Final - Ott Flashcards by Kappa Epsilon Pi Chapter

Alcohol Withdrawal: Time of Onsets

Stage 1: ______ hours

6 - 8

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Alcohol Withdrawal: Time of Onsets

Stage 2: ______ hours

~24 hours

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`Alcohol Withdrawal: Time of Onsets

Stage 3: ______ hours

~1 - 2 days

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Alcohol Withdrawal: Time of Onsets

Stage 4: ______ hours

3 - 5 days

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what are the clinical features of alcohol withdrawal during stage 1

autonomic hyperactivity (tachycardia, insomnia, N/V,diaphoresis)

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what are the clinical features of alcohol withdrawal during stage 2

still autonomic hyperactivity but w/ auditory and visual hallucinations

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what are the clinical features of alcohol withdrawal during stage 3

~4% of pts that go untreated develop GRAND MAL seizures after the drop in BAC

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what are the clinical features of alcohol withdrawal during stage 4

~5% of pts: delirium tremens!

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People are more likely to develop delirium tremens if they have ______ dysfunction

hepatic

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what things make a pt more likely to have DTs when alcohol withdrawal

prior hx of DTs
# of detoxs
early symptoms during withdrawal
hepatic dysfunction
consuming 1 pint of whiskey per day for 10 - 14 days prior to admission

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what is CIWA/how do we use it

validated scale —- known as Clinical Institute withdrawal assessment
ranks diff. symptom types from 0 - 7
(symptoms include N/V, tremors, sweats, anxiety, agitation, tactile disturbances, auditory/visual hallucinations)

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Main tx option for alcohol withdrawal?

BZDs

Diazepam, Chlordiazepoxide, Lorazepam

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BZDs for Alcohol Withdrawal:
Use _______ if no liver dysfunction

Use _______ if pt has liver dysfunction

Diazepam, Chlordiazepoxide

Lorazepam

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Using CIWA scores for Alcohol Withdrawal:

What to do it CIWA < 8 - 10

nonpharm tx

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Using CIWA scores for Alcohol Withdrawal:

What to do it CIWA 8 - 15

medicate

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Using CIWA scores for Alcohol Withdrawal:

What to do it CIWA > 15

risk of complications if not treated

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what other drugs can be used for alcohol withdrawal rather than BZDs

Thiamine!!

Anticonvulsants - Valproic acid 1st; CBZ 2nd

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what is wernicke korsakoff syndrome

when there is low thiamine — give thiamine before you give ppl dextrose containing fluids because this could cause encephalopathy

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Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders?
is known as aversive therapy

disulfiram

Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders?
is best for binge drinking

naltrexone

Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders?
need to monitor renal function

acamprosate

remember prosate —prostate— urination…

Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders?
monitor LVTs

disulfiram and naltrexone

Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders?
has a suicidality warning

acamprosate

Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders?
has to take 6 tabs daily (TID dosing)

acamprosate

Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders? which one has IM dosing option

naltrexone

Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders? which one is problematic if pt has pain management needs/gets in accident and needs pain meds

naltrexone (opioid antagggggg)

Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders? is for maintenance of abstinence

acamprosate

Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders? lasts in body for 14 days after last dose

disulfiram (aka pt counseling pt if they want a glass of wine for a special occasion, they have to stop it 2 weeks in advance)

what drugs can be used to help with opioid withdrawal

clonidine (new drug of lofexidine is just like clonidine) antidiarrheals analgesics antiemetics

maintenance tx options for opioid use disorders

methadone and buprenorphine

which drug needs DATA 2000 certified physicians

buprenorphine (X_______ DEA)

Methadone Tx Pearls: | _____ half life

long

Methadone Tx Pearls: | ______ dosing --- pts earn ______

witnessed earn TAKE home bottles

Methadone Tx Pearls: | Urine tox screen results?

+ for methadone - for everything else

Methadone Tx Pearls: | CYP_____ substrate

3A4

Methadone Tx Pearls: | Most serious concern?/Monitoring to go with this concern?

QT prolongation EKG monitoring

Buprenorphine Tx Pearls: | it is commonly given with ______ to decrease abuse

naloxone

Buprenorphine Tx Pearls: for initial dosing you should wait _____ hours since last opioid use so that the pt does not have early withdrawal to prevent buprenorphine induced withdrawal

4 hours

Buprenorphine Tx Pearls: | can keep titrating the buprenorphine/naloxone dosing til you achieve what?

achieve minimizing withdrawal but also not providing euphoric effects

what are the buprenohrpone ER forms?

implant and injection

issue with the buprenorphine impalnt?

pt must be stable on a low dose of buprenorphine | aka most pts starting off - this is NOT a good option

Buprenorphine ER Injection: | Dosed every _____?

month

why does buprenorphine ER injection have a REMS program

has a REMS program to prevent ppl taking the drug and giving it IV--- giving IV can cause thromboembolism

if someone comes in to hospital with psychosis from K2/spice of bathsalts --- should you give antipsychotics or not?

No! psychosis induced by those drugs is not typically responsive to antipsychotics

if a pt comes in with HTN due to cocaine intoxication--- do we give them a beta blocker to chill?

don't think so --- it is controversial -- worried about cardiovascular collapse