15

• concomitant or recent use of opioids
• hypersensitivity to naltrexone
• liver failure or acute hepatitis
• CAUTION: history of suicide attempts

Question 16

What is one metabolic advantage of IM naltrexone

Answer 16

-because IM, reduction in first pass metabolism, therefore less medication reactions

Question 17

Other considerations in prescribing naltrexone

Answer 17

• medical alert card carried at all times

- alternative emergency pain management that does not include opioids