Substance Abuse - Details

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Men: < 2/d or 14/wk or nom ore than 5 in sigle occasion Women: < 1/d or 7/wk or more than 4 in single occasion.

What are the limits of drinking?

How often have you exceeded your limit in past year? CAGE: Cut down, Annoyed, guilty, eye opener : > 2 + F/u what are a few reasons you continue to use? What are a few reasons you want to stop? AUDIT screen. > 8 +

How do you screen for alcohol dependence?

Smokers, teens, young adults, women who may become pregnant and adults with current sx.

Who do you screen fo substance abuse?

Past 12 mo 1/4 Risk of harm (driving under influence) Relationship problem, Role at home/work Trouble with Law.

How do you dx alcohol abuse?

Past 12 mo > 3+ Not able to stick to limits Not able to cut down, Continue despite problems Less time on other activities Tolerance, Withdrawl

How do you dx alcohol dependence?

Assess: Are you reach to change habits Advise: You drink more than is save, I advise cut down Assist: Ask if need help. Set goal to cut down, Support, Explore barriers to change if do not want help and confirm willingness to help when ready.

What is the Assess, Advise, Assist Method for Substance Abuse?

Naltrexone: Best Acamprosate Disulfiram Topiramate ( Topamax)

What are the approved drugs for alcohol dependence?

Opioid receptor antagonist Works by blunting feeling of intoxication and lead to less craving. Lowers risk to return drinking 4% Dose 50 mg/d Cost $3/pill. Can start while drinking. Vivitrol injectable 380 mg IM monthly SE: Nausea, dizziness. Serious SE: liver toxicity Monitor baseline LFT and Q 3 mo. Contraindicated if currently on opioids, or liver failure.

What is the MOA or Naltrexone ( Revia) ?

GABA/ Glutamate agonist TID dosing, $4/d Start after abstinent SE: GI ( diarrhea) OK with liver dysfunction. Anxiety/ depression. Dose needs renal adjustment.

What is the MOA for Acamprosate?

Blocks breakdown of alcohol with buildup of acetaldehyde ( toxic) SE: Nausea, sweating, tachycardia and flushing when drink

What is MOA for disulfiram?

Not FDA approved Decrease consumption and increase abstinence 25% Dose 25 mg/d

What is MOA for Topamax?

CIWA < 8 mild : treat as outpt > 8-15 consider hospitaliztion > 15 hospitalize

How do you evaluate for ETOH withdrawal?

Enroll in outpt program. Rehab> Monitor pulse, BP Labs: CBC, LFT, Urine drug, ETOH level and BMP Gen care: IVF, Thiamine 100 mg/d folic acid 1 mg/d Detox take 5 days. Librium long acting and less abuse potential Ativan short acting and safer with hepatic dysfunction and elderly.

ETOH withdraws outpt management

Atenolol for elevated pulse, BP and reduces craving as well Clonidine: for autonomic sx ( sweating, tremor and agitation) Dilantin: if hx of seizure Topomax: decrease consumption and increase abstinence

What are some of the adjective medications used in withdrawal?

Handouts for all who screen positive Simple advice and information for limit drinking. Advice, Assess and Assist SW referral help with AA and Rehab Labs: CBC, LFT Vaccinate: Hep AB, Pneumovax, Flu and Zostavax Addiction Specially referral if Audit > 19

What are the non medication options for treating ETOH disorders?

In past year how many times have you used an illicit drug or prescription medication for non medical reasons and for the feelings it caused? Once is a positive screen.

How do you screen for substance misuse disorder?

1. Hazardous use: Elicit-provide-elicit technique. Empower and support pt in change. 2. Substance abuse: Problems at home/work/relationship. Recommend abstinence and harm reduction (clean needle, Prep, no driving) 3. Substance dependent: Tolerance, withdrawal, unsuccessful cutting back. Referr to treatment facility a for meds or to SW to help.

What are the three categories of substance misuse?

Suboxone ( buprenorphine/Naloxone) Methadone Naltrexone.

What medications are used for substance use disorder?

Partial mu agonist for opioid receptor. Sublingual.

What is the MOA for Suboxone?

Referral addiction treatment center, AA, NA No meds available. Screen for DV, anxiety, depression, bipolar, PTSD, Antisocial, Fluoxetine ( Prozac) 40 mg/d can reduce short term craving Imipramine may improve adherence to treatment

How do you treat stimulant dependence?

Sweaty, agitation, psychosis, Tachycardia, MI, HTN Treat in ED: Charcoal, Benzo and antipsychotics Adverse outcomes: MI, Stroke, Seizure, Rhabdo, cardiomyopathy, psychosis, death, HIV transmission.

What are the sx of stimulant overdose and how do you treat?

THC: Psychoactive If inhaled acts within 2 min and dissipates 30 min. Better predictability. Less psychoactive metabolite after first pass effect of liver. CBD: Acts more peripherally and less psychoactive. Many preparations including edibles. Works well as anti-inflammatory analgesic. May also reduce anxiety. Edible has more variable absorption with long half life 20-30 hours. Active metabolites produced after first pass through liver.

What are two active ingredients in Marijuana? and how do they differ.

Chemo associated N/V anorexia, chronic pain, muscle spasm, neuropathy, depression, anxiety, PTSD, ADHD, refractory seizure, glaucoma, insomnia, MS spasticity, IBD.

What medical conditions benefit from MJ?

Tachycardia, increase or decrease in BP, cognitive changes, possible increase in chronic bronchitis and Hyperemesis ( rare)

What are some SE form MJ use?

Additive effects with opiate, muscle relaxants, ETOH and Benzo Decrease concentration of antipsychotics.

What are drug interactions of MJ?

Sedation, constipation, hypogonadism, Prolonged QT

What are the SE of methadone?

Headache, nausea, constipation, insomnia and poss. hypomania. Safe in pregnancy.

What are SE of Suboxone?

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