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PT2 Psyche 1-6 > abuse disorder therapeutics > Flashcards

abuse disorder therapeutics Flashcards

(65 cards)

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1
Q

DSM-5 severity scale

A
  • mild = 2-3 symptoms
  • moderate = 4-5 symptoms
  • severe = >5
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2
Q

steps in brief intervention

A
  • express concern about current use and health risks
  • provide feedback on the health risks
  • advise patient to abstain or limit use
  • if patient is ready to change support a goal
  • offer referral to addiction specialty treatment
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3
Q

tips for brief interventions

A
  • listen for discrepancies between goals and their actions
  • be empathetic
  • avoid arguments about diagnosis
  • indicated responsibility for change is with them
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4
Q

5 stages of change

A
  • precontemplation
  • contemplation
  • preparation
  • action
  • maintenance
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5
Q

management of acute intoxication

A

consider:

  • safety of user
  • safety of others
  • level of intoxication
  • assess general health and withdrawal risk
  • observe and triage if needed
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6
Q

best treatment for acute intoxication

A

time

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7
Q

recommended drinking limit for men

A

-14 or less drinks per week
OR
-4 or less drinks at a time

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8
Q

recommended drinking limit for women

A

-7 or less drinks per week
OR
-3 or less drinks at a time

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9
Q

contraindications for alcohol use

A
  • pregnancy
  • liver disease
  • other conditions worsened by alcohol
  • use of meds with interactions
  • alcohol use disorder
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10
Q

AUDIT-C

A

assessment of alcohol use

  • best for screening because it detects hazardous drinking and abuse
  • detects recent use
  • greater sensitivity in populations w/ less prevalence
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11
Q

positive AUDIT-C score

A

4 or greater for men

3 or greater for women

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12
Q

ethyl glucoronide test

A

positive shortly after alcohol intake and can be detected up to 5 days after heavy binge drinking

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13
Q

signs and symptoms of alcohol withdrawal

A
  • N/V
  • diaphoresis
  • agitation/anxiety
  • headache
  • tremor
  • seizures
  • hallucinations
  • delirium tremens
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14
Q

when to refer a person with alcohol withdrawal to hospital

A
  • hx of delirium tremens or seizures
  • risk of harm to self or others
  • active psychosis
  • inability to take oral meds
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15
Q

average duration of withdrawal symptoms

A

3-5 days

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16
Q

CIWA-Ar

A

scale used to evaluate symptoms of alcohol withdrawal
< 8 mild
8-15 moderate
>15 severe

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17
Q

alcohol withdrawal symptom prevention medications

A

benzos
thiamine
anticonvulsants?

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18
Q

supportive care meds for alcohol withdrawal

A
  • clonidine
  • loperimide
  • APAP
  • ibuprofen
  • promethazine/ondansetron
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19
Q

benzo of choice in alcohol withdrawal

A

lorazepam, less interactions especially with liver dysfunction

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20
Q

benzo dosing methods

A
  • symptom trigger dosing using CIWA to determine need

- fixed dosing following a regular schedule gradually tapered

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21
Q

supplements to give in alcohol withdrawal

A 
thiamine
folic acid
multivitamin
potassium
phosphorus
magnesium
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22
Q

first line alcohol maintenance medications

A
  • naltrexone oral (ReVia)
  • naltrexone LA injection (Vivitrol)
  • acamprosate
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23
Q

second line alcohol maintenance medications

A

disulfiram

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24
Q

use of naltrexone

A
  • reduce drinking, cravings, and increase abstinence

- start 7 to 10 days after detox and last dose of opioid

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25
naltrexone oral dosing
- first give test dose of 25 mg | - 50 mg for maintenance
26
naltrexone injection dosing
- 380 mg IM every 4 weeks | - must be refrigerated
27
naltrexone contraindications
- recent opioid use - hepatitis - pregnant women
28
naltrexone side effects
- N/V - injection site reactions - change in appetite and sleep
29
how long must a pt. be opioid free to use naltrexone
7-10 days
30
naltrexone renal considerations
for Vivitrol (injection) must have CrCl of 50 or greater
31
acamprosate MoA
NMDA receptor modulator
32
acamprosate dosing
666 mg 3 times per day
33
acamprosate side effects
diarrhea | flatulence
34
acamprosate renal considerations
- CrCl 30-50 start 1 tab TID | - CrCl < 30 do not give
35
disulfiram MoA
aldehyde dehydrogenase inhibitor
36
disulfiram use
- 2nd line due to severe side effects | - may use after pt has abstained for 24 hr
37
disulfiram dosing
250 mg daily can crush and mix with liquid AVOID ALCOHOL
38
disulfiram side effects
fatigue drowsiness metallic/garlic aftertaste
39
disulfiram contraindications
- severe heart disease - psychosis - metronidazole use
40
disulfiram monitoring
- baseline blood alcohol level - EKG - pregnancy test - LFTs baseline, 10-14 days after starting, then yearly
41
off label alcohol maintenance medications
topiramate | gabapentin
42
House bill 11
Good samaritan law
43
house bill 119
naloxone law, physicians can prescribe to 3rd parties and no legal liability for administering it
44
UCA §26‐55‐105
allows pharmacists to dispense
45
opioid withdrawal symptoms
- diarrhea - lacrimation - rhinorrhea - sweating - irritability
46
COWS
``` opiate withdrawal scale to evaluate symptoms 5-12 mild 13-24 moderate 25-36 mod-sev >36 severe ```
47
opioid replacement therapies
methadone | buprenorphine
48
supportive drug for opioid withdrawal
clonidine loperamide dicyclomine antiemetics
49
methadone duration of action
24-36 hours
50
methadone adverse effects
- QT prolongation | - hypotension
51
methadone prescribing
only done at licensed treatment center
52
methadone dosing
40-120 mg once daily
53
best treatment option for opioid abuse in pregnancy
methadone
54
drug that needs an X DEA number to prescribe
buprenorphine
55
buprenorphine dosing
4-8 mg on first day, titrate up
56
buprenorphine in pregnancy
the buprenorphine only formulation can be used in pregnancy, not the combos
57
buprenorphine compared to methadone
less overdose risk and abuse potential
58
what drug can be used for alcohol and opioid use disorders
naltrexone
59
when to avoid nicotine replacement therapy
MI in last 2 weeks or has unstable angina or arrhythmia
60
drugs for smoking cessation
bupropion | varenicline
61
bupropion dosing
- Days 1-3 150 mg in morning - Days 4-end 150 mg BID - start 1-2 weeks before quit date
62
bupropion contraindications
seizure disorders eating disorder heavy alcohol use
63
varenicline cautions
renal impairment | psychiatric illness
64
varenicline dosing
start 1 week before quit date - days 1-3 0.5 mg qam - days 4-7 0.5 mg BID - day 8-end 1 mg BID
65
varenicline side effects
nausea insomnia abnormal dreams

PT2 Psyche 1-6 (6 decks)

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