Treatment of Substance Use Disorders Flashcards
In people with a history of complicated withdrawal / serious medical conditions, what is the best treatment plan for alcohol withdrawal?
Usage of a standing dosage of benzodiazepines, on a regular schedule for at least 72 hours, after which they are stable and you can taper them.
What are the two benzos primarily considered for alcohol withdrawal, and when is it better to usage them?
Chlordiazepoxide - long half-life, good for most patients. Has many active metabolites
Lorazepam - Short half-life, only requires Phase II metabolism, much safer for those with liver damage
What is one reason why we want to prevent alcohol withdrawal, other than autonomic instability / seizure?
Repeated withdrawal may increased risk of permanent cognitive decline, and increase severity of future episodes
What scale is used to assess alcohol withdrawal, and why is this done?
CIWA - to ensure there are objective signs of withdrawal before giving out easy benzos to those addicted to a depressant
What type of seizures are alcohol withdrawal seizures, and who is predisposed?
Generalized tonic-clonic with loss of consciousness
-> predisposed = hypokalemia, hypomagnesia, epilepsy
What is the mechanism of action of disulfiram and its main problem?
Inhibits aldehyde dehydrogenase, and leads to a toxic accumulation of acetaldehyde if alcohol is drank, which may be fatal
-> poor adherence
What is the mechanism of action of fomepizole?
Inhibits alcohol dehydrogenase, used for the treatment of methanol poisioning
Why is Naltrexone thought to be useful in the treatment of alcoholism?
Alcohol is thought to release endogenous opioids, leading to reinforcement
-> as an opioid antagonist, naltrexone changes the subjective experience of alcohol
What is the mechanism of action of Acamprosate? What is it used to treat? How is it excreted?
Second line drug behind naltrexone for treatment of alcohol use disorder
Mechanism: NMDA antagonist, GABA-A agonist - “normalizes neurotransmitter systems”
-excreted by the kidney, so better i n liver problems
What is one anti-seizure drug which has been shown to reduce drinking habits?
Topiramate
How is opioid withdrawal typically managed?
Methadone or buprenorphine (partial agonist) until there are no withdrawal symptoms, then taper
Manage withdrawal symptoms via medication:
Ibuprofen for muscle aches
Dicyclomine for diarrhea
Clonidine for autonomic changes / sweating / insomnia
Can methadone be abused? Who prescribes it?
Yes - it can be ground up and injected for a high
It is a full opiate agonist given daily, prescribed by government-mandated methadone clinics
How is buprenorphine given? Why is it useful?
Can be prescribed in office, it is a 50% agonist of the mu receptor. Useful because it can act as an antagonist to full agonists as it has a high receptor affinity
Why do we want to give methadone to addicts if it’s still keeping them fully addicted?
- Reduces injectable heroin / HIV spread
2. Decreases criminal activity to obtain opiates
What opiate antaogonist is used to treat opiate addiction, and its major drawback?
Naltrexone -> drawback is adherence. It’s better in the management of alcohol use disorder
