pharmacotherapy exam iii

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pharmacotherapy exam iii
2010-11-18 17:22:55
pharmacotherapy substance use disorders

pharmacotherapy 3 exam 3 substance use disorders
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  1. how do you develope addiction
    • initial drug use is voluntary
    • who are vulnerable, over time users lose control over drug use and become addicted
    • repeated admin cuaseschagnes in functioning of the brain thus leading to addiction
    • almost all drugs of abuse activate the mesolimbic dopamine system which mediates reward and appetitae behaviors
  2. where is the primary site of addiction in the brain?
    primary site of dysfunction is mesolimbic system
  3. what are addictive behaviors
    • self administration of drugs bypasses cognitive filters
    • entire focus on drugs develop==unerlying change in cognitive reward centers
    • most addicts desire to stop using
    • addiction occurs in social, environmental and histroycal context
    • hallmark of addiction--denial
  4. what are etiologic categories of substance use disorder
    • psychosocial--marriage, social networks, race/culture, childhood environment
    • PSYCHIATRIC--genetics, linkage with alcoholics
    • drugs/indiviudal factors--individual reactions and susceptibility
    • SOCIAL
  5. what is DSMIV Criteria for substance abuse?
    • 12 month period of time
    • substance use resluting in faiutre to fulfill major role
    • physically hazardous
    • legal problems
    • continued even with social/interpersonal problems related to substance
  6. whats DSMIV criteria for substance dependence
    • 12 month period
    • tolerance--need for markeldy increased amounts of substance to achieve intoxication or desired effect, OR markedly diminisehd effect with continued use of sam eamount of substance
    • WITHDRAWAL--characteristic withdrawal sydnrom OR same substance is taken to relieve or avoid withdrawal symptoms
    • SUbstance taken in larger amts or over longer peroid of time
    • persistenet desire or unsuccessful efforst to cut down or control substance
    • great deal of time spent to obtain substance
    • important social/occupational or rec activies given up
    • substance use continued despite knowledge of havign a persistent or recurrent physical or psych problem
  7. what are early warning signs for addiction in the health care profession:
    • change in behavior
    • late to work
    • call in sick or not show
    • inadequate record keeping
    • decline in relations with coworkers
    • job performance problems
  8. what are predictors of positive outcome in substance abuse
    • employment
    • family (#2)
    • lower severity of illness
    • fewer psych problems
    • no fam history of chemical dependency
    • compliance with treatment and aftercare (#1)
  9. whats the program for addicted health care professionals to go to and what do they do
    • health professionals services program-- nurcing, medicine, pods, pharmd, dent, chiro, pt, emt, etc
    • goals--protect the public, facilitate needed care without discipline, coordinate care long tearm
  10. what are four types of medication availbale for alcoholism
    • agents for withdrawal management
    • agents that attenuate the desire to drink
    • agents that decrease drinking by treating associated psychiatric problems
    • agents taht attenuate drinking itself
  11. what are goals of detox
    • sage withdrawal from alcohol/drugs
    • provide humane withdrawal
    • prepare patient for ongoing treamtnet
  12. what predictors of withdrawal severity
    • prior history of severe withdrawal symptoms
    • high BAL ithout sgns of intoxication
    • withdrawal signs with high BAL
    • concurrent use of sedatives andalcohol
    • coxisting medical problems
  13. whats pathophys of alcohol withdrawal
    • CNS arousal hyperactivity
    • increased levels of NE and MHPG secondary to decreased inhibtitions of alpha 2 receptors on presynaptic receptors
    • decreased inhibitory effect of GABA
  14. what are signs/symotoms of alcoholic/secative withdrawal
    anxiety, seizure, deliurium, depression, hallucinations, irritable, nausea, vomiting, hyperreflexia, diaphoresis, elevated P, RR, BP, T tremors
  15. how does antabuse work and how is it used?
    • DOSED: 250mg/day, 500mg TIW
    • inhibits acetaldehyde dehydrogenase
    • decrease frequence of drinking but no long term improvement
    • hepatotoxicity and decrease in dopameine beta ydroxylase activity
    • works best for impulsive drinkers or in high risk situation--makes you sick
  16. what is reaction between disulfiram ethanol?
    • warmth, flusing
    • increased heart rate
    • palptations, dizziness,
    • decreased bp
    • nausea/vommiting
    • SOB
    • blurry vision
    • confusion
  17. what are drug interactions side effects of antabuse
    • DI--reduce clearance rates of valium, librium, desipramine, imipramine, dilatin, coumadin
    • SE--drowsiness, fatigue, opti neuritis, perifpheral neurpopathy, heptaotixicity
    • increased psych and depressive signs and symptoms may be related to increased dopamine levels
  18. how does naltrexone work with alcoholics
    • 50mg/day + psychosocial therapy
    • mu receptor blockaade leads to decreased reward and lower craving and alcohol consumption
    • less craiving,
    • fewer driking days
    • limited progression to full relapse
    • delayed time to first drink
    • CAN ALSO BE USED IN OPIATE ABUSERS--highly motivated ppl only ie healthcare workers
  19. what are indications for naltrexone, limitations?
    • when strong urges present
    • chornic relapsers
    • heavy problmeatic drinkers
    • cost, no response to opiates once on naltrexone
    • potential for precipitating opiate withdrawal if on opiate
    • compliance
  21. how does acamprosate work for alcholics?
    • attenuates glutaminerfic surge after alcohol cessation
    • amino acid derivative
    • increased abstinence
    • 666mg TID
  22. how does methadoen work?
    • synthetic mu receptor agonist
    • keeps heroin users in "straight" range instead of "high then sick"
    • acute paint--2.5-10mg q 4 hrs
    • dependence--40-180 mg QD
    • good drug, highly regulated
  23. how does buprenorphine work for opiate abusers?
    • parital opiate agonist
    • weak antagonist--kappa
    • blocks effect of other opiates
    • SL absorption--good
    • decrease opiate use/craving
    • long duration of action
    • low doses --acutely produce minimal effects
    • higher doses can precipitate withdrawal in persons physically dependedt on opiattes
  24. what is risk associated with buprenorphine?
    • repeated admin of buprenorphine produces or maintains physical dependence
    • degree of physical dependence is less than first prudced by full agoist opiods
    • withdrawal syndrom less severe with buprenorphine--varies upon three things:
    • level of physical dependence, higher-more risk for withdrawal
    • time interval between last does of agonist and first does of administered buprenorphine---longer time=less risk
    • dose of buprenorphine--lower=less risk
  25. what are substance abuse treatment goals
    • maximize motivatio for abstinence
    • rebulid a substance free lifestyle
    • maximize functioning
    • relapse prevention