Substance Abuse

Question 1

____ None or accidental use

Answer 1

Abstinence

Question 2

____ No pattern of use with limited negative consequences

Answer 2

Experimentation

Question 3

____ Drug-Seeking behavior to experience known effect

Answer 3

Social/Recreational Use

Question 4

____ Definite pattern of use indicating drug craving

Answer 4

Habituation

Question 5

____ Continued use with negative impact on life

Answer 5

Abuse

Question 6

____ Drug seeking behavior

Answer 6

Addiction
Behavioral patterns of compulsive drug use in which obtaining and using a drug constitute the principal focus of the user’s life [TQ]

Question 7

Abuse versus misuse:

Answer 7

Abuse is use of a drug in a manner inconsistent with social norms with the intent of altering mood or feeling state. Misuse is inappropriate use of a drug that is usually intended for therapeutic purposes.

Question 8

Alcohol Withdrawal: Benzodiazepines

Answer 8

• Long acting: chlordiazepoxide, diazepam (active metabolites)
• Short acting: lorazepam, oxazepam (no active metabolites)
• Safe at high doses, fewer ADRs on the liver
• Wean over several weeks
• Also useful for phase III of withdrawal seizure care

Question 9

Alcohol Withdrawal: Clonidine

Answer 9

-Decreases autonomic stimulation

Question 10

Alcohol Withdrawal: Carbamazepine and propanolo

Answer 10

-Decreases CNS excitation

Question 11

Alcohol Withdrawal: Disulfiram

Answer 11

• Physical and psych deterrent
• Patient experiences flushing, headache, nausea, vomiting, sweating, decreased BP, confusion
• If alcohol is consumed, does not reduce cravings
• Inhibits ADH activity, so patient must be alcohol free for 24 hours before first dose [TQ]

Question 12

Alcohol Withdrawal: Acamprosate

Answer 12

• MOA: reduces neuronal glutamatergic hyperactivity
• Reduces cravings for alcohol, anxiety and unpleasant effects that trigger patients to resume drinking
• Start 5 days after last drink
• Dosing: 666mg TID
• Not metabolized hepatically, excreted unchanged in kidneys**
• Good safety profile
• Full effects not seen for 5 days, continue if patient relapses
• Doesn’t affect opiate receptors

Question 13

Alcohol Withdrawal: Naltrexone

Answer 13

• MOA: blocks opioid receptors to reduce pleasurable effects of alcohol
• Reduces cravings for alcohol
• Start 3-7 days after last ingestion
• Treatment recommended for at least 3 months and up to a year for effective therapy

Question 14

Sedative Withdrawal

Answer 14

• Barbituates are more problematic than benzos
• Symptoms: weight loss, paresthesia, HA, agitation, anxiety, delirium
• Wean slowly
• Detox can be achieved in 2 weeks
• DOC: Clonidine/Propanolol
• Flumazenil: helpful in managing OD situations but can cause withdrawal in physically dependent patients

Question 15

Opioid Withdrawal: Methadone

Answer 15

• Synthetic opioid 1x daily
• Steady state reached after 5 days
• Black box: cardiac effects, respiratory depression, death

Question 16

Opioid Withdrawal: Buprenorphine

Answer 16

• Mixed Agonist-Antagonist

- Sublingual film

Question 17

Opioid Withdrawal: Clonidine

Answer 17

-Reduces sympathetic activity

Question 18

Opioid Withdrawal: Naltrexone

Answer 18

• Oral, competitive long acting opiate antagonist
• Displaces opiate agonists to accelerate detox
• Eliminates euphoric effects of opiates and reduces craving

Question 19

4 meds for alcohol withdrawal vs 4 meds for opioid withdrawal

Answer 19

Alcohol:
-Benzodiazepines
-Disulfiram
-Acamprosate
-Naltrexone
(and clonidine, carbamazepine, propranolol, gabapentin)

Opioid: [TQ]

• Methadone
• Buprenorphine
• Clonidine
• Naltrexone

Question 20

Cocaine Withdrawal

Answer 20

• Starts within several hours and lasts for several days

- Bromocriptine decreases craving