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Treatment modalities for substance-related disorders
pharm for alcolism
- disulfiram (antabuse)
- other meds-
- - naltrexone (revia)
- - SSRI
- - acamprosate (campral)
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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
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Revex
- d/c
- IM, IV, SC
- opioid antagonist
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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predisposing factors to gambling disorder
biological influences
- genetic
- - increased incidence among family members
- physiological
- - abnormalities in neurotransmitter systems
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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
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predisposing factors to gambling disorder
psychosocial/psychoanalytical view
suggest that gambling is used to release a build up of tension
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tx modalities for gambling disorder
- behavior therapy
- cognitive therapy
- psychoanalysis
- psychopharmacology
- - SSRI- ocd on it
- - clomipramine- tca
- - carbamazepine- anticonvulsants
- -naltrexone
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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
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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
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