TX SUD meds

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  1. Treatment modalities for substance-related disorders
    pharm for alcolism
    • disulfiram (antabuse)
    • other meds-
    • - naltrexone (revia)
    • - SSRI
    • - acamprosate (campral)
  2. Revia (long term)
    • naltrexone hydrochloride- works on same brain receptors as heroin and opiates, binds to them but does produce high
    • etoh doesnt bind to those receptors but studies show naltrexone works equally well against it
    • vivitrol (naltrexone) given injection
    • - given q 4th week
    • - in the last week urge to drink may take a oral vivitrol
  3. Revex
    • d/c
    • IM, IV, SC
    • opioid antagonist
  4. Disulfiram (antabuse) long term
    • deterrent drinking by making persons go thru syndrome of symptoms that produce a great deal of discomfort
    • can result to death if etoh level is too high
    • blocks oxidation of etoh and makes accumulation acetaldehydre
    • s/s can appear at 5-10mg/dl
    • 5-10 mins after drinking etoh
    • makes you sick
    • can result in death if you still drinking
  5. disulfiram (antabuse)- if you drink
    • 50mg/dl= flushed skin, throbbing head neck, resp difficulty, dizziness, n/v sweating, hyperventilation, tachycardia, hypotension, weakness, blurred vision, confusion
    • 125 to 150 mg/dl - respir depression, cv collapse, arrhythimas, mi, chf, unconsciousness, convulsions, death
    • not a cure for etoh abuse
  6. disulfiram- (antabuse)- more
    • measure of control to avoid impulsive drinking
    • must sustain etoh for 12 hours prior to first dose
    • obtain written consent- will happen on this med
  7. disulfiram criteria for taking
    • when d/c may still be sensitive to etoh for 2 weeks or may have reaction
    • things containing etoh, cough/cold med liquid, vanilla extract, aftershave, lotions, colognes, mouthwash, nail polish remover
    • carry card identifying disfuliram user
    • tell doctor dentisit and HC provider use this med
    • contradicted if high risk etoh ingestion and psychotic symptoms
  8. SSRI/Acamprosate (Campral)
    • SSRI, mixed results to treat etoh, works best moderate drinker
    • Campral- must have already detoxed
    • - concomitant psychotherapy
    • - long term maint of etoh abstinence
    • - abstinent at tx initiation
    • - theory restore balance neuronal excitation and inhibition
    • brain neuro chemistry back to order- this helps you get back to life
  9. Tx  modalities for substance-related disorders
    intoxication/substance withdrawal alcohol
    • benzo- librium or serax if liver disease
    • anticonvulsants- gabapentin- more apt for seizure
    • multivitamin- lack of food
    • thiamine- neuropathy, confusion, encephalopathy
  10. Benzo- short term acute
    • most widely used for group substitution
    • - start w/high doses reduce to 20%-25% until withdrawal complete
    • - used therapy etoh withdrawal
    • - chlordiazepoxide (librium) long acting
    • - ozazepam (serax)- short term used for those w/liver disease
    • - lorazepam (ativan)- short term used for those with liver disease
    • diazpam (valium) longer acting- no use in liver disease
  11. Tx  modalities for substance-related disorders intoxication/substance withdrawal opioids
    • opioids intoxication
    • drugs bind to opiate receptor don't activate
    • narcotic antagonists
    • - naloxone (narcan)
    • - naltrexone (revia)
    • - nalmefene (revex) d/c
    • methadone- most effective
    • buprenorphine- tx with opioid addiction mixed with narcan- subxone
    • clonidine- known** (ADHD/Antihtn) monitor BP, P before and after use. not addicting
  12. Tx  modalities for substance-related disorders intoxication/substance withdrawal depressants barbs
    • phenobarb (luminal) long acting
    • long acting babr used for withdrawal non barbs
    • taper down on this- help with withdrawal symptoms
  13. Tx  modalities for substance-related disorders intoxication/substance withdrawal stimulants
    • minor tranquilizer- librium
    • major tranquilizer- haldol- caution for seizure- diazpam for seizure
    • anticonvulsants
    • antidepressants
    • reduce craving
    • suicide precaution
    • allow sleep and rest as much as desire
    • depressed pt antidepressants
    • not medical emergency
  14. Tx  modalities for substance-related disorders intoxication/substance withdrawal hallucinogens
    • hallucinogens and cannabinols-substitution therapy not required
    • - benzodiazepines if anxiety/panic occurs
    • - antipsych are used to treat psychotic reactions
    • tx symptoms
    • lcd, mushroom
  15. Non-Substance addictions
    • gambling disorder
    • persistent and recurrent problematic gambling behavior that intensifies when the individual is under stress
    • as the need to gamble increases the individual may use any means required to obtain money to continue the addiction
  16. gambling disorder
    • usually begins in adolescence, although compulsive behaviors rarely occur before young adulthood
    • the disorder usually runs a chronic course, with periods of waxing and waning
    • the disorder interferes with interpersonal relationships, social, academic, or occupational functioning
    • most gamblers deny problems so treatment is difficult and usually sought legal problems, family pressure
  17. predisposing factors to gambling disorder
    biological influences
    • genetic
    • - increased incidence among family members
    • physiological
    • - abnormalities in neurotransmitter systems
  18. predisposing factors to gambling disorder
    psychosocial influences
    • loss of parent before age 15
    • inapproriate parent discipline
    • exposure to gambling activities as an adolescent
    • family emphasis on material and financial symbols
    • lack of family emphasis on saving, planning and budgeting
  19. predisposing factors to gambling disorder
    psychosocial/psychoanalytical view
    suggest that gambling is used to release a build up of tension
  20. tx modalities for gambling disorder
    • behavior therapy
    • cognitive therapy
    • psychoanalysis
    • psychopharmacology
    • - SSRI- ocd on it
    • - clomipramine- tca
    • - carbamazepine- anticonvulsants
    • -naltrexone
  21. tx modalities for gambling disorder
    gamblers anonymous
    • possibly most effective tx
    • organized model AA
    • only requirement for membership is an expressed desure to stop gambling
    • reformed gamblers help others resist the urge to gamble
  22. tx modalities for gambling disorder
    r/t organization- fam
    • Gam-Anon
    • - for fam and spouses of compulsive gamblers
    • Gam-a-Teen
    • for adolescent children of compulsive gamblers
Card Set:
TX SUD meds
2016-11-12 01:10:12

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