Naltrexone
To which drug class does naltrexone belong and what is its mechanism of action?
Opioid Antagonist
Naltrexone binds and blocks opioid receptors and reduces and suppresses opioid cravings. Naltrexone is not an opioid, is not addictive, and does not cause withdrawal symptoms with stop of use.
Name 3 uses for phenobarbital.
Seizure Control: Effective for most types of seizures (except absence seizures), including focal and generalized tonic-clonic seizures.
Sedation: Used short-term to treat insomnia or to relieve anxiety before surgical procedures.
Withdrawal Management: Sometimes used to manage withdrawal symptoms from alcohol or other barbiturates.
Name two benzodiazapines used in Substance Use Disorder treatment.
Chlordiazepoxide (Librium): Frequently used for its long half-life, which provides a smoother, self-tapering effect as it leaves the body.
Diazepam (Valium): Preferred for its rapid onset of action and long duration, helping to quickly stabilize symptoms and reduce the risk of breakthrough seizures.
Lorazepam (Ativan): The drug of choice for elderly patients or those with liver disease, as it does not rely on complex liver metabolism (oxidation) that long-acting agents do.
Oxazepam (Serax): Also preferred for patients with impaired liver function due to its simpler metabolic pathway.
To which drug class does methadone belong and what is its mechanism of action?
Opioid analgesic
Full agonist of mu-opioid receptor
This drug is an opioid analgesic that binds to mu opioid receptors and inhibits nerve activity.
Fentanyl
What are 3 side effects specific to naltrexone?
hepatotoxicity, precipitated opioid withdrawal, syncope, abdominal pain, anorexia, decreased appetite, diarrhea, nausea, vomiting, increased serum transaminases, pain at injection site, anxiety, asthenia, dizziness, headache, insomnia, arthralgia, arthritis, increased CPK, joint stiffness, pharyngitis
To which drug class does phenobarbital belong and what is its mechanism of action?
Barbituate, antisezuire
Acts on GABA-A receptors, increasing synaptic inhibition
Produces all levels of CNS depression.
Depresses the sensory cortex, decreases motor activity, and alters cerebellar function.
Inhibits transmission in the nervous system and raises the seizure threshold.
Provide a nursing consideration associated with benzodiazepines in the treatment of Substance Use Disorder.
To which drug class does buprenorphine belong, and what is its mechanism of action?
PARTIAL opioid agonist/analgesic
Binds to mu-opioid receptor at higher affinity levels than other full mu-opioid agonists
To which drug class does naloxone belong and what is its mechanism of action?
Opioid ANTAGONIST
Competitive inhibition of mu-opioid receptors, reverses effects of opioids
Name two disorders Naltrexone is used to treat.
Alcohol use disorder and opioid use disorder
What are 3 side effects specific to phenobarbital?
Hypotension, bradycardia, drowsiness, ataxia, vertigo, cognitive dysfunction, changes in thinking, memory impairment, maculopapular rash, Stevens-Johnson syndrome/toxic epidermal necrolysis, respiratory depression, suicide ideation, changes in appetite
What are 3 side effects specific to lorazepam?
Anterograde amnesia, drowsiness, sedated state, aggression/agitation, dizziness, drowsiness, lethargy, ataxia, confusion, forgetfulness, hangover, headache, mental depression, rhythmic myoclonic jerking (in preterm infants), paradoxical excitation, slurred speech
RESPIRATORY DEPRESSION
What are 3 side effects specific to buprenorphine?
Dental caries, oral infections, tooth loss, constipation, respiratory depression, precipitated withdrawal, hypertension, peripheral edema, abdominal pain, nausea, QT interval prolongation, confusion, dysphoria, hallucinations, sedation
What are three routes for Naloxone administration?
IV
IM
SQ
Intranasal
You should not be treated with this naltrexone if you are allergic to it, or if:
you are currently addicted to opioids;
you are having withdrawal symptoms from opioid addiction;
you are using any opioid pain medicine (including fentanyl, Vicodin, OxyContin, and many others);
you have failed the naloxone challenge test or have a positive urine screen for opioids or
you have used any opioid medicine such as methadone, buprenorphine, tramadol, and other opioids within 7 to 14 days.
Name two nursing considerations associated with phenobarbital.
Dependence: It is a Schedule IV controlled substance because it can be habit-forming. Abruptly stopping the medication can cause life-threatening withdrawal symptoms, such as seizures or delirium.
Alcohol: Avoid alcohol entirely while taking this drug, as it can cause dangerously slow breathing and increased sedation.
Interactions: Phenobarbital is a potent enzyme inducer, meaning it can significantly decrease the effectiveness of other medications, including birth control pills, blood thinners like warfarin, and certain antibiotics.
What therapeutic class and drug class does chlordiazepoxide belong to? And what is its more common trade name?
Therapeutic: antianxiety agents; sedative/hypnotics
Drug: Benzodiazepines
Librium
What are 3 side effects specific to methadone?
Constipation, respiratory depression, withdrawal, QT prolongation, overdose
What are two patient education considerations for naloxone?
The effects of some opioids may last longer than the effects of naloxone, and repeat doses may be necessary.
Intranasal Administration: Administer a single spray into one nostril. Do not prime or test the device prior to use, and seek emergency medical care immediately after use.
Advise patient and caregiver that symptoms of opioid withdrawal may occur in physically dependent patients, including neonates.
Naltrexone can cause serious side effects, including:
Risk of opioid overdose. Explain how someone might have an opioid overdose while taking an opioid antagonist.
Name two important patient teaching considerations.
Alcohol: Avoid alcohol entirely while taking this drug, as it can cause dangerously slow breathing and increased sedation.
Cognitive Issues: May cause memory problems, confusion, or irritability, particularly in children (who may experience hyperactivity) and older adults.
Drowsiness and Fatigue: The most frequent side effect as the body adjusts.
What is the mechanism of action of benzodiazepines?
Benzodiazepines act as positive allosteric modulators of the GABA receptor, the brain's primary inhibitory signaling system. They do not activate the receptor on their own; instead, they "boost" the effect of naturally occurring GABA.
What is the combination drug buprenorphine/naloxone more commonly known as?
Suboxone
In the combination drug buprenorphine/naloxone, what is the purpose of the naloxone?
Sublingual naloxone has no pharmacological effect; it is present in the formulation to discourage injection of the product by opioid-dependent patients.