Exam 5 (final) - Ott SUD

Question 1

BAC 80mg/dL (0.08mg%) significance

Answer 1

this is the legal limit to drive or operate machinery
-comes with moderate impairment usually

Question 2

BAC 50mg/dL (0.05mg%) significance

Answer 2

motor fxn impairment visible

Question 3

BAC 450mg/dL significance

Answer 3

respiratory depression

Question 4

BAC 500mg/dL significance

Answer 4

LD50 for ethanol

Question 5

stage 1 alcohol withdrawal

Answer 5

~6-8 hours after withdrawal
-anxiety, increased HR, NV, craving for alcohol

Question 6

stage 2 alcohol withdrawal

Answer 6

~24 hours after withdrawal
-same as stage 1 but may some with auditory or visual hallucinations for 1-3 days

Question 7

stage 3 alcohol withdrawal

Answer 7

~1-2 days after withdrawal
-grand mal seizures in ~4% of those who are untreated

Question 8

stage 4 alcohol withdrawal

Answer 8

~4 days (96 hours) after withdrawal
-Delirium Tremens (DTs): not common but very high risk (severe)

Question 9

DT risk factors (5)

Answer 9

-prior history (#1 indicator of future ones)
-number of detoxifications
-consuming the equivalent of 1 pint of whiskey per day for 10-14 days prior to admission
-early sx of withdrawal
-hepatic dysfunction

Question 10

CIWA-AR stands for what and is important why?

Answer 10

clinical institute withdrawal assessment
-this is the in-pt setting standard of care
-assesses withdrawal severity

Question 11

treatment of alcohol withdrawal options

Answer 11

-benzodiazepines
-liver dysfxn: use lorazepam or oxazepam (can use these even if pt does not have liver dysfxn)
-no liver dysfxn: diazepam or chlordiazepoxide

Question 12

when to medicate based on CIWA score?

Answer 12

score of <8: non-pharm
score of 8: medicate
score of 15+: risk of complications if untreated

Question 13

Thiamine importance w/ AUD

Answer 13

-always recommend thiamine if suspicious of alcohol use
-cofactor in glucose (dextrose) metabolism: if giving dextrose, make sure thiamine is given first

Question 14

phenytoin importance w/ AUD

Answer 14

-not shown to be effective to treat withdrawal symptoms
-pts can sometimes be left on this for months or years after having withdrawal seizures —>D/C it

Question 15

Wernicke’s encephalopathy syndrome

Answer 15

-result of thiamine deficiency
-life threatening, characterized by ataxia/confusion

Question 16

when to consider thiamine for a patient based on BAC

Answer 16

consider giving to any patient coming in with BAC of 0.08 or higher (won’t hurt them)

Question 17

disulfiram (Antabuse) clinical pearls

Answer 17

-NV or other unpleasant SE if alcohol is used
-pt must already be highly motivated to quit
-250mg maintenance dose
-effects seen up to 14 days after use

Question 18

acamprosate (Campral) clinical pearls (RSSDA)

Answer 18

-monitor renal fxn, AVOID in severe renal impairment
-suicide warning
-SE: Diarrhea, nausea, depression, anxiety
-333mg tablets (directions: take 2 tablets 3 times daily)
-safe to take if person uses alcohol

Question 19

of disulfiram, acamprosate, and naltrexone, which is most effective for AUD?

Answer 19

naltrexone

Question 20

of the drugs used to treat it, which is least effective for OUD?

Answer 20

naltrexone

Question 21

naltrexone clinical pearls (BTLW)

Answer 21

-decreases binge drinking
-reduces time between drinking days
-monitor LFTs routinely
-pt should carry wallet card to alert emergency providers

Question 22

naltrexone ______ dosage form is preferred

Answer 22

injection

Question 23

name 5 sx of opioid withdrawal

Answer 23

muscle aches/tension
agitation/anxiety
NV, ab cramping
diarrhea
sweating, runny nose

Question 24

in opioid withdrawal sx, how do you treat muscle aches

Answer 24

NSAIDs or APAP

Question 25

in opioid withdrawal sx, how do you treat anxiety/agitation

Answer 25

hydroxyzine or benzos

Question 26

in opioid withdrawal sx, how do you treat NV or ab cramping

Answer 26

ondansetron

Question 27

in opioid withdrawal sx, how do you treat diarrhea

Answer 27

loperamide

Question 28

in opioid withdrawal sx, how do you treat sweating/runny nose

Answer 28

clonidine or lofexidine -clonidine preferred bc of price

Question 29

clonidine dosing based on severity of withdrawal

Answer 29

mild: 0.3-0.6mg/day severe: up to 1.2mg/day -these are given in divided dose (0.1-0.2mg/dose up to hourly)

Question 30

lofexidine dosing (0.18mg tablets)

Answer 30

0.54mg (3 tabs) four times daily for 5-7 days (up to 14 days) -max daily dose: 2.88mg/day (16 tabs) -max single dose: 0.72mg (4 tabs)

Question 31

safe medications for OUD in pregnancy

Answer 31

methadone or buprenorphine

Question 32

buprenorphine is usually given in combo with ______ in a ______ form due to poor bioavailability of _______ when swallowed

Answer 32

naloxone, SL, buprenorphine or naloxone

Question 33

methadone normally has the worst interactions with an ______ (inhibitor or inducer) of ________

Answer 33

inhibitor, 3A4

Question 34

common 3A4 inhibitor drugs

Answer 34

diltiazem, verapamil, alprazolam, grapefruit, and some antibiotics

Question 35

methadone most serious SE

Answer 35

QTc prolongation

Question 36

buprenorphine substrate

Answer 36

3A4

Question 37

buprenorphine use (SL or SQ inj.) with ______ drugs may cause ______ syndrome

Answer 37

serotonergic, serotonin

Question 38

buprenorphine ER injection brand names

Answer 38

Sublocade, Brixadi

Question 39

buprenorphine ER injection is used in what case (what severity? how to start it?)

Answer 39

moderate-severe OUD -pts started on SL form and dose adjusted for 7 days prior to initiation of injection

Question 40

considerations of methadone compared to buprenorphine (OMLA)

Answer 40

-opioid so it has more effect on receptors -medicaid covers -effective long term -availability or program in area? transportation?

Question 41

considerations of buprenorphine compared to methadone

Answer 41

-less misuse potential -medicaid covers -monthly prescription available -less stigma

Question 42

dose of naltrexone long acting injection (for OUD and AUD)

Answer 42

380mg q4weeks

Question 43

naltrexone considered the "_________" treatment, pts must be ready to be done for good

Answer 43

abstinence

Question 44

there is an increased risk of OD if patient stops ________ and goes back to using opioids at previous doses

Answer 44

naltrexone -must educate pts on this

Question 45

what other comorbidity may come with substance withdrawal and how do you treat it?

Answer 45

depression, treat as normal clinical depression