Substance Dependance Flashcards
(13 cards)
Nicotine dependence
Nicotine replacement therapy (NRT) - Bupropion and varenicline are effective aids to smoking cessation
Some patients benefit from combination therapy (eg. Transdermal and oral preps )
Combination of NRT and varenicline or bupropion is not recommended
Choices of nicotine
- nicotine patches - slow release (16hrs) - remove patch over night
- nicotine patches 24hrs slow release ( for patients experiencing strong cravings on waking)
- immediate release release preps - gum, lozenges, sublingual tablets, inhalators - all prevent cravings
Side effects of nicotine replacement
Irritation the throat (inhalation cartridges) , increased salvation(spray, gums, lozenges), minor skin irritation (patches), coughing, nasal irritation , sneezing, watery eyes, Gi disturbances
More specific side effects
Oral spay - parathesia - burning sensation in arms or feet
- Patches = abnormal dreams (remove patch before bed may help)
- lozenges and oral spray- rash and hot flushes
- patches and oral spray - sweating and myalgia (patches can cause arthralgia (joint pain)
Opioid dependence - opioid substation therapy
- management requires medical, social and psychological treatment (access to a multidisciplinary team is recommended)
- methadone and buprenorphine - used as substructure therapy
- commence with short period stabilisation followed either by withdrawal or maintenance
- maintenance enables patients to achieve stability, reduces drug use and crime and also improves health
- review regularly and monitor signs of toxicity
- complete withdrawal from opioids usually takes 4 weeks in a n inpatient and up to 12 in community
Missed doses
- patient that misses 3 or more doses are at risk of overdose because loss of tolerance
- consider reducing the dose in these patients
- if patient misses 5 or more days, then assess for illicit drug use before starting substitution therapy (especially for patients on buprenorphine) because of the risk of precipitate withdrawal
Buprenorphine
- preferred by some patients because less sedating than methadone
- suitable for employed patients or those undertaking skilled tasks eg. Driving
- safe than ,ethadone when used with other sedating drugs and less interactions too!!
- milder withdrawal symptoms and dose reduction easier than with methadone
- lower risk of overdose than with methadone
Methadone
Long acting opioid agonist
Usually administered in a single daily dose - 1mg/ml oral solution
- suitable for patients with long history of opioid misuse or those who abuse a variety of sedative drugs and alcohol and who experience increase anxiety during withdrawal of opioids (because it has more pronounced sedative effects)
Opioid substitution during pregnancy
Acute withdrawal of opioids should be avoided in pregnancy because it can cause fetal death
Withdrawal during 1st trimesters can cause spontaneous miscarriages
Buprenorphine is not licensed for use in pregnancy
Adjunctive therapy and symptomatic treatment
Loperamide - diarrhoea
Mebeverine - Stomach cramps
NSAIDs - Muscular pains and headaches
Metoclopramide or prochloroperazine - nausea and vomitting
Benzodiazipines/zopiclone - insomnia (short course for a few days only)
Lofexidine - alleviates some physical symptoms of opioid withdrawal
Naoloxone - for accidental overdose
Naltrexone - prevents relapse
Alcohol dependence
A cluster of behavioural, cognitive and physiological factors that include a strong desire to drink alcohol, tolerance to its effects and difficulties controlling its use
Patients may persist in drinking despite harmful consequences such as physical or mental health problems
Abrupt reduction in patients who have been drinking for a long period of time may cause alcohol withdrawal syndrome which leads to seizures,delirium tremendously and death
Alcohol dependence medication use
Long acting Benzodiazipines (chlordiazepoxide or diazepam) attenuate - reduce effect alcohol withdrawal symptoms
- carbamazepine - alternative treatment in alcohol withdrawal(unlicensed)
Clomethiazole - alternative to carbamazepine or Benzodiazipines
- fast acting benzos (lorazepam) reduces seizures
Delirium tremens
- medical emergency characterised by agitation, paranoia, visual, auditory hallucinations
- oral lorazepam = 1st line
- haloperidol or parenteral lorazepam( adjunctive therapy)
What is wernickes encephalopathy
Patients with alcohol dependence are at high risk of developing W.E (Acute neurological condition , leading to confusion,loss of mental activity that can progress to coma and death)
Patients at high risk are those who are - malnourished or decompensated liver disease
Treatment - parenteral thiamine followed by oral thiamine
