Addiction

Question 1

administration of buprenorphine

Answer 1

SL as first-pass metabolism decreases bioavailability almost completely

Question 2

therapeutic indications for morphine

Answer 2

tx opioid dependence

Question 3

time frames for short and long-term detox as well as maintenance from opioids

Answer 3

short-term: 7-30 days
long-term: up to 180 days
maintenance: longer than 180 days

Question 4

what schedule drug is methadone

Answer 4

2

Question 5

what is the best way to detox heroine

Answer 5

transition to methadone, then buprenorphine, then naltrexone

tx withdraw symptoms w/ clonidine

Question 6

time frame for avoidance of opioids prior to intiation of buprenorphine

Answer 6

short-acting: 12-24 hours
long-acting: 24-48 hours

Question 7

effective dosage of methadone

Answer 7

> 60mg

Question 8

effective dosage of buprenorphine

Answer 8

6-16mg

Question 9

time frame for development of withdrawal symptoms from methadone

Answer 9

within 3-4 days with peak at 6 days

Question 10

dosages for methadone in maintenance program

Answer 10

initially 15-20mg then titrate up over several weeks to at least 70mg w/ max of 120mg daily

Question 11

how long should methadone maintenance programs last

Answer 11

several years

Question 12

who can administer buprenorphine

Answer 12

specially trained physicians

Question 13

tramadol dosages for depression/OCD

Answer 13

50-200mg daily

Question 14

opioid receptor agonists used for withdrawal

Answer 14

morphine
buprenorphine

Question 15

when does tolerance to naltrexone develop

Answer 15

It doesnt

Question 15

buprenorphine ceiling effect

Answer 15

eventually increased dosing prolongs action without further increasing agonist effects

Question 16

opioid receptor antagonists used for opioid addiction

Answer 16

naltrexone
nalmefene
naloxone

Question 17

how do opioid receptor antagonists work for opioid addiction

Answer 17

bind to opioid receptors without activating them

Question 18

how long does naltrexone block opioid effects

Answer 18

72 hours

Question 19

half-life and peak concentration of naltrexone

Answer 19

peak concentration in 1 hour
half-life 1-3 hours and 13 hours for metabolite

Question 20

why is naloxone used before initiation of naltrexone

Answer 20

to confirm patient is opioid free

Question 21

what is the most effective treatment for opioid addiction

Answer 21

opioid receptor antagonist with CBT

Question 22

how do you obtain rapid detox if initiated on the first day of opioid abstinence

Answer 22

continuous administration of clonidine to reduce adrenergic symptoms and adjunct benzodiazepines to reduce muscle spasms and insomnia

Question 23

how quickly can rapid detox from opioids be accomplished

Answer 23

48-72 hours

Question 24

why would you use opioid receptor antagonists in alcohol use disorder

Answer 24

to reduce cravings

Question 25

washout period required between last dose of short acting opioid and antagonist treatment

Answer 25

5 days (heroine)

Question 26

washout period between last dose of long acting opioids and antagonist use

Answer 26

10 days (methadone)

Question 27

what happens in a naloxone challenge

Answer 27

it will reduce the effects of opioid causing withdrawal but effects only last about an hour so symptoms are short lived helps to confirm opioid free state prior to initiating opioid antagonist treatment

Question 28

symptoms of acute opioid withdrawal

Answer 28

drug craving feeling of temperature change musculoskeletal pain GI distress

Question 29

what if pain relief is needed during opioid antagonist therapy

Answer 29

use benzodiazepine or nonopioid analgesic

Question 30

initial dosage of naltrexone

Answer 30

50mg daily

Question 31

dose-related hepatotoxicity of naltrexone

Answer 31

doses above 50mg daily monitor serum aminotransferase for first 6 months

Question 32

how quickly do you titrate up dosage of naltrexone and how do you administer it during maintenance

Answer 32

titrate over 1 hour - 2 weeks average dosage over a week (100mg qod or 150mg q3 days)

Question 33

what is used to treat alcohol use disorder

Answer 33

disulfiram and acamprosate

Question 34

what is the half-life of disulfiram

Answer 34

60-120 hours (may take 1-2 weeks to be eliminated from the body)

Question 35

how does disulfiram work

Answer 35

blocks effects of alcohol by causing increase in acetaldehyde in the blood which causes the unpleasant reaction

Question 36

what are the symptoms of disulfiram reaction

Answer 36

N/V, HA, flushing, sweating, thirst, dyspnea, tachycardia, chest pain, vertigo, blurred vision

Question 37

how long after alcohol consumption does disulfiram reaction occur and how long does it last

Answer 37

almost immediately and lasts 30 minutes to 2 hours

Question 38

when is the use of disulfiram contraindicated and why

Answer 38

significant pulmonary or cardiovascular disease because severe reaction can be fatal

Question 39

typical dosage of disulfiram

Answer 39

500mg daily x2 weeks followed by maintenance dose of 250mg

Question 40

maintenance range for disulfiram

Answer 40

125mg-500mg

Question 41

how long must alcohol be stopped prior to starting disulfiram

Answer 41

12 hours

Question 42

what kinds of alcohol must you avoid with disulfiram

Answer 42

all kinds including mouthwash, cough syrups, perfume

Question 43

common side effects of acamprosate

Answer 43

HA, diarrhea, flatulence, abdominal pain. [aresthesia, skin reactions

Question 44

when is acamprosate contraindicated

Answer 44

severe renal impairment

Question 45

recommended dosage of acamprosate

Answer 45

2 333mg tabs TID

Question 46

what if you miss a dose of acamprosate

Answer 46

take it ASAP unless almost time for next dose

Question 47

therapeutic indication for clonidine and guanfacine

Answer 47

withdrawal tourettes tic disorders hyperactivity/aggressiveness in children PTSD

Question 48

half life of clonidine

Answer 48

6-20 hours

Question 49

half-life of guanfacine

Answer 49

10-30 hours

Question 50

mechanism of action for clonidine and guanfacine

Answer 50

presynaptic a2-receptor agonists

Question 51

how does clonidine/guanfacine help withdrawal symptoms

Answer 51

reduces autonomic symptoms of rapid withdrawal but not subjective sensations

Question 52

time frame for therapeutic effect clonidine/guanfacine in tourettes

Answer 52

may take a long time to affect sx (4-6 months)

Question 53

common side effects of clonidine

Answer 53

dry mouth/eyes, fatigue, sedation, dizziness, nausea, hypotension, constipation

Question 54

how does OD of clonidine/guanfacine present

Answer 54

coma and constricted pupils similar to opioids with decreased BP, P, R

Question 55

when do withdrawal symptoms appear from clonidine

Answer 55

after 20 hours

Question 56

sx of abrupt cessation of clonidine/guanfacine

Answer 56

anxiety/restlessness sweating tremor abdominal pain palpitations HA dramatic increase in BP

Question 57

first pass metabolism of methadone

Answer 57

decreases bioavailability by half

Question 58

First-pass metabolism of buprenorphine

Answer 58

decreases bioavailability almost entirely (give SL)