Pharm Treatment for SUDs

Question 1

treatment for acute opiate toxicity

Answer 1

(OD can cause respiratory failure and death)

treatment = opiate antagonist (NALOXONE)
–injection or nasal spray

**it will precipitate withdrawal but THAT DOESNT MATTER
short acting – might need follow up doses

Question 2

4 treatments for opiate DETOXIFICATION

Answer 2

1) GO cold turkey - not recommended
2) MAIN = METHADONE detox - medical supervised withdrawal by replacing with methadone; slow decrease
3) CLONIDINE detox - suppress withdrawal symptoms by alpha2 receptor activation (inhibits locus ceruleus firing)
4) antagonist accelerated withdrawal (NALTREXONE) - rapid transition to non-dependent state + anesthetics for symptoms

Question 3

3 methods for relapse prevention

Answer 3

1) METHADONE - legal supply to induce a high tolerance to other opiates
2) long term antagonist NALTREXONE to block effect of any opiate
3) BUPRENORPHINE - partial agonist; blocks opiates AND induces a mild high

Question 4

buprenorphine/naloxone combination

Answer 4

sublingual tablet for maintenance therapy

B –> mild euphoria and blocks any heroin taken simultaneously
N - not absorbed sublingually BUT if it is dissolved and taken IV, naloxone blocks all mu-opioid receptors and prevent ANY euphoric effect

**prevents diversion of buprenorphine for illicit use!

AS effective as methadone maintenance and more effective than naltrexone alone

Question 5

is buprenorphine safe in pregnancy?

Answer 5

YES - use monotherapy, not combo

Question 6

treatment for cocaine or amphetamine users?

Answer 6

no specific treatment - treat symptoms (ex: B blocker for cardiac arrythmias)

Question 7

nicotine dependence treatment

Answer 7

gum, inhalers, patches
or
VARENICLINE (nicotine partial agonist) - reduces central stimulation by nicotine and reduces DA release)

Question 8

varenicline

Answer 8

(nicotine partial agonist) - reduces central stimulation by nicotine and reduces DA release)

Question 9

drugs used to reduce gastric acid secretion from alcohol poisoning?

Answer 9

ranitidine (H2 antagonist) or omeprazole (PPI)

Question 10

what do you do to prevent further absorption of ethanol?

Answer 10

gastric lavage

Question 11

treatment to slow methanol metabolism?

Answer 11

give ethanol or fomepizole

to reduce production of methanol metabolites

Question 12

management of alcohol withdrawal symptoms
for seizures?
for hallucinations?
for acid secretion?

Answer 12

seizures –> diazepam
hallucinations –> haloperidol
acid –> omeprazole or ranitidine

Question 13

3 pharm treatments for alcoholism

Answer 13

1) disulfiram - inhibits aldehyde dehydrogenase –> acetaldehyde builds up and causes unpleasant symptoms (AVERSION therapy - makes symptoms worse!!)
2) naltrexone - opioid receptor antagonist - reduces alcohol craving
3) acamprosate - decreases Glu neurotransmission

Question 14

disulfiram

Answer 14

inhibits aldehyde dehydrogenase –> acetaldehyde builds up and causes unpleasant symptoms

(AVERSION therapy - makes symptoms worse!!)

makes you not want to drink