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Therapeutics III > Drug and Alcohol - Block 3 > Flashcards

Drug and Alcohol - Block 3 Flashcards

1
Q

What is drug abuse?

A

Use of an illicit drug causing harm to individual/society

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2
Q

What is a pschoactive effects?

A

Action of drug in the CNS causing alterations in perception, reason for abuse

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3
Q

What is narcotic?

A

A drg that causes stupor and loss of sensibility or dulling of the senses

  • Any illicit and habit forming drug
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4
Q

What is reinforcing effects?

A

Promotes the compulsive ued of a drug

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5
Q

What is rapidity?

A

Rate at which a drug reaches its receptors in the CNS and exerts its effects
* Positive reinforcement

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6
Q

What is tolerance?

A

Decrease in drug’s effect as a consequence of repeated admin -> more drug for same effect
* Downregulation of dopamine rceptors secondary to repeated over and repeated exposue

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7
Q

What is dependence?

A

The appearance of withdrawal syndrome when chronic admin of drug is halted

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8
Q

What is addiction?

A

An abusive pattern of drug use characterized by an overwhelming involvement with the use of a drug

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9
Q

Categories of drugs of abus?

A

Opioids: heroin, morphine, meperidine, fentanyl
Psychomotor stimulants: Cocaine, amphetamines
MJ
Sedative hypnotics: Barbiturates, alcohol, BZD
Hallucinogens: LSD
Inhalants: Mitrous oxide, amyl nitrite, toulene

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10
Q

What are the characteristics of SUD according to DSM V?

A
  1. Taking substance in large amounts
  2. Wanting to cut down or stop but can’t
  3. Spending a lot of time with substance
  4. Cravings
  5. Not managing to do what you should
  6. Problems in relations or puts patient in danger
  7. Withdrawal sx
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11
Q

Describe the mechanism of limbic system?

A

Release dopamine and glutamate in response to stimulus

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12
Q

Describe the reward system of the brain?

A
  1. Pleasurable event/stimuli=dopamine release in frontal cortex =euphoria
  2. The higher a stimuli’s place in the hierarchy, the stronger the compulsion to seek that stimuli
  3. Reward sytem reinforces survial behaviors
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13
Q

What are the driving forces of SUD?

A
  1. Cravings
  2. Rapidity
  3. Tolerance
  4. Withdrawals
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14
Q

What is the cause for cravings?

A

Overstim of reward circuit from dopamine leads to intense pleasurable high

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15
Q

What are the common formulations of cocaine?

A
  1. IV
  2. Smoking
  3. Intranasal
  4. PO
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16
Q

How cn SUD lead to neurotoxicity?

A
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17
Q

What is the definition of SUD?

A

Maladaptve pattern of substance use -> clinically significant impairment or distress within a 12 month period

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18
Q

How do we diagnose OUD?

A

At least two of the following should be observed within a 12-month period:
1. Recurrent opioid use resulting in a failure to fulfill responsibilities
2. Continued use -> social problems
3. Activites are given up
4. Recurrent opioid causes physical harm
5. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem

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19
Q

What are the clinical presentation of OUD?

A
  1. Intoxication
  2. Withdrawal
  3. Dependence/Abuse
  4. Medical cmplications
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20
Q

What are the screening tools for SUD?

A
  1. Structured Clinical Interview (SCID)
  2. Questionnaires for screening drug problems
  3. Questionnaires for assessing the severity of drug problems
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21
Q

What are the social complications of SUD?

A
  1. Loss in interest/motivation
  2. Criminal activity to support habit
  3. Transmission of HIV, Hep B and C
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22
Q

What is the objectve of SUD tx? Goal of therapy?

A

Prevent medical and social ADR

Abstinence and harm prevention

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23
Q

Presentations of cocaine intoxication?

A
  1. Paranoid psychosis
  2. Chest discomfort/angina
  3. Sz, respiratory depression, acute HF, stroke, death
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24
Q

How do we treat cocaine intoxication?

A
  1. Buprenorphine/naltrexone to manage withdrawals
  2. Topiramate for relapse prevention
  3. Baclofen (reduce dopamine release)
  4. Tiagabine
  5. Disulfirum (makes high less pleasant)
  6. Modafinil
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25
Q

What are the non toxic physiological responses of amphetamines?

A
  1. Loss of appetite
  2. Euphoria
  3. Mood elevation
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26
Q

Signs of amphetamine intoxication?

A
  1. Sudden outbursts of aggression and violence
  2. Paranoid delusions
  3. Severe anorexia
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27
Q

Sx of amphetamine withdrawals?

A
  1. Dysphoric
  2. Fatigue
  3. Aches and pains
  4. Ax
  5. Insomnia
  6. Increased appetite
  7. Vivid dreams
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28
Q

How do we manage amphetamine detox?

A

No tx, but med is beeficial for withdrawn sx:
1. Modafinil: reduce fatigue
2. Propranolol: Reduce anxiety
3. Bupropion: Help with unpleasant mood
4. Short term BZD, antipsychotics: control irritability and agitation

29
Q

What are the signs of opioid withdrawals?

A
  1. Opioid cravings
  2. Restlessness, irritability, dysphoria
  3. Hyperalgesia
  4. Insomnia
  5. Ax
  6. Pupillary dilation
  7. Sweating
  8. N/V/D cramps
  9. Hot flashes
30
Q

What are the medical complications of opioids?

A
  1. Constipation
  2. Sexual dysfuntion
31
Q

What are signs of opioid intoxication?

A
  1. Euphoria
  2. Respiratry depression
  3. Nonarousable, unresponsive to stimulus
  4. Limp, cyanosis
  5. SLow heartbeat
32
Q

COunseling points for naloxone?

A
  1. Kicks off opioid from mu receptor
  2. 1-8 minute onset
  3. Readmin in 2 mins if no response
  4. Duration of action is about 60 minutes, so make sure to call 911 and get patient to ER even if seem fine after administration
  5. BZD prevents reversal
33
Q

What is the difference between physical and psychological dependence?

A

Physical: tolerance, withdrawal, cravings, risk of OD and death
Psychological: inability to cut down or control, increased amount of time spent, social withdrawal, opioid cause adverse consequences

34
Q

What is the tx for OUD?

A
  1. MAT
  2. Methadone
  3. Buprenorphine
  4. Maltrexone
  5. Tapering/weaning
  6. Clonidine
  7. Lofexidine (Lucemyra)
35
Q

What is the MOA of methadone and buprenorphine?

A
  1. Activtion of µ recepot
  2. Inhibits activation of peripheral nociceptors
  3. Prevent ascending transmission of pain signals
36
Q

What is methdone’s use for pain?

A
  1. Not considered first line
  2. Start 2.5 mg Q8H in opioid naive
  3. Increase by 5 mg every 5-7 days
  4. Effective dose can be as low 2.5mg TID
  5. Effective duration 6 hours
37
Q

Methodone’s use in OUD?

A

First line for IV abusers or high dose users:
1. Start dose 30mg increase by 5 based on symptoms to 50mg then by 10
2. Suppress withdrawal sx, cravings, and illicit opioid use, 60 mg QD or 80-85 mg

38
Q

DDI of methdone and buprinorphine?

A
  1. Antivirals decrease opioid
  2. Antibiotic increase opioid
  3. BDZ, barbs, alcohol
  4. SSRI (sertraline): increase methadone
39
Q

What is the use of naltrexone for OUD?

A
  1. Antagonist of mu receptor
  2. Required detox first, followed by 7-10 day wait perioid before initiation
  3. Increased rate of OD after tx dropout -> loss in tolerance
  4. Useful in concurrent BZD dependency
  5. No risk for diversion
40
Q

How should we taper opioids?

A
  1. <50MME
  2. Decrease 10% of original dose QW
  3. Psychosocial support
  4. Only reduce rate or pause taper but never reverse taper
41
Q

Tx for pain during OUD tx?

A

NSAIDs, APAP

42
Q

Tx for diarrea during OUD tx?

A

Loperamide (opioid as well though, so be careful)

43
Q

Tx for constipation during OUD tx?

A

Laxative

44
Q

N/V during OUD tx?

A
  1. Prochloperazine
  2. Halpeidol
  3. Ondansetron
45
Q

Ax, irritaility, cramps during OUD tx?

A
  1. Hydroxyzine
  2. Quetiapine
46
Q

Insomnia during OUD tx?

A

Trazadone

47
Q

Autonomic sx during OUD sx?

A
  1. Cloniine
  2. Reassess 3-7 days, taper upon sx resolution
48
Q

What are the advantages of using clonidine for OUD?

A
  1. decreases the noradrenergic hyperactivity associated with opioid withdrawal
  2. Reduce withdrawal sx (n/v/d, cramps, sweating but doesn’t reduce muscle aches, insomnia, cravings)
  3. Doesn’t produce opioid like tolerance or dependence or post methadone rebound in wd sx

0.1 mg TID

49
Q

What is Lofexidine?

A

alpha-adrenergic agonist that is used for the mitigation of WD sx for up to 14 days during abrupt DC of opiiods
* Expensive
* Possible adverse effects & warnings: Hypotension, bradycardia, syncope, Somnolence, Dry mouth, QT prolongation
* Increased risk of opioid overdose if resume using after withdrawal

50
Q

What is the mechanism of AUD?

A

During withdrawal, GABA levels decrease below normal capacity, which ultimately leads to hyperactivity of the nervous system
* Alcohol activates opioid receptors -> pleasure of drinking

51
Q

What are the complications of alcohol use?

A
  1. Daages to liver, heart, nerves, CBC, GI
  2. Impaired memory
52
Q

What are sx of alcohol withdrawals?

A
  1. SZ
  2. Delirium tremens
  3. Trembling
  4. Ax
53
Q

Differentiate the types of alcohol withdrawals

A

Onset of particular symptoms and severity:
Mild: sweating, agitation, tremor, NV, insomnia, Ax
* 6-24H, peaks 24-36H

Major: sz, increased BP, visual hallucinations
* 12-48H, peak 24H

Withdrawal delirium (DT): confusion, fever, tremor -> fatal
* 48-96H

54
Q

How do we screen for alcohol withdrawal?

A

Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-Ar)

55
Q

How do we manage withdrawals?

A
  1. Long and intermediate BZD is first line acute management
    * Lorazepam (good for elderly and live disease)
    * Diazepam
    * Chlordiazepoxide
  2. Anticonvulsants (Valproate, carbamazepine, gaapentin)
  3. Clonidine and atenolol: lower BP, HR, treors
  4. Haloperidol: uncontrolled agitation
  5. Penytoin-barb and propofol: refractory DT
56
Q

What is nutritional suport for alcohol wthdrawal>

A
  1. Folic acid
  2. Thiamine 100mg QD to prevent Wernicke’s encephalopathy
  3. Magnesium to resolve AWS sx
57
Q

What are anti crazing agents of for alcohol?

A
  1. Acamprosate: decrease craving by GABA and glutamate
  2. Naltrexone: reduce crazings and reinforcing properties of alcohol
58
Q

Agents that deter patients from consuming alcohol?

A

Dilsulfiram: inhibits acetaldehyde dehydrogenase

Support groups, AA, psychotherapy

Meds to control comorbidities

59
Q

Atibiotics that act similar to disulfiram?

A
  1. Metronidazole
  2. Ketoconazole
60
Q

RF of BZD use disorder?

A
  1. TDD used for 4-6 months
  2. Dose exceeds 2-3x upper limit of TD used for 2-3 months
  3. Withdrawal begins 12-48H after last use
  4. Drugs with faster onset -> higher potential for dependence
61
Q

What are your rapid BZDs?

A
  1. Diazepam
  2. Lorazepam
62
Q

Intermediate BZDs?

A
  1. Alprazolam
  2. Lorazepam
  3. Chlordiazepoxide
  4. Clonazepam
63
Q

Slow acting BZDs?

A

Oxazepam

64
Q

BZDs that are most commonly abused?

A
  1. Diazepam #1
  2. Lorazepam and alprazolam (slightly)
  3. Chlordiazepoxide (high)
65
Q

Sx of BZD withdrawals?

A
  1. Agitation, ax, irritability
  2. Delirium, sz
  3. Tremor
66
Q

How do you tx BZD withdrawals?

A
  1. Reduce BZD dose, taper, monitor using CIWA
  2. Can decrease dose by greater percentage in the beginning of withdrawal
  3. After reducing initial dose by 50%, may need to decrease dose deductions by 10% for patient comfort

Barbiturates
Adj med for ax depression, insomnia
Antipsychotics in cases of delirium

67
Q

Adjuct tx for BZD withdrawal?

A
  1. Hydroxyzine
  2. Carbamazepine
  3. Trazadone
  4. Valproate
  5. Imipramine
  6. Pregabalin
  7. Buspiron
  8. Gabapentin
  9. Flumazenil
  10. Melatonin
68
Q

What is Flumazenil? Disadvantages?

A

Revesal agent for BZD:
1. Induces sz
2. Ax, agitation, increased muscle tone
3. Respiratory depression
4. CV ADR
5. CNS effects

Requires careful monitoring for re-sedation

Therapeutics III (40 decks)

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