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Questions and Answers
What is the primary mechanism of action of disulfiram in relation to alcohol consumption?
What is a significant risk when discontinuing benzodiazepines abruptly?
Which of the following best describes the recommended approach to weaning a long-term benzodiazepine user?
What is a key reason for the high degree of relapse in individuals undergoing treatment for alcohol dependence who are placed on disulfiram?
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Which body system is primarily affected by the use of benzodiazepines?
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What characterizes complicated benzodiazepine withdrawal?
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What is the primary concern with the use of 'street' drugs mentioned in the content?
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What percentage of patients in Alcoholics Anonymous maintained three years of abstinence after a ten-year follow-up?
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What is a potential consequence of taking alcohol-sensitizing drugs like disulfiram for those attempting to quit drinking?
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Which neurotransmitter's release is indirectly influenced by the use of disulfiram?
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Study Notes
Opioid Treatment Medications
- Buprenorphine (Subutex, Suboxone, Buvidal, Sublocade) is a partial opioid agonist with a long half-life (18-30 hours).
- Administered under supervision as a once-daily dose; costs approximately $35 per week for the patient.
- Binds strongly to opioid receptors, effectively blocking the effects of stronger opioids and reducing overdose risk.
- Approximately 70-90% suppression of heroin self-administration observed.
Naltrexone
- Used in tablets or implants; available in exceptional circumstances.
- Suitable for individuals highly committed to abstinence, with caution required.
- Reduces cravings in many patients and must be taken regularly (ideally daily or at least three times a week).
- Not self-reinforcing; adherence can be a challenge.
Drug Withdrawal Management
- Alcohol: Enhances GABA-A, inhibits NMDA receptors; withdrawal symptoms include tremors, seizures, agitation, and nausea. Management includes thiamine supplementation and sedatives (e.g., diazepam).
- Benzodiazepines: Facilitate GABA action; withdrawal symptoms can include anxiety, insomnia, and tremors. Managed through gradual tapering and psychological support.
- Opioids: Cause euphoria and pain relief; withdrawal symptoms are nausea, cramps, and irritability. Managed using buprenorphine and gradual dose reduction.
- Amphetamines: CNS stimulants increase alertness; withdrawal includes depression and fatigue. Managed with psychological support and possible antidepressants.
- Cannabis: Alters mood and perception; withdrawal includes anxiety, irritability, and cravings. Managed with symptomatic treatments and psychological support.
- Tobacco: Increases heart rate and alertness; withdrawal symptoms involve irritability and difficulty concentrating. Managed with nicotine replacement therapy and behavioral support.
Alcohol-Sensitizing Drugs
- Disulfiram (Antabuse) works as an aldehyde dehydrogenase inhibitor, causing unpleasant reactions if alcohol is consumed.
- Used for alcohol dependence, particularly for patients accepting abstinence and those at high risk of drinking situations.
- Best given under supervision with a contingency plan to manage drinking behaviors.
Benzodiazepine Withdrawal
- Common street benzodiazepines include diazepam (Valium) and alprazolam (Xanax).
- Withdrawal symptoms: somatic (tremors, muscle stiffness) and psychological (anxiety, depression).
- Complicated withdrawals may lead to seizures and delirium.
- Gradual tapering from long-term use takes years; use diazepam for equivalency and monitor closely.
Risks of 'Street' Drugs
- Variable strength increases overdose risk; drugs may be adulterated with harmful substances.
- Notable cases include overdoses due to toxic cuts (e.g., heroin cut with fentanyl, cocaine with levamisole).
- Risks associated with contaminated drugs can lead to significant health crises, including infections and fatalities.
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Description
Test your knowledge on opioid treatment medications, including Buprenorphine and Naltrexone. This quiz covers their mechanisms, administration, and effectiveness in treating opioid dependence. Understand the cost, usage, and impact of these medications on overdose risk.
