Anxiety, Insomnia, SUD Flashcards

Question

Zaleplon

Answer 1

Nonbenzo modulater GABA receptor complex Very short half life -- causes fewer problems in the morning Indicated only for short-term tx of insomnia (5 weeks)

Answer 2

Nonbenzo modulator of GABA receptor complex Indicated to decrease sleep latency CR: improve sleep maintenance, approved for chronic therapy SL: PRN if difficulty to fall back asleep with >4 hours more of sleep remain

Answer 3

-Lacks anticonvulsant action -Lacks muscle-relaxant properties -Lacks respiratory depressant effect

Answer 4

Women and older adults: 5mg (IR) or 6.25mg (CR) Men: 5-10mg (IR) or 6.25-12.5mg (CR)

Answer 5

Complex behaviors while asleep (driving, eating, sex, talking on phone) Anaphylaxis Decreased respiratory drive

Answer 6

ALL except doxepin

Answer 7

ALL except ramelteon and zaleplon

Answer 8

Eszopiclone Ramelteon Zolpidem CR

Answer 9

Daridorexant Lemborexant Suvorexant Decrease sleep latency & promote maintenance CI in narcolepsy Take within 30 minutes of sleep (daridorexant, suvorexant) when you have 7 hours remaining of sleep

Answer 10

Daridorexant Doxepin Ramelteon Suvorexant

Answer 11

Both: Trazodone, diphenhydramine, melatonin, valerian Also, tiagabine, tryptophan, BZDs, chamomile, kava kava

Answer 12

Alcohol BZDs Barbiturates

Answer 13

6-12 hr: mild (NV, anxiety, tremor, tachycardia) 12-24 hr: Hallucinations 24-48 hr: Seizures 48-72 hr: delirium tremens

Answer 14

Benzodiazepines (cross tolerance at GABA) FDA approved: chlordiazepoxide, diazepam, clorazepate, oxazepam Lorazepam often used if liver issues

Answer 15

Give to all patients to prevent Wernicke-Korsakoff 100-250mg IM/IV for 3-5 days, then 100mg PO TID x1 week, then 100mg daily

Answer 16

Acamprosate or naltrexone

Answer 17

Reduces cravings Use with CBT Risk: hepatic impairment, monitor LFTs Vivitrol is IM long acting form

Answer 18

reduces cravings TID dosing Reduce if CrCl 30-50 Warning: suicidal ideation

Answer 19

Reserved for patients with considerable motivation Blocks alcohol dehydrogenase, so acetaldehyde concentrations increase = N/V, flushing, HA Avoid with metronidazole = increased risk of encephalopathy

Answer 20

Short acting: 7-10 days Long acting: ?= 14 days

Answer 21

Buprenorphine or methadone

Answer 22

FDA approved for opioid withdrawal only (not long-term therapy) Less effective than buprenorphine or methadone Prolongs QTc Similar to clonidine but less hypotensive

Answer 23

Most studied and most widely used for OUD Preferred in pregnancy Administered as a single daily dose at a clinic CYP3A4 substrate

Answer 24

1. Fatal respiratory depression (lipophilic and long half life so can still release after analgesic effect peaks) 2. Prolonged QTc, TdP (most common if dose > 200mg). If QTc > 500, decrease or D/C methadone

Answer 25

Partial agonist at mu opioid receptor Antagonist at kappa receptor Will displace opioids but only give a fraction of effect that levels out with increasing doses ("ceiling effect") -- this allows patients to feel normal without losing function Less likely to cause respiratory depression

Answer 26

Start when clearly withdrawing from opioids 1. Give 2 to 4mg of buprenorphine (or 2/0.5 or 4/1mg suboxone) 2. If withdrawal symptoms not relieved or return at 2 hours, then repeat dose 3. Can repeat for max of 8mg or 8/2mg on day 1

Answer 27

Occurs when 1. Patient is without withdrawal symptoms 2. Patient is not experiencing adverse effects of suboxone 3. No longer has uncontrollable cravings Adjust dose in 2/0.5mg or 4/1mg increments Monitor weekly

Answer 28

Administer at lowest possible dose indefinitely

Answer 29

1.Taper to methadone 30mg/day or equivalent 2. Transition to buprenorphine 3. After 2 days of buprenorphine monotherapy, may transition to suboxone

Answer 30

ER subcutaneous buprenorphine May use AFTER induction phase 300mg x1 then1 100mg monthly REMS/BBW due to serious harm from IV admin. Administer SC.

Answer 31

Must be off opioids for 7-10 days before starting (14 days if on methadone or buprenorphine) Does NOT provide opioid agonism, so may be less effective in patients with severe cravings

Answer 32

Ask about tobacco use Advise to quit Assess willingness to attempt to quit Assist in quit attempt Arrange for follow up

Answer 33

Relevance Risks Rewards Roadblocks Repetition

Answer 34

Stop smoking before use >10 cigs/day: start with 21mg/day patch x6w, then 14mg/day x2w, then 7mg/day x2w Remove every morning and replace, unless cause sleep disturbance, then remove at bedtime Can use with gum, lozenge, inhaler, or nasal spray

Answer 35

Chew until peppery flavor, then "park" between cheek and gum for 30 minutes or until flavor is gone Max: 24 pieces/24 hours At least 9 pieces used daily to increase quitting If smoke first cig within 30 min of awakening: 4mg gum Avoid coffee, juice ,soft drinks 15 minutes before using

Answer 36

Smoke within 30 minutes of awakening: start with 4mg Dissolve lozenge completely. Do not chew, swallow Do not eat/drink 15 min before or after Max 20 lozenge/24 hours

Answer 37

Start 7 days before quit date Continue for 8 weeks or up to 6 months Can use with nicotine patch

Answer 38

Nicotine receptor partial agonist Blocks effects of nicotine from smoking Start 1 week before quit date (can quit up to 35 days after starting) Continue for 12 weeks. If successful, can continue another 12 weeks May combine with nicotine patch or bupropion

Answer 39

Cardiovascular disease CrCl < 30

Answer 40

Treatment of choice = nonpharmacologic

Answer 41

Varenicline > nicotine patch Varenicline > bupropion Varenicline + nicotine patch > varenicline alone Varenicline > e-cigs If pt not ready to stop, start varenicline treatment than wait for them to be ready to stop

Answer 42

Comorbid psych condition: varenicline > nicotine patch Varenicline for > 12 weeks is >> varenicline for 6-12 weeks

Anxiety, Insomnia, SUD Flashcards

(67 cards)