Alcohol, Nicotine and substance dependence

What’s the treatment for alcohol withdrawal symptoms

1.) Chlordiazepoxide or diazepam

What’s the treatment for alcohol withdrawal seizures

1.) Lorazepam

What’s the treatment for delirium tremens

1st line:oral lorazepam

2nd line= Halopiderol

What’s the treatment for moderate-severe alcohol use disorders

1.) CBT+acomprosate or naltrexone

2.) alternative:dilsufiriam

What’s the treatment for Wernicke’s encephalopathy

thiamine

What’s the treatment for mild alcohol use disorders

CBT

What are the prolonged release formulations of NRT

1.) 16-24 hour patches

2.) give 24 hour patch if they wake up with cravings

3.) 16 hour patch if px has nightmares or is pregnant

What are the immediate release formulations of NRT

gum, lozenge,nasal spray, sublingual tablet

What are the side effects of NRT products

GI disturbances

mild local reactions

Varenceline facts

1.) it’s a selective nicotine receptor partial agonist

2.) side effects: nausea, headache, insomnia

3.) caution in CVD, psychiatric illness, epilepsy+ renal impairment

Bupropion facts

1.) caution in epilepsy and psychiatric illness

2.) can cause serotonin syndrome

Methadone facts

1.) suitable for patients using large amounts of heroin

2.) more effective in retaining patients

3.) side effects are qt prolongation

Buprenophrine facts

1.) lower risk of fatal overdose

2.) given with naloxone discourages injecting

3.) has less mental clouding+sedation than methadone

4.) MR suitable in those with adherence issues

What are the side effects of buprenophrine

1.) take 1st dose on withdrawal signs

2.) take 1st dose 6-12 hours after heroin

Missed days of Methadone or Buprenophrine

don’t replace missed doses when they next collect

3 or missed days=refer back to prescriber

Opioid detoxification

1.) takes up to 12 weeks offer methadone/Buprenophrine (Meth preferred)

2.) methadone 5mg reduction every 1-2 weeks

3.) Buprenophrine 2mg reduction every 2 weeks- final reduction of 400mcg

What are the withdrawal symptoms of methadone/buprenophrine

1.) D+V

2.) stomach cramps

3.) agitation

4.) insomnia

5.) headaches

Pregnancy and opioid dependence

1.) continue methadone/Buprenophrine

2.) vomited methadone leads to withdrawal which can cause foetal distress