Flashcards in Substance Abuse Disorders - Therapeutics (Dr. Aebi) Deck (57)
What are the main points in classifying someone as having substance abuse?
At least 2 of these present in a 12 month period
- Substance often taken more than was intended
- Efforts to cut down unsuccessful
- Lots of time spent obtaining/using/recovering from effects
- Continued use despite problems
- Important things given up because of drug
- Continues use despite knowledge that there is a problem
What is the best way to stop using nicotine products?
In a combination of pharmacotherapy and psychosocial interventions (drug and therapy together).
Can you use NRT for smoking reduction? Smoking cessation?
What is first-line therapy for smoking cessation?
Nicotine replacement therapy
What is second-line therapy for smoking cessation?
What is the best nicotine replacement therapy?
Whatever the patient is willing to try.
Which NRT agent can cause vivid dreams?
The nicotine patch
What is a serious adverse reaction to NRT?
Can you cut the patch if the dose seems too big? What if it gives you bad dreams at night?
Cannot cut this patch, nicotine will evaporate. Patch can be worn for 16-24 hours.
What happens if you leave the patch on for more than 24 hours?
What is the MOA of varenicline?
It is a partial agonist at alpha-4-beta-2 neuronal nicotinic receptors.
What monitoring is needed for varenicline?
What is contraindicated with varenicline?
Moderate alcohol use
If a patient has any of the following side effects of varenicline, what should you do? Angina, MI, CVA, depression, mood changes, hostility, suicidal ideation.
It is best to switch drugs
Can you use varenicline for a person being treated for bipolar disorder?
It is best not to... there is a black box warning against possibly worsening psychiatric symptoms.
What is the MOA of bupropion?
It inhibits neuronal uptake of dopamine and NE
What monitoring do you need for bupropion?
Abstinence from tobacco, renal function, BP, psychiatric reactions
What drug should you avoid if you have had bulimia or anorexia?
Which drug should you avoid if you are on the antibiotic linezolid?
Both nortiptyline and bupropion
With bupropion, by how much should you separate BID doses?
By at least 8 hours apart. If you miss a dose, skip it and take the next dose as scheduled.
What is the MOA of nortriptyline?
TCA that inhibits serotonin and NE, anti-muscarinic, blocks H1 and alpha1
Where is nortriptyline metabolized?
In the liver by 2D6
Which smoking cessation aide typically causes constipation?
What is nortriptyline contraindicated with?
People with cardiac issues
Which smoking cessation drugs should avoid in people with hepatic issues? Renal issues?
Nortriptyline is metabolized by the liver. Bupropion and varenicline are metabolized by the kidney. Clonidine should have lower doses initially in really impaired patients.
What is the MOA of clonidine?
It is a centrally acting alpha 2 agonist
What else will clonidine do besides help with smoking cessation?
Lower blood pressure
What are important counseling points about clonidine?
Do not operate heavy machinery. Do not abruptly discontinue.
If a person smokes more than 10 cigarettes a day, what strength patch should they start on?
The 21mg patch daily. If less than 10 cigarettes/day then start on 14mg patch daily.