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Therapeutics 3 - Spring 2018 > Final - Ott > Flashcards

Final - Ott Flashcards

(45 cards)

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1
Q

Alcohol Withdrawal: Time of Onsets

Stage 1: ______ hours

A

6 - 8

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2
Q

Alcohol Withdrawal: Time of Onsets

Stage 2: ______ hours

A

~24 hours

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3
Q

`Alcohol Withdrawal: Time of Onsets

Stage 3: ______ hours

A

~1 - 2 days

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4
Q

Alcohol Withdrawal: Time of Onsets

Stage 4: ______ hours

A

3 - 5 days

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5
Q

what are the clinical features of alcohol withdrawal during stage 1

A

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

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6
Q

what are the clinical features of alcohol withdrawal during stage 2

A

still autonomic hyperactivity but w/ auditory and visual hallucinations

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7
Q

what are the clinical features of alcohol withdrawal during stage 3

A

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

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8
Q

what are the clinical features of alcohol withdrawal during stage 4

A

~5% of pts: delirium tremens!

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9
Q

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

A

hepatic

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10
Q

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

A 
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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11
Q

what is CIWA/how do we use it

A

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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12
Q

Main tx option for alcohol withdrawal?

A

BZDs

Diazepam, Chlordiazepoxide, Lorazepam

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13
Q

BZDs for Alcohol Withdrawal:
Use _______ if no liver dysfunction

Use _______ if pt has liver dysfunction

A

Diazepam, Chlordiazepoxide

Lorazepam

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14
Q

Using CIWA scores for Alcohol Withdrawal:

What to do it CIWA < 8 - 10

A

nonpharm tx

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15
Q

Using CIWA scores for Alcohol Withdrawal:

What to do it CIWA 8 - 15

A

medicate

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16
Q

Using CIWA scores for Alcohol Withdrawal:

What to do it CIWA > 15

A

risk of complications if not treated

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17
Q

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

A

Thiamine!!

Anticonvulsants - Valproic acid 1st; CBZ 2nd

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18
Q

what is wernicke korsakoff syndrome

A

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

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19
Q

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

20
Q

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

21
Q

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

Study These Flashcards
A

acamprosate

remember prosate —prostate— urination…

22
Q

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

Study These Flashcards
A

disulfiram and naltrexone

23
Q

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

24
Q

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

25
Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders? which one has IM dosing option
naltrexone
26
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)
27
Disulfiram, Acamprosate, or Naltrexone for alcohol use disorders? is for maintenance of abstinence
acamprosate
28
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)
29
what drugs can be used to help with opioid withdrawal
clonidine (new drug of lofexidine is just like clonidine) antidiarrheals analgesics antiemetics
30
maintenance tx options for opioid use disorders
methadone and buprenorphine
31
which drug needs DATA 2000 certified physicians
buprenorphine (X_______ DEA)
32
Methadone Tx Pearls: | _____ half life
long
33
Methadone Tx Pearls: | ______ dosing --- pts earn ______
witnessed earn TAKE home bottles
34
Methadone Tx Pearls: | Urine tox screen results?
+ for methadone - for everything else
35
Methadone Tx Pearls: | CYP_____ substrate
3A4
36
Methadone Tx Pearls: | Most serious concern?/Monitoring to go with this concern?
QT prolongation EKG monitoring
37
Buprenorphine Tx Pearls: | it is commonly given with ______ to decrease abuse
naloxone
38
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
39
Buprenorphine Tx Pearls: | can keep titrating the buprenorphine/naloxone dosing til you achieve what?
achieve minimizing withdrawal but also not providing euphoric effects
40
what are the buprenohrpone ER forms?
implant and injection
41
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
42
Buprenorphine ER Injection: | Dosed every _____?
month
43
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
44
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
45
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

Therapeutics 3 - Spring 2018 (20 decks)

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