Specialty topics

Question 1

Common at treatment entry

Think subsequent psychiatric disorders

Answer 1

Depression and anxiety

We should be asking when it was diagnosed. Is this something new? Is this secondary to substance usage?

Question 2

Which medication do we try to avoid when treating the substance abuse population:

Think CNS depressant

Answer 2

Benzos

Question 3

Biggest risk of utilization of Benzos

Answer 3

Misuse

Question 4

First line tx for depression and anxiety

Answer 4

SSRIs

CBT

Question 5

Response for stimulant users

Answer 5

Validate that they are on the correct dosage

Refer to psychiatrist for CC of ADHD

Cont stimulant as prescribed

Prescription Drug Monitoring Program for validation.

Question 6

At what age can you begin tx with Buprenorphine

Answer 6

16

Question 7

At what age can you begin tx with methadone

Answer 7

18

Question 8

What is the exception for methadone tx for people 16 and 17

Answer 8

At least two prior unsuccesful attempts & parental agreement

Question 9

Considered the first line tx for adolescents with Opioid addiction

Answer 9

Buprinorphine

Question 10

Which is better in pregant patients: Buprenorphine vs methadone

Answer 10

Both just as effective

Buprenorphine remains the treatment of choice

Methadone - Better for patients in unstable households

Question 11

In pregnant women, when should we try to titrate methadone up

Answer 11

The second and third trimester

This is because increased metabolism and blood volume

Question 12

What may need to occur with methadone dosages when during advancement of pregnancy

Answer 12

You may need to split the dosage

Half life goes lower and clearance increses

Question 13

How is Buprenorphine managed in pregant women

Answer 13

Does not need dose increase, but may need split on 3rd trimester

Transition back to original dosage pre-pregnancy

Recommened for opioid dependent mothers

Mother can breastfeed

You can still use suboxone if needed.