Addiction med

Question 1

SUD (4), AUD, OUD

Answer 1

Substance use do (Tobacco, ETOH, Marijuana, Ilicit drugs
Alcohol use do
Opioid use do

Question 2

Addiciton def.

Answer 2

CHRONIC, RELAPSING disorder
“disease necessisating tx”

Question 3

T/F: Treat relapse slowly

Answer 3

False, treat relapse QUICKLY

Question 4

OD deaths largely from

Answer 4

FENTANYL and synthetic opioids

Question 5

___% of pts prescribed opiates will misuse them
___% of provider Rx will lead pts to SUD

Answer 5

30%
10%

Question 6

T/F: Using drugs alone leads to more OD’s?

Answer 6

Trueee

Question 7

Which NT is most commonly overstimulated w/opioids?

Answer 7

DOPAMINE
“Nearly all addictive drugs directly or indirectly target the brain’s reward system by flooding the circuit with dopamine”.

Question 8

__% of a pts propensity for addiction is genetic

Answer 8

50%

Question 9

**Children of parents with SUD/AUD are __x more likely to develop an addiction

Answer 9

8

Question 10

Earlier age at 1st encounter w/drugs or ETOH, more likely to develop addiction
adult mental illness:
__before 14yo,
____before 24yo

Answer 10

1/2
3/4

Question 11

___% ind w/mental illness also struggle w/SUD

Answer 11

50%

Question 12

Alcoholics __x more likely to be dx w/antisocial personality compared to gen pop

Answer 12

21

Question 13

Women who abuse Rx opioids are ___% more likely to be dx with PTSD

Answer 13

200%

Question 14

Addcition is a ___ not a lack of ___

Answer 14

Disease
Willpower

Question 15

T/F: Addicts fear community judgement

Answer 15

True

Question 16

T/F: we should ask addcition questions like “we ask this of everyone”

Answer 16

NO. JUST ASK IT. Dont give it a pretext

Question 17

5 Points of speaking to pts about addcition

Answer 17

*Recommend that pt stop, but acknowledge diffculty & discuss ↓ over time.
*Keep discussion medicine-based
**∙ Provide EBM facts
“60% smokers die of complication 2/2 smoking”
∙ Openly discuss the health consequences
“80-90% more likely2 get lung CA as a smoker”
∙ Phrase from a QOL perspective
“Conseq of heavy ETOH inc liver failure which…”
∙ Addiction is a disease and is treatable

Question 18

**_____ leading preventable COD

Answer 18

Cigarette smoking

Question 19

• Smoking ↑ the risk of CAD & CVA ___x

Answer 19

2-4x

Question 20

1 in __ Americans smoke cigarettes

Answer 20

7

Question 21

T/F: Vaping is decreasing

Answer 21

False. its going UPP

Question 22

A 3–10-min discussion with a provider:
- ↑ the likelihood for pt’s success in quitting __x
- ↑ __x if the discussion exceeds 10 min
- However, if pt not ready to quit- don’t harass!

Answer 22

1.6
2.3x

Question 23

Avg of __ attempts before cessation of cig smoking

Answer 23

4

Question 24

Nicotine w/d Sx

Answer 24

• Feeling irritable, angry, or anxious
• Having trouble thinking
• Craving tobacco products
• Feeling hungrier than usual

Question 25

1yr after quitting, risk for a heart attack ↓ sharply 2-5yr after quitting, risk for CVA ↓ by 1/2 10yrs after quitting, risk for lung CA ↓ by 1/2

Answer 25

just saying

Question 26

Rx for Smoking cessation

Answer 26

Varenicline (Chantix) Bupropion (Welbutrin) Nicontine replacement (gum, patches, lozenge)

Question 27

T/F: you can have a pt on nicotine replacement with no plan to stop later

Answer 27

false

Question 28

Ecgarettes?

Answer 28

No FDA regulation Lack of research

Question 29

1:__ adults suffer AUD

Answer 29

12

Question 30

Which pt interactions need ETOH use screening? (2)

Answer 30

ALL pts as part of routine exam Before prescribing Rx that can interact w/ETOH

Question 31

Screen ETOH use for these pts

Answer 31

- Pregnant - H/o other substance abuse - Have depression, anxiety, or mental health do. - Have liver disease

Question 32

CAGE Questionnaire Score 0 Score 3-4 Score 1-2

Answer 32

CAGE score 0 has a good (-)predictive value CAGE score 3-4 strongly supports dx of AUD CAGE 1-2 interpreted with caution

Question 33

T/F: ETOH w/d can be life threatening

Answer 33

TRUE

Question 34

ETOH w/d starts at __-__hrs after last drink and lasts __-__hrs

Answer 34

8-12 48-72hrs

Question 35

Mild ETOH w/d

Answer 35

* onset 6-12h, can last 3d tremor, tachy, anxiety, GI upset

Question 36

Seizures ETOH w/d

Answer 36

* 24-48h gen tonic-clonic risk: h/o prior seizures

Question 37

* Delirium tremens

Answer 37

onset 24-72h confusion, hallucination (tactile & visual), tremor, autonomic dysfunction, CV instability –can be fatal

Question 38

What kind of hallucinations with delirium tremens?

Answer 38

Tactile, visual

Question 39

T/F: Delirium tremens can occur 10d out from w/d

Answer 39

True. Scary

Question 40

Wernicke Encephalopaty Korsakoff S/Sx of both? Which one is reversible? Tx for both?

Answer 40

* Wernicke encephalopathy: Wernicke's "CAN" Confusion, Ataxia, Neuralgia=ophthalmoplegia (CN VI), reversible * Korsakoff: sequela of Wernicke: psychosis irrreversible THIAMINE, THIAMINE, THIAMINE! For active W/d

Question 41

Avg person clears __-__mg/dL/hr of ETOH

Answer 41

15-20

Question 42

Rx for acute ETOH w/d sx?

Answer 42

**Barbiturates> Benzos cornerstone of Tx *Phenobarbitol works well, doesn't cause a "High"

Question 43

5 Strategies for Cutting down on ETOH?

Answer 43

- Keep track - Be aware of sizes - Set goals - Eat while drinking - Drink slower

Question 44

ETOH: *Treat depression-rel to relapse ______

Answer 44

Aggressively don't let them spiral

Question 45

3 oral ETOH MAT Rx 1 Injectable

Answer 45

1)**Naltrexone – helps ↓ drinking by stopping the pleasurable effects of ETOH. Cannot drink on these Rx (Patients must be abstinent prior to initiation of these): 2) Acamprosate – ↓ cravings 3) Disulfiram (Antabuse) – blocks the metabolism of alcohol (toxic ETOH compounds→ pt becomes ill) 4) Vivitrol is the injectable long-acting form

Question 46

Can you combo the MAT Rx?

Answer 46

Research doesnt support it. If pt cannot tolerate 1 for >3mo, try another

Question 47

Alcohol reduction Resources

Answer 47

AA

Question 48

Common Opioid Rx? (7)

Answer 48

Hydrocodone, Oxycodone, Percocet, Vicodin, Morphine, Codeine, Fentanyl

Question 49

Illicit Opioid?

Answer 49

Heroin

Question 50

Maintenance Opioid Tx?

Answer 50

Methadone

Question 51

___ OD is leading accidental COD

Answer 51

Drug

Question 52

__% of opioid misuse begins with using drugs that are not prescribed to that individual

Answer 52

75%

Question 53

< ___ MME is goal

Answer 53

50

Question 54

Acute pain Opioid Rx script

Answer 54

<14d <50MME

Question 55

Why is fentanyl an epidemic?

Answer 55

"dirt cheap & simple to make" Very few steps - Every batch is different could be 50x or 100x more potent than morphine - Used to cut with other drugs

Question 56

T/F: Opiate w/d can kill you

Answer 56

FALSE. ETOH and Benzo w/d can kill you

Question 57

Opiate W/d 10-24hrs

Answer 57

Emesis

Question 58

Opiate W/d 36-48hrs

Answer 58

Diaphoresis, Nausea, Rhinorrhea, MYDRIASIS, Conjunctiva

Question 59

Opiate W/d 48-72hrs

Answer 59

Anxiety, Insomnia, Localized pain

Question 60

Opiate W/d 72hrs-1wk

Answer 60

All sx gradually start fading away

Question 61

COWS

Answer 61

w/d scale for initation & amt of Saboxone to distribute

Question 62

What happens if you give saboxone too early?

Answer 62

Precipitate w/d

Question 63

Which tx can cause a high? Methadone or Saboxone?

Answer 63

Methadone

Question 64

T/F: COWS sx are objective?

Answer 64

No, they ar subjective

Question 65

T/F: *Supervised Detox - Provider/patient create a ↓ usage plan Is a good method?

Answer 65

FALSE - Research actually shows this is fairly unsuccessful and might actually lead to more overdoses

Question 66

MAT Tx for Opioids (3 Rx)

Answer 66

- Methadone - Buprenorphine (Suboxone) - Naltrexone

Question 67

T/F: MAT↑ tx retention & ↓ risk of OD

Answer 67

So true

Question 68

If pt is not ready to stop opioids, __ should be given at a minimum

Answer 68

Narcan yall

Question 69

What is an electronic database that tracks controlled substance Rx/state?

Answer 69

Prescription drug monitoring programs (PDMPs)

Question 70

T/F: In colorado, all pharmacies in CO required to input all controlled substance prescriptions AND report on same day as suspensement

Answer 70

TRUE

Question 71

T/F: Not all providers must be registered with PDMP

Answer 71

FALSe

Question 72

Bill 18-22

Answer 72

Clinical Practice for Opioid Prescribing Initial prescription of an opioid is limited to a seven-day supply, if the prescriber has not written an opioid prescription for the patient in the last 12 months The prescriber may exercise discretion in including a second fill for a seven-day supply.

Question 73

T/F: We should use stats when communicating with pts about addction

Answer 73

True

Question 74

T/F: You can tell patients who are not currently interested in cessation that you can discuss it in the future

Answer 74

yes