Alcohol
Short term effects?
- N/V, HA, memory loss, slurred speech, impaired judgement, hangovers, blackouts
Disulfiram (Antabuse): MOA? Route?
- Inhibits the enzyme involved in metabolizing alcohol
- Best used for pts who are newly abstinent
- PO dose is 125-500 mgs daily
Cannabis is the most commonly what?
- Most commonly used recreational drug in the United States
Short term effects?
Drowsiness, mental confusion, nausea, constipation, and dose-dependent respiratory depression
Methadone MOA?
– Mixed agonist/antagonist
- At separate receptor sites thereby preventing withdrawal and the euphoria normally felt with opioids
Long term effects?
- Stomach issues, heart problems, cancer, brain damage, liver cirrhosis, and immune system compromise
Who is Disulfiram (Antabuse) contraindicated with? SE's? Labs?
- Contraindicated in pts who are intoxicated and should NOT be taken within 12 hours of alcohol consumption
- If pt ingests ANYTHING containing alcohol, side effects occur within 10 minutes and last for more than an hour
- SE: N/V, HA, chest pain, difficulty breathing, can cause hepatotoxicity, peripheral neuropathy, and optic neuritis
- Pts should have baseline LFT’s and repeated LFT’s 2 weeks after therapy
Short term effects?
- Impairs short term memory, learning, and ability to focus, problems with balance and coordination, elevated HR, hallucinations, anxiety and panic attacks in some patients
4 drugs used?
1) Naloxone (Narcan)
2) Naltrexone (Revia)
3) Methadone
4) Buprenorphine (Subutex or Suboxone, which has Narcan added to it)
Methadone: Abuse and Dose?
- Maintenance therapy is 80-120 mgs/day
- High abuse potential and a HUGE cash business for clinics
Toxicity?
- Life threatening – aspiration, seizures, cardiac arrest, resp. arrest
Acamprosate (Campral) only used for who? Usual dose? MOA?
- GABA analogue
- Only used for pts who are abstinent
- Usual dose is 666mgs PO daily
Long term effects?
- Chronic cough, frequent URI’s, increased cancer risk
What is the opioid overdose drug of choice?
- Naloxone (Narcan)
- Opioid antagonist
Naltrexone (Revia) MOA?
Opioid antagonist
What is used for alcohol detox?
- Detoxification: Mostly use Benzos and Barbs to prevent seizures;
- Non-pharmacologic therapy like counseling, groups, behavior modifications
Acamprosate (Campral): contraindicated with who? SE's?
- Contraindicated with Cr Cl <30 ml/hr
- SE: Pain, loss of appetite, N/V/D, dizziness, anxiety, pruritis, depression, insomnia, parasthesias
Cannabis in adolescents?
- Decreased motivation and decreased performance on memory-related tasks
Naloxone (Narcan) route? How often is it given?
- Given intranasally, IM, IV, or SQ: 0.1-0.2 mgs every 2-3 minutes until pt responds
Naltrexone (Revia) PO dose?
Given po 50 mgs daily after the pt has been opioid free for 7-10 days
Meds for alcohol abuse?
- Medications: Disulfiram, Acamprosate, Naltrexone
Naltrexone (Revia): MOA? Used for who? Dose?
- Opioid antagonist with a high affinity for mu receptors
- Used for pts who are abstinent
- Dose is 50 mgs PO daily for 12 weeks or less
- Should not be used in conjunction with any drugs that bind to opioid receptors
Cannabis Treatment?
- No medication for treatment
- All non-pharmacological therapies
Buprenorphine (Subutex or Suboxone, which has Narcan added to it): Usual dose? Abuse Potential?
– Mixed agonist/antagonist
- Usual dose is 8-24 mgs/day sublingual
- Lower potential for misuse than methadone
Naltrexone (Revia) other form than PO?
- Available in a monthly extended-release injectable form