substance use disorders

what is disulfiram (Antabuse)

it is an alcohol deterrent - inhibits the breakdown of acetaldehyde in alcohol

can a person drink while on disulfiram? whats the time frame?

if you drink with this in your system = bad SE = makes you not want to drink

• best for those who are newly sober

• do not take if pt has drunk within the last 12 hours

• side effects can happen within 10 minutes of ingesting alcohol

• dont drink for 2 weeks after taking

what side effects are seen with disulfiram

• N/V, HA, chest pain, difficulty breathing

• rash, drowsiness, impotence, metallic aftertaste

• serious: psychosis, hepatotoxicity, neuropathy, optic neuritis

what organ should be monitored while pt is taking antabuse

monitor liver function

what is naltrexone

opioid antagonist - helps reduce cravings

when can the pt start taking naltrexone

must be abstinent - free of opioids for 7-10 days

• start with daily dosing PO, later IM can be done every 4 weeks for maintenance

how long is person normally on naltrexone

normal daily dosing is 12 weeks or less

what is a concern with naltrexone

Concerned for opioid use disorder- should do a test dose and observe for the first hour

• if no withdrawal, can go onto daily dosing

if they relapse on opioids and begin at their previous dose, this can be life-threatening

• = respiratory arrest and circulatory collapse

what are SE with naltrexone

• insomnia

• N/V/C

• anxiety

• HA

• abdominal pain, myalgia/arthralgia (muscle and joint pain)

• serious: suicide, depression, hepatotoxicity, hypersensitivity reaction

  • assess SI prior to starting

what is Naloxone

aka Narcan - a short acting opioid antagonist

whats the difference between the Naloxone and Naltrexone

naloxone is used to reverse the symptoms of an overdose, while naltrexone is used in recovery to help decrease the cravings

how is naloxone given? what to be mindful of?

can be administered IV, IM, subQ (in hospital setting)

• give every 2-3 minutes until response

• be mindful of withdrawal symptoms (N/V, high temp, HTN, restless)

what is methadone

a long-acting opioid

• can be used to treat pain but often prescribed in opioid use disorder

can anyone go on methadone?

Methadone is used to stabilize and maintain pts with OUD only through a certified program that is approved by the state

• pt has to follow federal guidelines and be medically monitored

• very regimen, consent

• “methadone program” NOT long term

how does methadone work / what does it do to the brain

changes the way your brain responds to pain and blocks the effects of opioids

• take daily = blocks euphoria and tranquility and prevents withdrawal and cravings

• must be tapered off under medical supervision

What substances interact with methadone

these lower the methadone level and can lead to withdrawal:

• seizure medications

• St. John’s Wort

what SE are common with methadone

• N/V/C

• lightheaded

• dizziness

• sedation

what are examples of nicotine replacement therapies/alternatives

• gum

• patch

• spray

• inhaler

• lozenge

how do nicotine replacements work

they relieve withdrawal symptoms and provide stimulation and stress relief

• is self-dosed (take gum or spray when needed) - except for the patch (this is continuous throughout the day

what is varenicline (Chantix)

nicotine receptor agonist that stimulates dopamine

• it reduces craving and withdrawal symptoms

how should varenicline be taken? whats its timeline?

• begin taking 1 week before “quit date” (decreases cravings before starting)

• tapered start (stopping nicotine) → increase Chantix dose over that week

• Maintain varenicline for 11 weeks

what organ is monitored during varenicline

kidney function - looking at creatinine clearance

what are SE with varenicline

• N/V/C/D, HA, xerostomia, fatigue/malaise

• black box warning: neuropsychotic

  • may alter neurotransmitters = behavior change, depression, SI

  • must educate pt on this and report thoughts of self harm