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exam 3 - psychopharmacology > week 9 Substance use DOs/Addictive DOs > Flashcards

week 9 Substance use DOs/Addictive DOs Flashcards

(54 cards)

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1
Q

what is the primary nuerotransmitter involved in addiction?

A

dopamine

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2
Q

what key areas are involved in addiction?

A

dopamine mesocorticolimbic system,
ventral tegmental area (VTA), nucleus accumbens amygdala
olfactory tubercle.

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3
Q

whats the tx for Mild to moderate alcohol intoxication?

A

no formal tx

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4
Q

whats the tx for severe alcohol intoxication (blood alcohol levels > 300 mg/dl, death >
400 mg/dl) ?
Hint: maintain prevention hourly

A

Maintain cardiopulmonary functions.
Prevention of aspiration.
Hourly Serial blood alcohol levels.

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5
Q

whats used to prevent Warnicke’s encephalopathy in alcohol intoxication?

A

Thiamine 100 mg IM/IV daily X3 preceding administration of glucose containing solutions

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6
Q

what can be given (if necessary) for agitatioin in alcohol intoxication?

A

Haloperidol

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7
Q

what drug class must be avoided during acute intoxication (alcohol)?

A

benzodiazepines

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8
Q

what medical problems need to also be managed in stimulant intoxication?

A

hyperthermia, HTN, cardiac arrhythmias, stroke, and seizures.

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9
Q

what drugs are used to manage psychological problems in stimulant intoxications?

A

Benzodiazepines Antipsychotics

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10
Q

what are serious s/s of opioid intoxication?

A

cardiac/respiratory depression

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11
Q

what is given to reverse opioid intoxication?

A

naloxone

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12
Q

What are Goals of treatment for withdrawal from ethanol, cocaine, amphetamines, and opioids ?

A

Evaluation of withdrawal symptoms.
Is pharmacologic intervention is necessary?
Management of medical consequences.
Referral for substance abuse program.

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13
Q

what are the 4 different alcohol withdrawal syndromes?

A
  1. Uncomplicated.
  2. With seizures.
  3. With delirium (delirium tremens).
  4. With hallucinations (Alcohol hallucinosis).
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14
Q

how are symptoms of UNCOMPLICATED ALCOHOL WITHDRAWAL rated?

Hint: see water

A 
using a validated scale e.g., Clinical Institute Withdrawal Assessment  Scale for Alcohol- Revised (CIWA-Ar).
Ratings are:
8-10 outpatient Tx
> 15 inpatient Tx
> 20 pharm Tx (always)
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15
Q

what are evidence based treatment of choice for uncomplicated alcohol wd?:

A 
Benzodiazepines are evidence based treatment of  choice:
Lorazepam
Oxazepam
Diazepam
Chlordiazepoxide
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16
Q

what is tx for ALCOHOL WITHDRAWAL SEIZURES?

A 
Requires medical treatment
Benzodiazepines:
Diazepam IV
Lorazepam IV/IM
Electrolyte imbalances
Thiamine IV/IM
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17
Q

whats the tx for ALCOHOL WITHDRAWAL DELIRIUM, DELIRIUM TREMENS (DT)?

A 
Acute care management
Parenteral benzodiazepines:
Diazepam IV
Lorazepam IV/IM
Antipsychotics?
Thiamine IV/IM
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18
Q

whats the tx for ALCOHOLIC HALLUCINOSIS (Usually auditory)?

A

Antipsychotics agents

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19
Q

is there pharm tx for stimulant (cocaine, amphetamine)w/d?

A

No data to support medication use

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20
Q

what does opiod w/d tx consist of?

A

Usually not life threatening
Manage and stabilize medical conditions
Clinical withdrawal scale (COWS)
Symptomatic treatment to minimize withdrawal
symptoms
Treatment
µ - opioid agonist (methadone) Only at federally approved methadone clinics.
µ - partial agonist (buprenorphine)
Buprenorphine + naloxone (Suboxone); SL filmtabs, SL tabs
2 mg/0.5 mg or 8 mg/2 mg
Buprenorphine (generic); SL tabs

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21
Q

what are s/s and tx for stimulant w/d (cocaine, amphetamines)?

A

Profound depression with suicidal thoughts
Usually outpatient care
No data to support medication use

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22
Q

what are some components for nicotine w/d tx?

Study These Flashcards
A

NICOTINE WITHDRAWAL
Standard of care to provide smokers with advice and assistance to quit, or referral to specialized services.
Several neurotransmitters are affected
CAGE, 4 C’s, and the Fagerstrom test for nicotine dependence
All nicotine replacement therapies are regulated
by FDA.

23
Q

what are the components of the CAGE QUESTIONNAIRE FOR NICOTINE DEPENDENCE?

Study These Flashcards
A
  1. Have you ever felt a need to CUT down or control your smoking, but had difficulty doing so?
  2. Do you ever get ANNOYED or angry with people who criticize your smoking or tell you that you ought to quit smoking?
  3. Have you ever felt GUILTY about your smoking or about something you did while smoking?
  4. Do you ever smoke within half an hour of waking up (EYE-opener)?
  • —Two “yes” responses constitute a positive screening test.
24
Q

how to ASSESS NICOTINE ADDICTION USING THE “FOUR CS” TEST?

Study These Flashcards
A 
Qs on:
compulsion
control 
consequences
cutting down (and w/d sx)
25
what are therapies for smoking cessation?
``` nicotine patch nicotine gum nicotine lozenge nicotine nasal spray nicotine vapor inhaler bupropion clonidine varenicline TCADs (nortriptyline, doxepin) ```
26
what are NON-PHARMACOLOGIC TREATMENTS FOR TOBACCO CESSATION?
``` Behavioral treatment increases abstinence rates (5 A’s) Ask if they smoke Advise to quit Assess motivation for change Assist if willing to change Arrange for follow-up ```
27
How to assist if a patient wants to quit smoking with Bupropion?
Start bupropion-sr 1-2 weeks before quit date Help the patient set a quit date Remove all tobacco products the night before the quit date Follow-up with the patient on the quit date or the next day for support Provide NRT: patch, nasal spray, mouth inhaler, gum, or lozenge Identify and educate a support person Educate about the high risk for relapse and how to cope with it: “don’t quit quitting”
28
what are some goals of treating SUBSTANCE DEPENDENCE/goals in recovery from addiction?
develop a sober social network develop coping skills (e.g., 12 -step) relapse prevention skills/strategies (toolbox of coping skills) addressing/processing hx of conflicts, abuse etc in life searching for spiritual meaning in life
29
what are NON-PHARMACOLOGIC THERAPY for addiction recovery?
``` Psychotherapy should be core therapeutic strategy MET (motivational enhancement therapy) CBT TSF (12-step facilitation) Contingency management Group Therapy ```
30
what is the PHARMACOLOGIC THERAPY-MAINTENANCE THERAPY for alcohol dependence?
Disulfiram Natrexone Acamprosate
31
what are the aspects of DISULFIRAM in alcohol dependence Tx?
Classic ethanol-disulfiram reaction Negative reinforcement, drinking is avoided to prevent unpleasant effects. Dose: 250 mg orally/daily (range 125- 500 mg daily) only after the blood alcohol level is zero. Adverse effects: Rash, drowsiness, metallic or garlic-like taste, and HA Optic neuritis, peripheral neuropathy, hepatotoxicity Monitoring: Baseline LFT’s and periodic assessment (q1-6 months) Drug interactions: Warfarin (increased INR) Phenytoin, Theophylline (increased blood levels) Benzodiazepines (except lorazepam, temazepam and oxazapam) (increased blood levels)
32
what are the aspects of NALTREXONE in alcohol dependence Tx?
Competitive opioid antagonist especially at µ- opioid receptors, that decreases alcohol intake Decreases relapse to heavy drinking, but not for total continuous abstinence. ***Contraindicated in patients with severe liver and renal impairment*** Dose: Oral,50 mg/day (range (25-100 mg) IM, 380 mg once monthly Dosage forms: Tabs, 50 mg (Depade, ReVia) IM Suspension, 380 mg (Vivitrol) Adverse effects: Nausea, headache, fatigue, and nervousness Monitoring: Baseline LFT’s and periodic assessment (q1-6 months) Drug interactions: Opioids (decreased effects) Acamprosate (increased bioavailability, minor clinical significance)
33
what are the aspects of ACAMPROSATE in alcohol dependence Tx?
``` NMDA receptor antagonist Increases continuous abstinence rates in alcohol dependent patients for periods of 3-12 months. Dose: Oral, 666 mg tid CrCl 30-50 ml/min: 333 mg tid CrCl < 30 ml/min: avoid use Dosage forms: Tabs, 333 mg (Campral) Adverse effects: Nausea, vomiting, and diarrhea Possibly increased rates of suicidal thinking Monitoring: Baseline renal function for CrCl Drug interactions: naltrexone (increased bioavailability of acamprosate, minor clinical significance) ```
34
what are the Tx strategies for STIMULANT DEPENDENCE | ?
No proven therapies for cocaine or amphetamine dependence | Disulfiram 250 mg/day has been used investigationally in treating cocaine dependence in combination with CBT.
35
what are the Tx strategies for opioid dependence?
``` Maintenance therapy may be appropriate for those patients who have failed one or more trials of abstinence. 2 strategies Opioid agonists Methadone- black box warning for QT prolongation and respiratory depression. buprenorphine Opioid antagonists Naloxone Naltrexone ```
36
what are the aspects of opioid agonists?
Methadone Buprenorphine + naloxone (Suboxone) Dose: 8-16 mg day (maximum 64 mg/day) Dosage forms: SL filmtabs, 2 mg/0.5 mg or 8 mg/2 mg (Suboxone) SL tablets, 2 mg/0.5 mg or 8 mg/2 mg (Suboxone) Buprenorphine (generic); SL tabs Adverse effects: Oral hypoesthesia, respiratory depression, headache, abdominal pain, constipation, vomiting, glossodynia, oral mucosa erythema, intoxication, disturbances in attention, palpitations, insomnia, withdrawal, hyperhidrosis, and blurred vision. Monitoring: Baseline LFT’s and periodic assessment (every 1-6 months) Drug interactions: CNS depressants (alcohol, opioids, benzodiazepines) CYP3A4 inducers: decreased buprenorphine levels CYP3A4 inhibitors: increased buprenorphine levels Clonidine: increased blood pressure with naloxone component sodium oxybate; contraindicated due to additive CNS depression
37
what are the aspects of opioid antagonist(s)?
Naltrexone Previously detailed on earlier slide. Long acting for health professionals or others that are motivated to maintain abstinence.
38
(Agbeli DB tip) what can aid in preventing of Wernicke Encephalopathy in alcohol withdrawal?
thiamine administration
39
(Agbeli DB tip) (in RED) what Tx is there for opioid use DO with comorbid pain?
(in RED) Suboxone can be used in managing pain
40
• (Agbeli DB tip) (in RED) Inappropriate use of opioids may be an indication that the patient’s pain is uncontrolled. True or False?
(in RED) True
41
• (Agbeli DB tip) (in RED) When to consider Acamprosate when managing alcohol use disorder in recovery?
(in RED) Safe for use in Hepatic dysfunction
42
MOA of Buprenorphine?
Buprenorphine is a partial agonist at the mu receptor, meaning that it only partially activates opiate receptors
43
• What is a concern if buprenorphine is initiated too soon after a patient’s last opioid use?
can induce withdrawal symptoms in patients dependent on opioids if it is administered quickly after the last dose of a pure agonist like fentanyl or oxycodone.
44
• Mechanism of action for naloxone (rapidly reverses an opioid OD)?
Naloxone is thought to act as a competitive antagonist at mc, κ, and σ opiate receptors in the CNS; it is thought that the drug has the highest affinity for the μ receptor.
45
can suboxone (Buprenorphine/Naloxone) be used for chronic pain?
yes
46
• Delivery methods for naltrexone ?
po, injection, implant, (NO LIQUID)
47
• Signs of opioid intoxication/withdrawal?
``` Acute Intoxication- Tx with naloxone. *Respiratory depression-low RR *Hypotension Bradycardia Hypothermic *Miosis (excess. pupil constriction) unconscious USE NALOXONE ``` ``` Withdrawal *anxiety *Increased lacrimation *Muscle aches *Abdominal cramps and diarrhea USE BUPRENORPHINE/NALOXONE (suboxone) CLONIDINE BENTYL ```
48
what can be used for both ETOH and Opioid use DO?
naltrexone
49
MOA of disulfiram?
irreversibly inhibits aldehyde dehydrogenase (ALDH1A1) by competing with nicotinamide adenine dinucleotide (NAD)
50
Banana bag ingredients?
thiamine, multivitamin, folic acid
51
antabuse use in cocaine DO does what?
increase synaptic dopamine and acts as an agonist Tx
52
what are memory tools used as a brief intervention in smoking cessations?
Five A's Ask n Act ABC
53
what re meds for cocaine-induced chest pain?
nitroglycerin aspirin NO metoprolol
54
what re the intoxication/withdrawal Sx for cocaine?
``` intoxication: auditory hallucinations agitation violent behavior muscle twitching tachycardia USE LORAZEPAM ``` withdrawal: often no visible Sx fatigue irritability

exam 3 - psychopharmacology (3 decks)

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