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Questions and Answers
Benzodiazepines have a higher potential for abuse than alcohol.
Benzodiazepines have a higher potential for abuse than alcohol.
False
Acamprosate's mechanism of action is well understood.
Acamprosate's mechanism of action is well understood.
False
Methadone therapy can be administered to individuals over the age of 18.
Methadone therapy can be administered to individuals over the age of 18.
True
Agonist therapy involves using a drug in the same class as the abused substance.
Agonist therapy involves using a drug in the same class as the abused substance.
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Combining alcohol and prescribed benzodiazepines is considered safe and effective for treating alcohol dependence.
Combining alcohol and prescribed benzodiazepines is considered safe and effective for treating alcohol dependence.
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Pharmacotherapy is recommended for patients with mild substance abuse consequences.
Pharmacotherapy is recommended for patients with mild substance abuse consequences.
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Pregnant opioid/heroin addicts should never be offered opioid therapy.
Pregnant opioid/heroin addicts should never be offered opioid therapy.
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Medications alone are sufficient to address the behaviors associated with addiction.
Medications alone are sufficient to address the behaviors associated with addiction.
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Benzodiazepines are one of the substances for which pharmacotherapy is available.
Benzodiazepines are one of the substances for which pharmacotherapy is available.
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Withdrawal/detoxification is a target phase for pharmacotherapy in substance use disorders.
Withdrawal/detoxification is a target phase for pharmacotherapy in substance use disorders.
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Cocaine has pharmacotherapy options available for treatment.
Cocaine has pharmacotherapy options available for treatment.
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Patients must be fully medically withdrawn from substances before safely taking maintenance medication.
Patients must be fully medically withdrawn from substances before safely taking maintenance medication.
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Aversive pharmacological treatment strategies aim to provide positive reinforcement.
Aversive pharmacological treatment strategies aim to provide positive reinforcement.
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Naltrexone is primarily used as a treatment for opioid dependence.
Naltrexone is primarily used as a treatment for opioid dependence.
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Buprenorphine is a mixed partial agonist opioid receptor.
Buprenorphine is a mixed partial agonist opioid receptor.
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Relapse rates following detoxification without medication treatment are low, around 10%.
Relapse rates following detoxification without medication treatment are low, around 10%.
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The odds ratio of having an addictive disorder among those with a mental disorder is 2.7.
The odds ratio of having an addictive disorder among those with a mental disorder is 2.7.
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Naloxone is effective when taken orally, regardless of how it is administered.
Naloxone is effective when taken orally, regardless of how it is administered.
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Monitoring liver function is necessary for patients taking naltrexone due to potential hepatotoxicity.
Monitoring liver function is necessary for patients taking naltrexone due to potential hepatotoxicity.
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More than half of individuals with non-alcohol drug disorders also have a mental disorder.
More than half of individuals with non-alcohol drug disorders also have a mental disorder.
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The biggest issue with naltrexone treatment is its high cost.
The biggest issue with naltrexone treatment is its high cost.
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Methadone has a duration of action that ranges from 12 to 24 hours.
Methadone has a duration of action that ranges from 12 to 24 hours.
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Illicit opiate use tends to increase with higher doses of methadone.
Illicit opiate use tends to increase with higher doses of methadone.
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A naloxone challenge can be utilized to assess opioid dependence.
A naloxone challenge can be utilized to assess opioid dependence.
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Methadone should only be administered through unregistered treatment programs.
Methadone should only be administered through unregistered treatment programs.
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Withdrawal symptoms include signs such as tracks and physiologic changes.
Withdrawal symptoms include signs such as tracks and physiologic changes.
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Methadone can interact with common medications leading to decreased concentration levels.
Methadone can interact with common medications leading to decreased concentration levels.
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A lower dose of methadone, between 20-30 mg, is more effective at reducing opioid use than higher doses.
A lower dose of methadone, between 20-30 mg, is more effective at reducing opioid use than higher doses.
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Naltrexone is used as an antagonist therapy for opioid dependence.
Naltrexone is used as an antagonist therapy for opioid dependence.
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Disulfiram works by enhancing alcohol metabolism, leading to increased blood acetaldehyde levels.
Disulfiram works by enhancing alcohol metabolism, leading to increased blood acetaldehyde levels.
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Naltrexone is used to prevent relapse to alcohol use by inhibiting the miu opioid receptor binding.
Naltrexone is used to prevent relapse to alcohol use by inhibiting the miu opioid receptor binding.
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Patients taking disulfiram should avoid alcohol-containing foods to prevent adverse reactions.
Patients taking disulfiram should avoid alcohol-containing foods to prevent adverse reactions.
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Common side effects of disulfiram include yellowing of the skin and eyes.
Common side effects of disulfiram include yellowing of the skin and eyes.
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Injectable naltrexone is administered once every three months.
Injectable naltrexone is administered once every three months.
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Heavy drinking relapse is decreased when using naltrexone, as indicated by a relative risk of 0.64.
Heavy drinking relapse is decreased when using naltrexone, as indicated by a relative risk of 0.64.
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Naltrexone is contraindicated for patients with acute hepatitis or liver failure.
Naltrexone is contraindicated for patients with acute hepatitis or liver failure.
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The clinical dose of naltrexone is 100 mg per day.
The clinical dose of naltrexone is 100 mg per day.
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Patients on naltrexone must be cautious about using non-steroidal anti-inflammatory drugs due to potential hepatic effects.
Patients on naltrexone must be cautious about using non-steroidal anti-inflammatory drugs due to potential hepatic effects.
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Acamprosate has been found to be superior to naltrexone in reducing relapse rates.
Acamprosate has been found to be superior to naltrexone in reducing relapse rates.
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Harm reduction focuses on preventing or reducing the negative health consequences associated with certain behaviors.
Harm reduction focuses on preventing or reducing the negative health consequences associated with certain behaviors.
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The 'Cold Turkey' method involves gradually easing the process of substance cessation.
The 'Cold Turkey' method involves gradually easing the process of substance cessation.
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Cognitive Behavioral Therapy helps individuals develop coping strategies to avoid relapse triggers.
Cognitive Behavioral Therapy helps individuals develop coping strategies to avoid relapse triggers.
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Harm reduction interventions often include short-term strategies for immediate results.
Harm reduction interventions often include short-term strategies for immediate results.
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Behavioral strategies aim to modify attitudes and behaviors related to drug abuse.
Behavioral strategies aim to modify attitudes and behaviors related to drug abuse.
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Needle exchange programs are part of harm reduction strategies to minimize health risks.
Needle exchange programs are part of harm reduction strategies to minimize health risks.
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Substitution with oral drugs is not a recognized intervention in harm reduction.
Substitution with oral drugs is not a recognized intervention in harm reduction.
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Relapse triggers can include negative mood states, poor coping skills, and social isolation.
Relapse triggers can include negative mood states, poor coping skills, and social isolation.
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Study Notes
Treatment and Rehabilitation of Drug Addiction
- Drug addiction treatment often involves a combination of approaches, including pharmacotherapy.
- Patients' medical conditions should be assessed to determine if medications are appropriate, considering factors like pregnancy and existing medical illnesses.
- Medications should be used appropriately, avoiding those with adverse impacts on patients, such as disulfiram.
- Medications may be used during withdrawal or for maintenance to support abstinence.
Pharmacotherapy Targets
- Intoxication/overdose
- Withdrawal/detoxification
- Abstinence initiation/use reduction
- Relapse prevention
- Sequelae (complications, such as psychosis or agitation)
Pharmacological Treatment Strategies for SUDs
- Agonist (replacement/substitution)
- Antagonist (blockade)
- Aversive (negative reinforcement)
- Correction of underlying/associated disorders (such as depression)
Available/Unavailable Pharmacotherapies
- Available: Opioids, Alcohol, Benzodiazepines, Tobacco (nicotine dependence)
- Unavailable: Cocaine, Methamphetamine, Hallucinogens, Cannabis, Solvents/Inhalants
Alcohol Dependence Pharmacotherapy
- Two Phases: Acute alcohol withdrawal, relapse prevention.
- Relapse Prevention Medications: Disulfiram, Naltrexone (oral and injectable), Acamprosate
- Important Note: Monitor patients for the emergence of depression, anxiety, or suicidal thoughts during treatment. Benzodiazepines and non-benzodiazepines may be used.
Disulfiram (Antabuse)
- Mechanism: Blocks alcohol metabolism, increasing acetaldehyde levels, creating an unpleasant reaction if alcohol is consumed.
- Side Effects (Common): Metallic taste, sulfur-like odor
- Side Effects (Rare): Hepatotoxicity, neuropathy, psychosis
- Treatment of Reaction: Supportive care (fluids, oxygen)
- Contraindications: Cardiac disease, esophageal varices, pregnancy, severe mental health conditions, severe hepatic dysfunction.
- Avoidance: Alcohol-containing foods
- Clinical Dose: 250 mg daily (range 125-500 mg/day)
Naltrexone
- Oral Form: 50 mg per day
- Injectable Form: Extended-release (Vivitrol; monthly injection)
- Mechanism: Similar to naloxone, blocks opioid receptors preventing relapse.
- Pharmacology: Blocks the effects of endogenous opioids involved in alcohol reinforcement (pleasure) and craving.
- Safety Issues: Hepatotoxicity in high doses, Contraindicated in acute hepatitis or liver failure.
- Caution: Monitor liver function for 3-9 months. Be cautious with NSAIDs (nonsteroidal anti-inflammatory drugs) which might have additive hepatic effects.
- Contraindications: Concurrent opioid analgesics, opioid dependence, hypersensitivity.
Naltrexone for Alcohol Dependence - Clinical Evidence
- Cochrane Reviews demonstrate reduced relapses to heavy drinking and return to any drinking.
- Naltrexone increases time to first drink.
- Naltrexone reduces craving more effectively than acamprosate.
Naltrexone - Specifics on Use
- Oral: 50mg daily
- Injectable Extended Release: 1 injection per month
Naltrexone Safety
- High doses can cause liver damage (hepatoxicity).
- Monitor liver function regularly (monthly for the first three months, then every three months).
- Contraindicated in acute hepatitis or liver failure
Other Safety Issues with Naltrexone
- Concurrent use with opioid analgesics is contraindicated—naltrexone blocks the analgesic effect.
- Hypersensitivity, opioid dependence, or withdrawal should necessitate avoiding naltrexone.
- Pregnancy risk associated with naltrexone is classified as Category C
Opioid Dependence Treatment
- Agonist Treatment (Methadone): Used for opioid dependence maintenance therapy.
- Agonist Treatment (characteristics): Long-acting mu agonist, duration of action 24-36 hours.
- Appropriate Patients: 18 years or older, opioid dependence greater than 1 year, medical compromises, and infectious diseases.
- Opioid Dependence Maintenance Therapy; Methadone: Important considerations involve dosage, potential for substitution of one addiction for another.
- Other Considerations: Methadone can interact with many medications.
- Benefits: Lifestyle stabilization, improved health/nutrition, decrease in criminal behavior, and reduced injection drug use.
- Antagonist Treatment (Naltrexone) for opioid dependence: Blocks opioid receptors. High relapse rate after detoxification though.
Buprenorphine
- Mixed partial agonist opioid receptor.
- Weak opioid receptor antagonist.
- Advantage over methadone: avoids life-threatening respiratory depression.
- Often combined with naloxone to reduce misuse.
Epidemiology: Mental Illness in SUDs
- Comorbidity rates are high—37% with alcohol disorders and 53% with non-alcohol drug disorders experienced comorbid mental health disorders.
- Mental health disorders are comorbid with substance use disorders.
SUDs in Mental Illness
- The odds ratio for addictive disorders among individuals with mental health conditions is 2.7.
- The prevalence of addictive disorders in this population is nearly 30%.
- Comorbidity with alcohol use disorders is 22%, and with other drug disorders is 15%.
Why Use Psychiatric Medications in Patients with SUD Comorbidity?
- To treat the comorbid psychiatric condition.
- To treat substance use disorders directly or indirectly.
Harm Reduction
- A non-abstinence approach.
- Aims at preventing or reducing negative consequences of substance use, such as HIV transmission and overdose deaths.
- Key elements include information, education, and support.
Cognitive & Behavioral Strategies
- CBT: A common method for anticipating problems and building coping strategies.
- Behavioral Approaches: Engage patients in treatment for drug abuse by providing incentives for abstinence; modify attitudes and behaviors related to drug abuse and build life skills to better handle stress and environmental triggers.
- "Cold Turkey": Abrupt cessation of substance use .
- Disadvantages: Severe withdrawal symptoms; distress on heart and blood vessels, even death.
Take Home Points
- Three FDA-approved medications for alcohol maintenance.
- Three FDA-approved medications for opioid maintenance.
- Non-pharmacological interventions are also useful in managing substance use disorders.
Interventions
- Information/education
- STD education/safer sex
- Family planning
- Health care related to infectious diseases; screening, and immunizations
- Substitution programs with oral drugs
- Linking with other services (medical, psychiatric, obstetric, dental, social, forensic)
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Description
This quiz evaluates your understanding of pharmacotherapy options and their applications in treating substance use disorders. Topics include the role of benzodiazepines, methadone therapy, and the mechanisms behind various treatment approaches. Test your knowledge on safety guidelines and the implications of pharmacotherapy for specific populations.
