Substance Use Disorders Flashcards
(48 cards)
What are the 5 C’s?
Craving, impaired Control, use despite Consequences, Chronicity, Compulsive
What increases the rate of alcohol absorption? (3)
- gastric bypass
- fasting state
- carbonation
What decreases the rate of alcohol absorption? (3)
- smoking
- anticholinergic agents
- carbohydrates/food
Where does alcohol distribute?
into total body water
What are two reasons that women experience greater effects from alcohol?
- males have a larger Vd because females/obese have more adipose and less total body water
- women have less efficient pre-hepatic alcohol dehydrogenase
What stage of alcohol withdrawal includes autonomic hyperactivity, tremors, hyperhidrosis, tachycardia, HTN, GI upset, anxiety, insomnia & vivid dreams?
How many hours in does this occur?
minor withdrawal
5-10 hours
What stage of alcohol withdrawal includes hallucinations (tactile/visual) & seizures (generalized tonic clonic)?
How many hours in does this occur?
major withdrawal
12-72 hours
What type of metabolism does alcohol undergo?
zero order
- removes fixed amount per unit time regardless of dose
What symptom is hallmark of delirium tremens?
How quickly does delirium tremens occur?
disordered consciousness
48-96 hours
What is the typical cause of death for a patient with delirium tremens?
arrhythmia or secondary complications (pneumonia, liver failure)
What are the components for management of alcohol withdrawal? (4)
- thiamine B1 50-100 mg QD
- D5W & 1/2 NS
- multivitamin
- benzo standing orders
What are the benzo standing order regimens for alcohol withdrawal?
symptom triggered
- one dose EVERY HOUR if CIWA Ar = 8-10
fixed schedule
- benzo taper
- Diazepam: 10 mg q6h x 4, 5mg q6h x8
- Lorazepam: 2mg q6h x4, 1mg q6h x 8
What agents are used for maintenance of sobriety? (6)
FDA approved: naltrexone, acamprosate, disulfiram
Off label: baclofen, gabapentin, topiramate
What are the CI for naltrexone use?
current opioid use
LFTs > 5x ULN
What is a patient required to do to start naltrexone?
be opioid free for 5-7 days
What alcohol/opiate maintenance agent is also available as a monthly injection?
naltrexone
What are the CI for acamprosate?
CrCl < 30
What is a patient required to do to start disulfiram?
must be abstinent for 12 hours prior
How long after the last dose of disulfiram can a reaction still occur with alcohol consumption?
14 days
What are the CI of disulfiram?
severe cardiac disease
coronary occlusion
What dose adjustments exist for acamprosate?
1/2 dose of CrCl 30-50 or body weight < 60 kg
What is a patient required to do to start acamprosate?
nothing, but ideally they should be abstinent to start
What way does the dose response curve shift in the case of sensitization?
LEFT
What way does the dose response curve shift in the case of tolerance?
RIGHT
