Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
CNS 2a Knebel
AOW/OUD/SUD/AUD
| Question | Answer |
|---|---|
| Who is at Risk of an Opioid Overdose? | Opioid prescription plus any one of the following: -Respiratory disease (COPD, asthma, sleep apnea, smoking) -Renal or hepatic disease -Concurrent antidepressant, benzodiazepine or alcohol use -Difficulty accessing medical care -History of substance abuse -Methadone prescription -Recent release from correctional or rehabilitation facility -High-dose opioid prescription ->100 mg/day morphine equivalence |
| S/sx of opioid overdose? | Clammy, pale skin; blue lips or skin; pinpoint pupils; slow HR; slow, irregular or stopped breathing; unresponsive to voice or touch |
| Naloxone (narcan,evzio) MOA? | opioid receptor antagonist; Opioid reversal (overdose, respiratory depression) Co- formulated with opioid agonists to minimize abuse potential |
| Naloxone formulations? | Intranasal spray Solution for injection Auto-injector for IM, subQ administration (Evzio®) IV |
| Dosing of Naloxone? | O.4 mg subQ, IM, IV, PO Q2-3 minutes 4 mg/spray intransally Q2-3 minutes *Half-life: 30-80 minutes = may require multiple administrations with long-acting opioids |
| SE of Naloxone? | Agitation increased HR Pain (injection site and reversal) |
| Naloxone Onset of Action? | IV: 1-2 minutes IM: 2-5 minutes Intranasal: ~8 minutes |
| Clinical pearls of Naloxone? | Since antagonist, can induce opioid withdrawal symptoms Nonresponse = likely other cause of symptoms |
| Response to Naloxone Admin? | -If opioids present: analgesia reversal, agitation, N/V and increased BP; Opiate overdose: Abrupt return to consciousness --> tremor and hyperventilation Adverse cardiovascular effects have occurred: Most frequently in postoperative patients with preexisting cardiovascular disease |
| Opioid withdrawal Criteria A means any of the following--> | -Cessation of (or reduction in) opioid use that has been heavy and prolonged (several weeks or longer) -Administration of an opioid antagonist after a period of opioid use |
| Opioid Withdrawal (3 or more) of the following developing w/in minutes to several days after criteria A--> | Dysphoric mood; N/V; Muscle aches; Lacrimation or rhinorrhea; Pupillary dilation (mydriasis), piloerection (goosebumps), or sweating; Diarrhea; Yawning; Fever; Insomnia |
| Timeline of Opioid Withdrawal--> | -Onset of withdrawal depends on the PK (e.g. half-life) of the opioid being used (Heroin: 6-12 hours after discontinuation Methadone: 3-5 days) -Duration varies and is dependent on 1/2 life (may expereince aches and fatigue well beyond the immediate withdrawal phase) -Severity is NOT fatal by is extremely unpleasant (Alcohol and BZD withdrawal can be FATAL!!!) |
| Assessing Opioid Withdrawal--> What scale do we use? | Clinical Opiate Withdrawal Scale (COWS) |
| COWS is an 11-item assessment scale that rates symptom severity for both subjective and objective symptoms. Rank severity and COWS range for each? | 5-12 = mild 13-24 = moderate 25-36 = moderately sever >36 = severe *symptoms scored include (naming a few)--> Resting HR, sweating, pupil size, bone or joint achiness, etc |
| Acute Opioid Withdrawal Treatment modalities--> (1) Clonidine; (2) Buprenorphine; (3) Supportive Care? | 1. Blunts noradrenergic outflow that occurs during opiate withdrawal without affecting any opiate receptors 0.1 or 0.2 mg by mouth PRN every 4 to 6 hours 2. 8/2 mg sublingual film given PRN over the course of 4 days 3. NSAIDs for body aches Loperamide for diarrhea Antihistamines for insomnia, anxiety, etc. |
| Methadone and buprenorphine are the oral drugs used for | maintenance therapy (OUD) |
| Methadone must be given in a licensed ____ _____ | treatment program |
| Buprenorphine is usually given in combination with naloxone in a? | sublingual tablet or film strip dosage form |
| Physician must be able to refer patients to appropriate? | counseling and other non‐pharmacologic therapies *Often limits on number of patient they are able to treat in a given year |
| Methadone drug facts? | Full mu-agonist; hepatic metabolism (CYP 3A4); C-II; -Half-life of 24-59 hours (longer in hepatic impairment); -Dosed daily when used for treatment of OUDs (except for rapid metabolizers); -OUD effective dose Typically 80-120 mg daily; Should be able to function without impairment of physical or emotional responses *2.5 mg --> pain OUD--> 80-100 mg |
| Methadone brand? use? formulation? | Methadol®, Methadose®); Severe chronic pain Opioid detoxifi- cation; -Tablet -Oral solution -Solution for injection |
| Methadone analgesic dosing? SE? Clinical pearls? | -2.5 mg PO Q8H (for analgesia, not opioid detoxification) -**Prolongs QTc**; Opioid specific -Safe to use in renal impairment ONLY certain prescribers can use for opioid detoxification |
| Goals of Methadone Tx include? | Alleviate withdrawal symptoms; Block euphoric effects of self-administered opioids; Eliminate opioid craving |
| Methadone dosing: Introduction? | -no higher than 30 mg on day 1 unless physician can document withdrawal, in which case can give additional 10 mg; -Risk of death from overdose is highest during induction (Increased risk with increased dose and sedative use (clonazepam, diazepam, alprazolam); 42% of methadone deaths occur during first week) -Take 3-7 days to reach SS, so dose changes should reflect this time period*** |
| Methadone dosing: Maintenance? | Long-half life allows for once-a-day maintenance dose (Usual range: 60 to 120 mg/day); |
| Methadone dosing for Opioid Addiction Treatment--> | May only be dispensed by opioid treatment programs; Exceptions are for Inpatient tx; pregnancy; emergency periods (NTE 3 days); *pt must present to clinic everyday to dose (generally will not do home supply) *urine drug screens (federally mandated 8x/yr |
| Methadone BBW--> | QTc interval prolongation (usually seen with larger pain dosages); Opioid addiction tx (can only be dispensed by specific programs and emergency periods; Risk of abuse/dependence *Cytochrome P450 (CYP450) **3A4**, 2B6, 2C19, 2C9, or 2D6 inhibitors may result in an increase in methadone plasma concentrations *neonatal withdrawal syndrome |
| Methadone ADR include? | Low energy, QT prolongation; Postural hypotension; Malaise; Constipation |
| Buprenorphine Drug info? | Partial opioid agonist; C-III; Given with naloxone in the same dosage form to decrease abuse (Naloxone is not absorbed through the GI tract; If injected, will block opiate effect of buprenorphine); *street value (often obtained by opiate users to prevent withdrawal if the person can't get an opiate |
| what are the 2 common preparations for Buprenorphine? | Buprenorphine (Subutex) --> SL tablet (seen inpatient) Buprenorphine/Naloxone (Suboxone)--> SL film (preferred) |
| Buprenorphine Dosing: Initial dosing? | To start on buprenorphine, patients need to be in visible opioid withdrawal otherwise risk precipitated withdrawal -Should wait at least four (4) hours since last opioid use so that the patient is in early withdrawal to prevent buprenorphine‐induced withdrawal |
| Buprenorphine Induction | -4 mg buprenorphine OR 4/1 mg buprenorphine/naloxone x 1, repeat after 3 ‐4 hours if needed -Can also start with 8 mg based on history -Increase dose to 12/3 or 16/4 mg/day based on patient need to minimize withdrawal but not provide euphoric effects -Maintenance dose target: 12-16 mg buprenorphine/day -Typically dosed daily -If converting from methadone: should be on less than 30 mg and avoid dosing 72 hours prior to starting buprenorphine |
| Buprenorphine: Maintenance | Urine drug testing (required by most offices) (test for presence of buprenorphine and metabolites); buprenorphine is synthetic so you must test for its specifically (wont be + opiates) *pt may have take-home supply (can dispense >30 day supply but pt should be engaging in therapy) |
| Buprenorphine: Maintenance 2023 update: | “any qualified practitioner can treat patients who screen positive for OUD with buprenorphine.” -All prescriptions for buprenorphine only require a standard DEA registration number. -There are no longer any limits or patient caps on the number of patients a prescriber may treat for opioid use disorder with buprenorphine. -No longer require X DEA number |
| Choosing Methadone over Buprenorphine? | Efficacy; FDA approved for use in pregnancy; Tx program requiers daily attendance unless pt graduates to take-home bottles; must give urine sample/attend programs (high level of monitoring); Inexpensive, NOT covered by medicaid; STIGMA; Full agonist: possibly better efficacy; QTc concerns |
| Choosing Buprenorphine over Methadone? | Effective tx over short-term, longer-term clinical trials are lacking; office-based, can get 30-day Rx; LESS STIGMA; less abuse potential over Methadone; Possible to divert; Physician myst be certfified and each office group can only have 100 pts at one time; MEDICAID may cover; Monthly Sublocade injection available |
| Naltrexone MOA? Dose? | non-selective antagonist of opioid receptors (primarily MU-opioid); by blocking opioid receptors, the "reward" and acute reinforcing effects from DA are diminished, and consumption is reduced; 50-100 mg daily (PO; 380 mg every 4 weeks (IM); No PO tolerance required |
| Naltrexone (IM) (Vivitrol) drug facts? | FDA‐approved to treat opiate dependence disorder Given in same dose as that used for alcohol dependence *Concern in opiate dependence for pts trying to "overcome opiate recptor blockade" with higher doses of opiates **Must let pt know about pain management issues--> need to let providers know if injured or in need of acute pain management (PAIN BRACELET)--> meaning opioids won't work on this pt |
| Naltrexone (Revia, Vivitrol) Precautions and monitoring? Common SE seen? | Use caution in moderate-severe renal impairment (not studied) **Avoid use in severe acute hepatitis/hepatic failure **Can precipitate opioid withdrawal **Monitor LFTs (baseline and periodic) looking for 4-5x ULN *Nausea |
| OUD Tx in pregnancy Methadone? | Gold standard (FDA approved); Gestational withdrawal is harmful for the fetus; Neonatal abstinence syndrome (risk v benefit) |
| OUD Tx in pregnancy Buprenorphine? | Buprenorphine (Subutex) ONLY formulations should be used in pregnancy |
| What are normal AST/ALT levels? | Normal Range: 10-40 IU/L Normal Range: 10-30 IU/L |
| Harm reduction definition? | practical strategies that reduce the negative consequences associated with drug use and other risky behaviors *DOES NOT enable, condone, endorse, or encourage drug use i.e. needle exchange |
| Definition of Detoxification is--> | Immediate and opposite effects of the drug being taken |
| Alcohol and BZD maintenance medication Tx--> | may be similar pharmacology of drug of abuse (methadone) OR **may be targeted at preventing intoxication or "reward and reinforcement" |
| Alcohol Use Disorder Unhealthy use--> Men? | >14 standard drinks per week or >4 drinks per occasion |
| Alcohol Use Disorder Unhealthy use--> Women? | >7 standard drinks per week or >3 drinks per occasion |
| Alcohol Use Disorder Risky Use--> | includes binge drinking, heavy drinking, and any use by pregnant women or those under age 21. *Consumption not severe enough to meet criteria for DSM-5 diagnosis; 1/3 of pts in this categroy are at risk for DEPENDENCE |
| Alcohol Use Disorder Binge drinking is defined as? | Consuming excessive alcohol in short time span (about 2h) that BAC >0.08 g/dL; Typically occurs after 5 standard drinks in men and 4 standard drinks in women; Most common among younger adults aged 18-34 years and twice as common in men |
| Definition of Alcohol use disorder is? | Characterized by a problematic pattern of alcohol use; Clinically significant impairment or distress (AODL); Psyhcological, behavioral, or phsyiologic features |
| Diagnosis: DSM-V Criteria AUD--> just know that the DSM-5 criteria requires? | Presence of at least 2 of these symptoms indicates: Alcohol Use Disorder (AUD) |
| DSM-V severity is defined as? | Mild: 2 to 3 Moderate: 4 to 5 Severe: 6 or more |
| Main criteria from the DSM-V AUD that Knebel pointed out was? | Wanted a drink so badly you couldn’t think of anything else? **New to DSM-V (Cravings)** |
| AUD risk factors include? | genetic, individual, family, Social, Culture, Race, Sex, and Age |
| Blood Alcohol Level and Clinical Presentation--> Know that 0.08 is? | Judgement is further impaired, More likely to do thing htat you would not do when sober. Legally drunk in ALL STATES |
| Alcohol Pharmacology and PK--> Psychoactive drug that is a: GABA agonist equals? Net result equals? | inhibitory; CNS depression; *knetics --> Zero-order elimination = not concentration dependent |
| Short term neurobiology--> Drinks increase GABA, Dopamine, and Serotonin, but drinks decrease? | Glutamate (delayed infomration processing; but with increased DA and 5-HT we get Euphoria/reward activation) |
| At the synapse--> If a persone is in Homeostais: Non-alcoholic: GABA and Glu are ______ and cancel each other out | balanced |
| At the synapse--> If a persone is in Homeostais: Intoxication--> Occasional user: GABA and Glu are imbalanced meaning we have MORE _____ and less Glu | GABA |
| At the synapse--> If a persone is in Homeostais: Withdrawal state: Glu is more _________ and GABA is decreased | upregulated |
| Clinical Manifestations of AUD include: | Neurobiological (Electrolyte disturbances); Psychiatric (Seizures, Depression/Anxiety); Endocrine (Hypo/hyperglycemia/ Sexual performance); CV (HTN/Arrhythmias); HEPATIC (Cirrhosis/hepaitc); Miscellaneous (Trauma/injury) |
| The 2 main electrolyte Nutritional Deficits to look out for are? | Thiamine and Sodium |
| Thiamine deficiencies contribute to? | CNS problems/WERNICKE's encehalopathy |
| Sodium deficit leads to? | fatigue, rhabdomyolysis, tremor, seizures, and altered mental status |
| How does alcohol affect the GI? | interferes with GI functioning (direct injury to tissue) and promotes malabsorption of nutrients |
| Wernicke's Encephalopathy is mainly a lack of? | Thiamine |
| Wernicke's Encephalopathy definition? | Definition: Acute, reversible neuropsychiatric disorder arising due to vitamin B1 (thiamine) deficiency |
| Wernicke's Encephalopathy classic triad of symptoms includes? | Mental status changes Ophthalmoplegia Ataxia |
| Ultimate goal of treating Wernicke's encephalopathy is to prevent development of? | Korsakoff's syndrome (irreversible brain damage) |
| Knebel--> Wernicke encephalopathy (WE) is an acute neurological condition characterized by a clinical triad of ophthalmoparesis with? | nystagmus, ataxia, and confusion * |
| Wernicke encephalopathy is a life-threatening illness caused by thiamine deficiency, which primarily affects the | peripheral and CNS |
| Wernicke encephalopathy can lead to KREB's cycle disruption? | deficiency of thiamine will lead to decreased levels of alpha-keto-glutarate, acetate, citrate, acetylcholine and accumulation of lactate and pyruvate. This deficiency can cause metabolic imbalances leading to neurologic complications including neuronal cell death. Neuronal death in the mammillary bodies and thalamus were implicated in multiple cases of Wernicke encephalopathy studied. |
| Wernicke’s Encephalopathy compared to Korsakoff's psychosis? | Korsakoff syndrome (preventable and usually suspected as a concesqeunce of at least one episode of Wernicke's encephalopathy. Korsakoff is a neuropsychiatric disorder associated with memory disturbances in which there are significant defecits in anterograde and retrograde memory. *Where Wernicke's encephalopathy is untreated, or is not treated soon enough, Korsakoff's syndrome usually develops, though often gradually. |
| Treatment of Wernicke's initially with what drug and dose? | Thiamine 100 mg IM or slow 500 mg IV push |
| Thiamine is a co-factor in glucose metabolusm, Wernicke's can be precipitated by high ____ _____ | glucose loads |
| Thiamine (Vitamin B1): Water soluble vitamin: MOA? Clinical pearls? | Cofactor for carbohydrate metabolism; CP: Magnesium is a necessary cofactor for thiamine absorption *Key Pearl: GIVE THIAMINE PARENTERALLY WHEN FEASIBLY POSSIBLE *Pregnancy Category A* |
| Monitoring parameters for AUD include looking at which parameters and ranges? | B12 (200-900 ng/mL) Folate (2-20 ng/mL) Thiamine (70-180 nmol/L) Blood Alcohol concentration (Undetectable/<0.8mg/dL) |
| DSM-5 Alcohol Withdrawal Criteria includes >/= 2 of the following, developed within hours to a few days after cessation/reduction in alcohol use? | insomnia, N/V, Psychomotor agitation, anxiety, Generalized tonic-clonic seizures |
| Stages of Alcohol withdrawal--> Stage 4, we see time ofonset after withdrawal at what time? | 3-5 days (Delirium tremens (DTs) in ~5% of patients (confusion, illusions, hallucinations, agitation, tachycardia, hyperthermia) *Mortality associated with DTs ~5 – 15% attributable to arrhythmias, shock, infection, trauma or aspiration |
| Stages of Alcohol withdrawal--> Time of onset after withdrawal is how long? | 6-8h (Moderate autonomic hyperactivity (anxiety, tremulousness, tachycardia, insomnia, nausea, vomiting, diaphoresis) and a craving for alcohol) |
| Timeline of Alcohol Withdrawal Symptoms (if undertreated): 6-36 Hours Since Last Use: | GI upset Autonomic dysfunction Shaking/tremor; Anxiety |
| Timeline of Alcohol Withdrawal Symptoms (if undertreated): 48h since last use: | Seizures Visual, auditory, and/or tactile hallucinations |
| Timeline of Alcohol Withdrawal Symptoms (if undertreated): 48-96h since last use: | Delirium tremens hallucinations, disorientation, tachycardia, hypertension, fever, agitation, and diaphoresis |
| Alcohol withdrawal risk factors includes? | Chronic, heavy drinking History of generalized seizures History of delirium tremens |
| Assessing Alcohol withdrawal using CIWA: stands for? | Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) |
| Assessing Alcohol withdrawal using CIWA: consisted of a 10 question assessment scale that scores: | (0-7) severity of the following symptoms |
| What symptoms is the CIWA score looking for? | Auditory, visual, Tactile distrubances; Orientation, Anxiety, Agitation, N/V, Tremor, Sweating, HA |
| Clinical Utility of CIWA found to? | Reduce amount of total benzodiazepine used Reduce amount of time patients were on withdrawal protocol |
| Possible CIWA Confounding Factors Affecting Scoring includes? | -Withdrawal from multiple substances (COWS overlap withdrwal -Primary Axis I diagnosis (Hallucinations due to psychotic illness) -Prescription medications (Bblockers, CCB, mask autonomic dysfunction -H/O traumatic brain injury (baseline AMS, baseline tremor) |
| Alcohol withdrawal Pharamcotherapy: BZD's are the drug of choice, why? | used for both alcohol and BZD withdrawal; used in combo with assessment scale, Tapers vs PRN vs TAPEr + PRN; |
| Longer-acting BZD agents may afford for smoother detox with fewer breakthrough symptoms: (1) liver dysfunction use which drugs? (2) Alcohol Lliver disease: (3) which BZD is rarely used? | 1. diazepam/chlodiazepoxide 2. Lorazepam 3. Tranxene (Clorazepate) |
| Advantages of using prophylaxis/fixed dosing for alcohol withdrawal? Disadvantage? Example? | prevent withdrawal Disadvantage: unnecessary BZD dosing i.e. Chlordiazepoxide 25mg TID x 2 days, BID x 2 days, daily x 2 days, then d/c *May also see PRN use of lorazepam to supplement |
| Individualzed dosing for alcohol withdrawal? | Use BZD if symptoms warrant: Use CIWA‐Ar Scale CIWA < 8‐10 (Non-pharm) CIWA 8 – 15 (Medicate) CIWA > 15 (Complicated risk) *Reduces treatment duration, decreased benzodiazepine dosing |
| BZD tapers (fixed-dose) may be required in institutions that can not use frequent CIWA-Ar scoring and may be? | preferable in patients who are detoxing as an outpatient (reduce by 10-15%/week for patients on prescription benzos > 5 weeks) *May be required in patients that were drinking large amounts of alcohol daily, in addition to PRNs |
| PRN (symptom triggered) with BZD for withdrawal dosing based on? | -assessment scale score (i.e., >8 on CIWA-Ar) -Reduces amount of total benzodiazepine used -Reduces amount of time on withdrawal protocol |
| Benzodiazepine for Withdrawal Dosing Strategies include what 2 types? | Benzodiazepine Tapers (fixed-dose) PRN (symptom triggered) |
| BZD withdrawal; When treating BZD overdose use? | Flumazenil |
| Flumazenil MOA? Clinical Pearls? | Benzodiazepine Overdose; MOA: Benzodiazepine Antagonist Increased risk of seizures (epilepsy, intracranial pressure, status epilepticus)** |
| BZD ADR's include? | Sedation; Anterograde amnesia; Worsening delirium; Respiratory depression; Psychomotor impairment |
| BZD pharmacology and PK know what key point? | Untreated benzodiazepine withdrawal can be FATAL; Just as with alcohol withdrawal |
| BZD Withdrawal Symptoms inlcude? | Signs and symptoms of undertreated withdrawal are the exact same as alcohol withdrawal; Pts with BZD withdrawal are less likely to develop Wernicke's Encephalopathy |
| BZD summary table includes what SHORT agents? | Lorazepam; Oxazepam (Serax) |
| BZD summary table includes what intermediate agent? | Alprazolam (Xanax) |
| BZD summary table includes what LONG agents? | Chlordiazepoxide (Librium®) Clonazepam (Klonopin®) Diazepam (Valium®) |
| Withdrawal Clinical Pearls included in Alcohol withdrawal? | Duration of alcohol withdrawal is dependent on how much and how long the patient has been drinking |
| Withdrawal Clinical Pearls included in BZD withdrawal? | Duration and onset of withdrawal is dependent upon the type and amount of benzodiazepine the patient was using |
| AUD Maintenance Tx includes what FDA approved medications? | Acomprosate; Disulfiram; Naltrexone; Naltrexone-XR |
| Tx for AUD include what goals of Tx? | Abstinence from alcohol use Reduction or moderation of alcohol use Reduction or moderation of elements of harm *person is always recovering, never recovered; Long-term tx is necesary to reduce risk of relapse; Pt must be engaged in tx; Tx includes pharmacotherapy (where approp.) and psychotherapy; Psychotherapy includes individual and group tx (AA meetings) |
| AUD Non-pharm tx incudes? | Motivational Enhancement Therapy (MET) Cognitive-Behavioral Therapy (CBT) Community-Based Peer Support Groups (AA & 12-Step) Literature Conclusions/Meta-Analaysis |
| AUD--> progression to Pharmacotherapy--> | Most drug therapy does not cause significant adverse effects when combined with alcohol, rather they reduce cravings and binge drinking amounts Drug therapy is not a magic bullet, psychotherapy is necessary; *Fewer than 20% of individuals with AUD are treated with pharmacotherapy |
| Pharmacologic therapies: 1st line--> | APA recommends (1B) that naltrexone or acamprosate be offered to patients with moderate to severe alcohol use disorder who: have a goal of reducing alcohol consumption or achieving abstinence prefer pharmacotherapy or have not responded to nonpharmacological treatments alone have no contraindications to the use of these medications |
| Rationale of Naltrexone or acamprosate as 1st line agents? | Have the best available evidence as pharmacotherapy for patients with AUD Showed small benefits overall on alcohol-related outcomes (moderate strength of evidence) Minimal side effects -Possible SE are minimal compared with the harms of continued alcohol use |
| Naltrexone (Revia, Vivitrol) MOA? Dose? | Non-selective antagonist of opioid receptors (primarily mu-opioid) Opioid system involved in mesolimbic dopaminergic system (reward system) helps with “reward cravings” associated with alcohol consumption Dose: 50-100 mg daily (PO) 380 mg Every 4 weeks (IM) |
| Naltrexone (Revia, Vivitrol)--> Cochrane review? | (Rosner et al., 2010) found naltrexone reduced the risk to return to heavy drinking compared to placebo |
| Pros of Naltrexone (Revia, Vivitrol) are? | reduces cravings and return to heavy drinking ***Can drink alcohol while on this medication*** |
| Cons of Naltrexone (Revia, Vivitrol) are? | Caution in hepatic impairment, patient must be highly motivated (PO), injection is very expensive, opiates less/ineffective for pain management *Common SE--> Nausea |
| Precautions/CI of Naltrexone (Revia, Vivitrol) are? | Use caution in moderate-severe renal impairment (not studied) Avoid use in severe acute hepatitis/hepatic failure Can precipitate opioid withdrawal *monitor LFT's |
| Acomprosate (Campral) MOA? | GABA agonist, NMDA antagonist After chronic exposure to alcohol, upregulation of NMDA receptors occurs to compensate for alcohol Works for “relief cravings” i.e., drinking because of negative mood and/or experiencing withdrawal like symptoms ***Do not drink while on this medication*** |
| Cochrane review of Acomprosate (Campral) found? | (Rosner et al., 2010), acamprosate reduced risk to return to any drinking by 14% and **increased abstinence** duration by 11% |
| Dose of Acomprosate (Campral) is? | Weight > 60 kg: 666 mg PO TID Weight < 60 kg: 666 mg PO BID Renal: 333 mg PO TID (CrCl < 50 mL/min); Contraindicated (CrCl < 30 mL/min) |
| Pros of Acamprosate (Campral) are? | has effect on craving, some data to support improved abstinence, can be used in hepatic dysfunction |
| Cons of Acamprosate (Campral) are? | extremely expensive, patient must be highly motivated, cannot be used in renal impairment Precautions/Contraindications Severe renal impairment (avoid use) CNS Depression Suicidal thinking/behavior *Monitor Renal Function Common SE: Diarrhea/Fatigue |
| Agent selection: Naltrexone Clinical Pearls? | Does NOT require abstinence from alcohol prior to initiation Vivitrol bypasses liver metabolism which limits drug-drug interactions *Avoid use in pts with Hepatic Dysfunction |
| Agent selection: Acomprosate Clinical Pearls? | Requires abstinence from alcohol prior to initiation Take regardless of relapse *Avoid use in pts with Renal Dysfunction |
| Pharmacologic 2nd line therapies for AUD have level of evidence 2C. What drugs? | Disulfiram (FDA approved) Gabapentin Topiramate *Reserved for pts with moderate to severe alcohol use disorder who: Have goal of reducing alcohol consumption or achieving abstinence Have not responded to nonpharmacological treatment/failure of 1st line Have no contraindications |
| Disulfiram (Antabuse)--> MOA: | Inhibitor of aldehyde dehydrogenase When the patient consumes alcohol while taking disulfiram, the accumulation of acetaldehyde causes a physical response such as tachycardia, flushing, headache, nausea, and vomiting |
| Disulfiram (Antabuse) dosing pearls? | **First dose 12 hours after the last drink; Abstinence required 14 days after discontinuation** |
| CI of Disulfiram includes what key points? | Concomitant metronidazole, paraldehyde, or alcohol containing solutions use |
Created by:
Xander635
Popular Pharmacology sets