Substance Dependence

Question 1

alcohol dependence treatment

Answer 1

• psychological intervention (CBT)
• acamprosate or naltrexone
• 2nd = disulfiram

Question 2

What is the recommended maximum weekly intake for alcohol?

Answer 2

14 units per weeks spread evenly over 3 days or more

Question 3

Which tool can be used to assess alcohol misuse?

Answer 3

AUDIT-C

Question 4

alcohol dependence delirium treatment

Answer 4

1st = lorazepam
2nd = haloperidol

Question 5

alcohol dependence withdrawal seizures treatment

Answer 5

lorazepam
- a fast acting benzodiazepine

Question 6

alcohol dependence withdrawal symptoms treatment

Answer 6

chlordiazepoxide/diazepam
- a LONG acting benzo

Question 7

Wernicke’s encephalopathy treatment

Answer 7

Thiamine (vitamin B1)
- symptoms include confusion, eye movements and difficulty balancing/ co-ordinating

Question 8

NRT treatment combination

Answer 8

• short acting: gum, inhalators, lozenges, oral or nasal spray, sublingual tablets
• long acting (16 hours if having nightmares, 24 hours if pregnant and waking with cravings

Question 9

varenicline side-effects

Answer 9

nausea, headache, insomnia
- caution in CVD, psychiatric illness, renal impairment and epilepsy

Question 10

bupropion warnings

Answer 10

• caution in epilepsy and psychiatric illness
• MHRA warning: serotonin syndrome

Question 11

opioid detoxification

Answer 11

patient should be offered methadone or buprenorphine
- personally tailored but can take up to 12 weeks

Question 12

opioid detoxification- with methadone

Answer 12

methadone is reduced by 5mg every 1-2 weeks

Question 13

opioid detoxification- with buprenorphine

Answer 13

buprenorphine reduced by 2mg every 2 weeks (400mcg reduction at the end)

Question 14

opioid detoxification withdrawal symptoms

Answer 14

D&V, stomach cramps, agitation, headaches, insomnia

Question 15

buprenorphine benefits over methadone

Answer 15

• lower risk of fatal overdose
• can be given with naloxone (discourages injecting)
• has less mental clouding and sedation than methadone
• MR may be suitable for poor adherence

Question 16

opioid dependence in pregnancy

Answer 16

continue but withdraw if vomiting due to foetal distress

Question 17

What is max days supply of methadone or buprenorphine?

Answer 17

14 days
- for instalment prescriptions, prescriber must specify the number of instalments and the interval between instalments

Question 18

What type of script is methadone and buprenorphine prescribed on?

Answer 18

fp10MDA (blue script)