Term
| methadone (Dolophine, Methadose) |
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Definition
Indication: long-acting full opioid agonist at mu receptor, for tx of opiate dependence;
Dose:
Induction - initial dose: 20-30 mg, if symptoms persist after 2-4 hrs, then administer 5-10 mg more;
Maintenance - most pts require dose of at least 80 mg;
ADRs:
euphoria, sedation, constipation, increase in QT interval (torsades de pointes), respiratory depression;
Drug Interactions:
CYP3A4 inhibitors cause increased drug concentration (amiodarone, clarithromycin, grapefruit juice, ketoconazole);
CYP3A4 inducers cause decreased drug levels (carbamazepine, efavirenz, phenytoin, rifampin);
Monitoring Parameters:
can only be dispensed for opiate dependence & licensed opiate addiction tx centers;
safe & effective;
Goal of Tx: reduce or cease use of illicit opiates & adverse consequences;
Drug of choice in pregnant women |
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Term
| buprenorphine (Subutex, Suboxone [w/ naloxone]) |
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Definition
Indication: tx of opiate dependence;
MoA: partial mu agonist, kappa antagonist;
C-III
Dosage forms: sublingual tab alone or sublingual tab in 4:1 ratio w/ naloxone;
Dose:
Med should not be induced until symptoms of mild withdrawal are noted;
Induction - initial: 4 mg, if symptoms persist, give additional 4 mg dose;
Total daily dose from day 1 should be given on day 2 & may be repeated in 2-4 hrs PRN; continue this titration until no signs of withdrawal are present;
Maintenance: 4-24 mg/day, MAX = 32 mg;
ADRs:
constipation, nausea, vomiting, dizziness, precipitation of opiate withdrawal;
Drug Interactions:
CYP3A4 inhbitors increase drug levels (amiodarone, clarithromycin, grapefruit juice, ketoconazole);
CYP3A4 inducers (carbamazepine, efavirenz, phenytoin, rifampin) cause decreased drug levels;
Monitoring Parameters:
office-based prescribing to MDs specializing in addiction medicine/psychiatry after completing 8-hr training course |
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Term
| naltrexone (ReVia, Vivitrol) |
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Definition
Indications: tx of opioid dependence, and alcohol dependence; effective in reducing # of drinks consumed & craving for EtOH;
MoA: mu antagonist; Non-Controlled substance
Dosing:
Oral - 50 mg daily
IM - 380 mg IM gluteal injection monthly
ADRs:
abdominal pain, nausea, anxiety, HA, hepatotoxicity, injection-site rxns
Monitoring Parameters:
LFTs
Pt must be abstinent from opiates for at least 7 days or medication may precipitate withdrawal symptoms;
Highly effective in preventing relapse |
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Term
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Definition
BZD used in treatment of alcohol withdrawal;
Dosing:
50 mg TID or 50 mg every hour PRN |
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Term
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Definition
BZD used to treat alcohol withdrawal symptoms;
Dosing:
2 mg TID or 2 mg every hour PRN |
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Term
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Definition
Used to prevent Wernicke's encephalopathy (ataxia, nystagmus, mental confusion) from alcohol withdrawal;
Dosing:
100 mg IV or IM on day 1, then 100-200 mg PO for 1 month PRIOR to administration of glucose |
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Term
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Definition
MoA: antagonizes aldehyde dehydrogenase in pathway for alcohol metabolism;
Aversive therapy --> if pt consumes EtOH while on this drug, causes severe facial flushing, HA, N/V, chest pain, palpitations, weakness, dizziness, confusion;
Effective in limited population;
Dosing:
Start 12-24 hrs after last EtOH ingestion, start at 250 mg daily;
ADRs:
drowsiness, garlic-like or metallic-like aftertaste, sexual dysfunction, hepatititis, optic neuritis, peripheral neuropathy, psychotic rxns, nausea, HA;
Monitoring Parameters:
LFTs at baseline, periodically during tx;
Pt Counseling: using ANY EtOH (even after-shaves, shampoos) may produce rxn |
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Term
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Definition
MoA: glutamate NMDA receptor antagonist;
Indication: alcohol dependence
Effective in limited population
Dosing:
2 - 333 mg tabs (666 mg) PO TID
ADRs:
diarrhea, nausea, bloating
Use w/ caution in Renal impairment |
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Term
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Definition
| self-administration of any drug in a culturally disapproved manner that causes adverse consequences |
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Term
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Definition
behavior pattern characterized by:
overwhelming involvment with the use of the drug, securing its supply; strong tendency to relapse after discontinuation |
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Term
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Definition
| physiological state of neuroadaptation due to repeated administration of a drug that requires continued use to prevent withdrawal |
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Term
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Definition
| decreased effect after repeated administration that requires large doses to obtain effect see at onset of use |
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Term
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Definition
| psychological & physiologic reactions to abrupt cessation of a dependence-producing drug |
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Term
| Criteria for Substance Dependence |
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Definition
A pattern of substance use that results from negative consequences over at least 12 months. At least 3 of following need to be present:
tolerance; withdrawal; use of larger amount or over a longer period of time than intended; desire or effort to reduce substance use; large amount of time spent in substance seeking activities, substance use, or recovery from substance use; important activities are given up or reduced because of substance use; continued use despite negative consequences |
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Term
| Criteria for Substance Abuse |
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Definition
A pattern of substance use that results in frequent negative consequences over at least 12 months. At least 1 of following present:
difficulty meeting obligations at work, school, and home due to substance use; continued use in situations which could physically dangerous; frequent legal problems secondary to use; continued use despite social or interpersonal problems |
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Term
| Benzodiazepine Addiction, Dependence |
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Definition
about 1.8 million ppl abuse anti-anxiety meds each year; meds with faster onset are preferred --> "high"; Short-acting meds: withdrawal symptoms form in 12-24 hrs;
Long-acting meds: withdrawal symptoms occur for several days |
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Term
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Definition
| slurred speech; poor coordination; blood shot eyes; decreased blood pressure; memory impairment; drowsiness; dizziness |
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Term
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Definition
| tremor/muscle twitches; N/V; anxiety/restlessness; yawning; tachycardia/high BP; seizures/convulsions; hallucinations |
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Term
| Treatment of BZD Dependence |
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Definition
Initation a longer-acting BZD and SLOWLY taper;
Decrease dose by 10-25% every 1-2 wks depending on tolerability;
Ex: pt on alprazolam 8 mg daily --> convert pt to diazepam 80 mg daiy --> decrease dose by 10-25% every 1-2 wks as tolerated;
If withdrawal symptoms occur, may need to reinitiate taper at slower pace; |
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Term
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Definition
| acts on mu, delta, & kappa opiate receptors to produce effect; used as pain relievers or drugs of abuse; produce a very intense but brief euphoria followed by tranquility; Chronic use allows both tolerance & dependence to devlop |
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Term
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Definition
| euphoria; dysphoria; apathy; psychomotor retardation; sedation; slurred speech; attention impairment; miosis |
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Term
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Definition
bone, joint, muscle pain/muscle cramps; anxiety/insomnia; rhinorrhea/coughing; tachycardia; lacrimation; sweating; HPN; mydriasis; yawning; piloerection; vomiting/stomach cramps
*NOT LIFE THREATENING* |
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Term
| Symptomatic Treatment of Opiate Withdrawal |
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Definition
NSAIDs for muscle pain: ibuprofen 600 mg TID PRN pain;
BZDs for anxiety: lorazepam 1 mg TID prn anxiety
Sleep Aides for Insomnia: trazadone 50 mg qHS PRN insomnia OR zolpidem 10 mg qHS PRN insomnia;
Antidiarrheals for diarrhea: loperamide 2 mg TID-QID PRN diarrhea;
Antihypertensives for autonomic instability: clonidine 0.1 mg TID for HPN/tachycardia;
Antiemetics & antispasmodics for GI upset: promethazine 25 mg PO or IM q6hrs PRN nausea OR dicyclomine 20 mg q6hrs PRN abdominal cramping |
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Term
| Treatment of Opiate Dependence |
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Definition
1) Pt must be motivated to participate in care as a structured program that involves drug screens, individual & group counseling should be used along with one of following:
methadone, buprenorphine, naltrexone, |
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Term
| "CAGE" Screen for Diagnosing Alcoholism |
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Definition
Have you ever:
thought you should CUT back on your drinking?
felt ANNOYED by people criticizing your drinking?
felt GUILTY or bad about your drinking?
had a monring EYE-OPENER to relieve hangover or nerves? |
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Term
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Definition
| growth retardation before and/or after birth; abnormal feature of face & head; CNS abnormalities; |
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Term
| Lab Findings Associated with Alcohol Abuse |
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Definition
| blood alcohol level; positive breathalyzer; elevated MCV; elevated AST, ALT, LDH; decreased B12, folic acid; increased uric acid, triglycerides, elevated amylase, evidence of bone suppression |
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Term
| Stage 1 Alcohol Withdrawal |
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Definition
| 6-8 hrs after last drink; anxiety, hyperreflexia, HTN, tachycardia, sweating, hyperthermia, N/V, insomnia, craving |
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Term
| Stage 2 Alcohol Withdrawal |
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Definition
| 24 hrs after last drink; auditory & visual hallucinations, anxiety, tremor |
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Term
| Stage 3 Alcohol Withdrawal |
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Definition
| 7-48 hrs after last drink; seizures |
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Term
| Stage 4 Alcohol Withdrawal |
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Definition
| 3-5 days after last drink; DELIRIUM TREMENS - confusion, hallucinations, agitation, tachycardia, fever - 5% mortality in pts left untreated |
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Term
| Treatment of Alcohol Withdrawal |
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Definition
1) BZDs (chlordiazepoxide, diazepam, lorazepam, oxazepam)
2) thaimine
3) Adjunctive therapies: hydration or electrolyte replacement, propanolol, atenolol, or clonidine for HTN, antipsychotics for managing hallucinations & agitation |
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Term
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Definition
| psychomotor agitation; euphoria; grandiosity; hypervigilance; tachycardia; mydriasis; sweating/chills; nausea/vomiting |
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Term
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Definition
fatigue; sleep disturbance; depression; paranoid psychosis; increases sympathetic tone --> increased HR; at toxic doses --> cardiac failure, arrhythmias, shock, convulsions;
Long-term effects: "burn-out", cognitive loss, treatment-resistant depression |
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Term
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Definition
| sense of well being; relaxation; slowing of thought processes; loss of temporal awareness; panic; toxic delirium; rarely - psychosis |
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