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Mental Health 1 > Pharmacotherapy for Drug and Alcohol Misuse > Flashcards

Pharmacotherapy for Drug and Alcohol Misuse Flashcards

1
Q

State the four uses of pharmacotherapies in addiction

A

Substitution, treating withdrawal, preventing relapse, and preventing harms

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2
Q

What percentage of alcohol dependent patients are not treated? (Kohn et al, 2004)

A

92% - mostly as they do not seek treatment

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3
Q

Are substitutions ever prescribed for alcohol?

A

No - but theoretically diazepam or valium could be, as they are very similar in their effects

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4
Q

Why should alcoholics not go cold-turkey outside of hospital?

A

Alcohol withdrawal is life-threatening and they could suffer seizures

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5
Q

How many major subunits does the GABA-A receptor have?

A

5

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6
Q

How does chronic drinking affect the GABA-A receptor?

A

It causes receptor tolerance, probably by changing the subunit profile

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7
Q

How does chronic drinking affect the NMDA receptor?

A

Alcohol antagonises the NMDA receptor. Chronic drinking leads to receptor upregulation to combat the antagonistic affect - in animal models, this is associated with impaired memory

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8
Q

Describe the effects of alcohol withdrawal on the brain

A

It increases activity in the NMDA receptor and L-type calcium channels, leading to calcium influx, hyper-excitability, and cell death. This increased activity causes seizures. It also causes decreased GABA-ergic activity and less magnesium ion inhibition of the NMDA receptor

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9
Q

Describe the effect of multiple alcohol detoxifications

A

Multiple detoxifications are associated with less response to treatment (Malcolm et al, 2000) and worse performance on cognitive tests (Duka et al, 2003)

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10
Q

Name a drug used at specialist addiction treatment centres to calm NMDA activity during alcohol withdrawal

A

Acamprosate

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11
Q

Name the 2 drugs used to reduce signs and symptoms of alcohol withdrawal

A

Benzodiazepines and carbamazepine

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12
Q

Why is carmabazepine not used for alcohol withdrawal in the UK?

A

It side effects - confusion and ataxia - are the same as the symptoms of alcohol withdrawal

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13
Q

State some harms of long-term alcohol use

A

Malnutrition, liver disease, inflammation, Marchiafava-Bignami disease, central pontine myelinosis

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14
Q

What is Marchiafava-Bignami disease?

A

Corpus callosum demyelination, necrosis, and atrophy, lrading to loss of consciousness, aggression, seizures,depression, hemiparesis, ataxia, apraxia, and coma

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15
Q

What is central pontine myelinolysis?

A

A neurological condition involving severe damage to the myelin sheath of nerve cells of the pons. It is most commonly caused iatrogenically by increasing serum sodium of a hyponatraemic patient too quickly - the mechanism of damage in alcoholism is unclear

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16
Q

What is the most common vitamin deficiency in alcoholics?

A

B1 (thiamine)

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17
Q

State the 2 main consequences of thiamine deficiency

A

Wernicke’s encephalopathy and Korsakoff’s syndrome

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18
Q

Describe the triad of symptoms in Wernicke’s encephalopathy

A

Ophthalmoplegia, ataxia, acute confusion (many patients do not have all three)

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19
Q

Describe Korsakoff’s syndrome

A

Irreversible short-term memory loss in the presence of otherwise normal cognitive peformance

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20
Q

What is the most common presenting symptom of Wernicke’s encephalopathy?

A

Acute confusion - which makes it hard to differentiate from acute alcohol intoxication

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21
Q

State a cause of Wernicke’s encephalopathy other than alcoholism

A

Hyperemesis gravidarum

22
Q

Why do alcoholics require IM or IV thiamine?

A

They cannot absorb sufficient from an oral route

23
Q

What is the daily requirement of thiamine?

A

1mg

24
Q

Describe the relationship between the D2 receptor, D3 receptor, and addiction

A

Low levels of D2 are associated with drug-liking and impulsivity and are seen in stimulant and alcohol addicts. High levels of D3 are seen in stimulant addicts but not alcoholics

25
Q

Which drug of addiction is bupropion licensed for?

A

Nicotine

26
Q

Describe the mechanism of action of disulfiram

A

It inhibits aldehyde dehydrogenase in the liver, causing a buildup of the alcohol breakdown product acetaldehyde and leading to nausea, vomiting, flushing, palpitations, headache, and hypotension

27
Q

State some contraindications for prescribing disulfiram

A

Psychosis, severe liver disease, severe cardiac disease, epilepsy

28
Q

How can disulfiram cause psychiatric side effects, and what are they?

A

It inhibits aldehyde hydrogenase, which is in the same family as dopamine-B-hydrozylase - the enzyme which converts dopamine to noradrenaline. It hence increases the amount of dopamine and decreases noradrenaline, leading to anxiety, mania, psychosis, and depression

29
Q

Why are GABA-B agonists efficacious in alcoholism?

A

GABA inhibits dopamine firing in response to a stimulus and hence removes the pleasure associated with drinking

30
Q

Name a GABA-B agonist that can be prescribed for alcoholism

A

Baclofen

31
Q

What is baclofen usually prescribed for?

A

Treating muscle spasms in multiple sclerosis

32
Q

Why are opiate antagonists efficacious in alcoholism?

A

Opioids are inhibitory against GABA via the mu-opioid receptor - opiate antagonists block this, allowing GABA to function and block dopamine release, removing the pleasure associated with drinking

33
Q

Name 2 opiate antagonists prescribed for alcoholism

A

Naltrexone and namlefene

34
Q

Which patients cannot take opiate antagonists for alcoholism?

A

Those on opioid analgesia

35
Q

How does alcoholism affect the mu and kappa receptors?

A

They are usually balanced - in alcoholics, the kappa system is upregulated, leading to feelings of dysphoria

36
Q

Describe the method of action of nalmefene

A

It antagonises the mu and kappa opioid receptors, reducing the pleasurable effects of alcohol

37
Q

State some side effects of nalmefene

A

Nausea, insomnia, depersonalisation - most pronounced over first few days

38
Q

What is acamprosate?

A

An anti-glutamate drug derived from taurine

39
Q

Which abstinence-maintaining drug can be started while an individual is still drinking?

A

Nalmefene

40
Q

What is the key therapeutic approach in opiate addiction?

A

Substitution - either with a full opioid receptor agonist, a partial agonist, or an antagonist

41
Q

Name a full opioid receptor agonist and its major side effect

A

Methadone - respiratory depression (a danger of all full agonists)

42
Q

Name a partial opioid receptor agonist

A

Buprenorphine

43
Q

Give at least 2 disadvantages of prescribing buprenorphine in heroin addiction

A

Much more expensive than methadone, less liked by heroin adducts (prevents heroin having effects when taken ‘on top’), can still cause lethal respiratory depression when taken with other depressants, causes some withdrawal symptoms

44
Q

Give an advantage of prescribing buprenorphine in heroin addiction

A

Less sedating than methadone, safer - especially for elderly addicts as tolerance decreases with age and frailty

45
Q

Give 2 disadvantages of prescribing naltrexone for heroin addiction

A

No reinforcement therefore poor compliance, precipitates extreme withdrawal symptoms

46
Q

Which heroin addict patient group is likely to take naltrexone?

A

Professional ex-opiate addicts who want to continue working, e.g. dentists or doctors

47
Q

Why must naloxone always be prescribed with methadone, and what is it?

A

It is a short-acting opiate antagonist and must be prescribed in case of overdose

48
Q

Describe the symptoms of opiate withdrawal

A

Mydriasis, diarrhoea, dysphoria, tachycardia, sweating, insomnia, pilorection, rhinorrhoea, shivering, restlessness, craving

49
Q

Other than opiate agonists, name a class of drugs which can treat opiate withdrawal

A

Noradrenergic agonists

50
Q

Name a drug used to treat nicotine withdrawal

A

Varenicline

Mental Health 1 (35 decks)

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