Therapeutics - Addictions 2
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What is the Pharmacotherapy for Alcohol withdrawal?
- Benzodiazepine substitution therapy
- Clonidine and beta blockers
- Phenytoin –seizure prevention
- Thiamine – nutritional supplement
What drug is used for aversive therapy and how does it work?
- Disulfiram – inhibits the enzyme acetaldehyde dehydrogenase
- Causes Flushing, tachycardia, headache, chest pain, vomiting, MI, dysrhythmias, hypotension, CHF, and seizures when alcohol is consumed
What drugs cause Disulfarim like reactions?
- Metronidazole (Flagyl)
- Furazolidone (Furoxone)
- Ketoconazole (Nizoral)
- Cefamandole (IV)
- Cefoperazone (IV)
- Cefotetan (IV)
- Moxalactam (IV)
How does Naltrexone work in Alcohol abuse?
Rreduces cravings and the reinforcing properties of alcohol by influencing alcohol’s activation of the endogenous opioid system
What are the SE of Naltrexone?
Nausea, GI upset, HA, anxiety and fatigue; contraindicated in liver disease
What is the brand name for Naltrexone injectable?
How often is Naltrexone Injectable (Vivitrol) given?
What are the cons of Naltrexone Injectable (Vivitrol)?
What drugs are used for treatment of Alcoholism (not necessarily withdrawal/acute issues?
- Naltrexone – reduce cravings
- Topirimate (Topimax)
- Ondasetron (Zofran)
- Aripiprazole (Abilify)
- Acamprosate (Campral)
Which SSRIs can be used for alcoholism treatment?
Fluoxetine and citalopram – conflicting results
How does Odansetron aid in Alcoholism?
- Sserotonin receptor subtype 3 antagonist
- May attenuate dopamine release in the mesocorticolimbic neurons
- reduced drinking in patients with early-onset alcoholism in one controlled study
What s the role of Acamprosate (Campral) is Alcoholism treatment?
- Decrease craving through its effects on GABA and glutamate neurotransmission
- modest effects
- maybe effective up to a year after discontinuation
How is Acamprosate (Campral) excerted?
What is the Downside to Acamprosate (Campral)?
Diarrhea, dosing regimen, cost
Acamprosate (Campral) is used in combination with what other drug to increase its effectiveness in treating alcoholism?
In a chronic drinker, daily uses of ______________in the “recommended” dose range may result in hepatotoxicity due to increased metabolism to toxic metabolite.
Following an OD of _______________, if taken with alcohol in a relative nondrinker, alcohol may provide some protection.
Newer antidepressants such as SSRIs/SNRIs are
- not much of a problem - any SEDATING
- antidepressant will be more sedating with alcohol
Tricyclic antidepressants (TCAs) and _______ can have a dangerous interaction, especially on OD.
Alcohol increases the absorption of __________________and may decrease elimination of the _________________. Alcohol also adds to the respiratory depression caused by ________________in large amounts.
What are the opioid antagonists?
Naloxone is mainly used for what and why?
- short half-life
- Used more as a measurement to see if this is the problem – test drug
Naltrexone is mainly used for what and why?
- long acting opioid antagonist – orally available
- Used to cause withdrawal on a longer term basis
Nalmefene (Revex) has what characteristics?
half-life of about 10 hours – may cause a prolonged severe withdrawal
Is Methadone cross tolerant?
Is Clonidine cross tolerant?
What is Buprenorphine?
Partial opioid agonist
Methadone has what benefits?
- Aliminates withdrawal symptoms,
- Reduce the craving for opioids
- Avoid the risks associated with needle use
- Allows the individual to focus on lifestyle modifications to support recovery from dependence
____________________contained in tobacco smoke can induce ____________ in the liver.
- Polycyclic hydrocarbons
______________ speed the elimination of drugs metabolized by CYP1A2 and may decrease their efficacy.
Polycyclic hydrocarbons in cigarette smoke
It is the cigarette smoke NOT the ______________ that induces liver enzymes.
Blood levels of drugs affected may increase when cigarettes are replaced by nicotine patches, sprays, gums or inhalers.
Which drugs are eliminated faster in the presence of CYP1A2 induction by Cigarette smoking, thus requiring higher doses in smokers?
- amitriptyline, clomipramine, imipramine
- olanzapine (Zyprexa)
- cyclobenzaprine (Flexeril)
- diazepam (minor pathway)
- R-warfarin (less active isomer)
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