NURS 309: MEDS TO TREAT SUBSTANCE USE DISORDER

Disulfiram – Class & Action

A client is prescribed disulfiram to support alcohol abstinence. How does this medication work?

Disulfiram – Therapeutic Use

What is disulfiram used for?

Deterrent therapy for alcohol use disorder to support abstinence from drinking alcohol.

Disulfiram – Nursing Assessment

Before giving disulfiram, what should the nurse assess?

Verify alcohol abstinence for at least 12 hours before administration. Assess liver function tests, CBC, metabolic profile, and monitor for hepatitis or liver dysfunction.

Disulfiram – Administration

How is disulfiram administered?

Orally once daily. Tablets may be crushed and mixed with water, milk, coffee, or juice if needed.

Disulfiram – Common Side Effects

What side effects may occur?

Headache, dizziness, drowsiness, metallic taste or bad breath, rash, pruritus, sweating, and impaired memory.

Disulfiram – Adverse Effects

Which adverse effects require immediate attention?

Hepatitis, hepatotoxicity, liver failure, psychosis, seizures, and peripheral neuropathy.

Disulfiram – Drug Interactions

Which medications interact with disulfiram?

Metronidazole, amprenavir, dronabinol, paraldehyde, amitriptyline, phenytoin, diazepam, omeprazole, acetaminophen, and any alcohol-containing products.

Disulfiram – Contraindications

Who should avoid disulfiram?

Clients with coronary artery disease, heart failure, liver disease, psychosis, hypersensitivity, or those who are breastfeeding. Also contraindicated in clients who are currently intoxicated with alcohol.

Disulfiram – Precautions

Which clients require caution?

Clients with diabetes mellitus, thyroid disorders, renal disease, or traumatic brain injury.

Disulfiram – Client Teaching

What should clients be taught?

Avoid all alcohol (including hidden sources like mouthwash, hand sanitizers, colognes) during therapy and for at least 2 weeks after stopping. Recognize disulfiram-alcohol reaction symptoms (flushing, nausea, vomiting, hypotension, tachycardia, dyspnea).

It is an alcohol deterrent that inhibits aldehyde dehydrogenase, causing acetaldehyde buildup when alcohol is consumed, resulting in an unpleasant & potentially dangerous reaction.

Thiamine (Vitamin B1) – Class & Action

A client with alcohol use disorder is prescribed IV thiamine. How does this medication work?

Thiamine – Therapeutic Use

What is IV thiamine used for?

Prevention and treatment of Wernicke’s encephalopathy, vitamin B1 deficiency, nutritional deficiency states, and as part of rehydration/electrolyte replacement therapy.

Thiamine – Nursing Assessment

Before and during administration, what should the nurse assess?

Monitor for signs of allergic reaction during IV administration. Assess nutritional status and risk factors for deficiency (especially chronic alcohol use).

Thiamine – Administration

How is thiamine administered?

IV administration for rapid replacement in deficiency states; monitor closely during infusion due to rare but serious reactions.

Thiamine – Common Side Effects

What side effects may occur?

Extremely rare side effects; most clients tolerate well.

Thiamine – Adverse Effects

Which adverse effects require immediate attention?

Vascular collapse and angioedema (rare but severe hypersensitivity reactions).

Thiamine – Drug Interactions

Are there significant interactions with thiamine?

None noted.

Thiamine – Contraindications

Who should avoid thiamine?

Clients with known hypersensitivity to thiamine.

Thiamine – Precautions

Which clients require caution?

Clients receiving IV therapy should be monitored closely for allergic reactions, especially those with nutritional deficiencies or chronic alcohol use.

Thiamine – Client Teaching

What should clients be taught?

Review dietary sources of thiamine such as whole grains, legumes, nuts, and pork; maintain balanced nutrition to prevent deficiency.

It is a vitamin replacement that restores thiamine levels needed for carbohydrate metabolism & neurologic function, preventing deficiency-related complications.

Lorazepam – Class & Action

A client is prescribed lorazepam for anxiety or seizure control. How does this medication work?

Lorazepam – Therapeutic Use

What is lorazepam used for?

Treatment of anxiety, sedation, acute seizure control, and status epilepticus.

Lorazepam – Nursing Assessment

Before giving lorazepam, what should the nurse assess?

Level of anxiety, orientation, mood, respiratory status, seizure characteristics (onset, duration, triggers, postictal state), and signs of CNS depression, especially in older adults.

Lorazepam – Administration

How is lorazepam administered?

PO (IR, XR, liquid), IM, or IV. IV must be given slowly (≤2 mg/min). XR capsules should not be crushed. May sprinkle XR contents on applesauce if needed.

Lorazepam – Common Side Effects

What side effects may occur?

Drowsiness, dizziness, lethargy, ataxia, confusion, headache, nausea, vomiting, constipation, diarrhea, and weakness.

Lorazepam – Adverse Effects

Which adverse effects require immediate attention?

Respiratory depression, apnea, bradycardia, hypotension, severe CNS depression, psychological or physical dependence, blood dyscrasias, and nephrotoxicity.

Lorazepam – Drug Interactions

Which medications interact with lorazepam?

Opioids, alcohol, CNS depressants, kava-kava, valerian, chamomile, valproate, probenecid, and levodopa (increased sedation and CNS depression).

Lorazepam – Contraindications

Who should avoid lorazepam?

Clients with hypersensitivity, closed-angle glaucoma, sleep apnea, severe hypotension, uncontrolled severe pain, or coma.

Lorazepam – Precautions

Which clients require caution?

Older adults (use lower doses), pregnancy, breastfeeding, COPD, severe hepatic/renal/pulmonary impairment, depression, psychosis, myasthenia gravis, seizure disorders, and history of suicide attempt.

Lorazepam – Client Teaching

What should clients be taught?

Avoid alcohol and CNS depressants; do not drive until effects are known; do not stop abruptly (risk of withdrawal/seizures); taper gradually; report excessive sedation or breathing difficulty; notify provider if pregnant; avoid breastfeeding.

It is a benzodiazepine that enhances GABA activity in the CNS, decreasing neuronal excitability and producing sedation, anxiolysis, & anticonvulsant effects.

Methadone – Class & Action

A client is prescribed methadone for opioid use disorder. How does this medication work?Methadone – Therapeutic Use

What is methadone used for?

Detoxification and maintenance therapy for opioid use disorder (OUD), and suppression of withdrawal manifestations.

Methadone – Nursing Assessment

Before giving methadone, what should the nurse assess?

Assess blood pressure, pulse, and respiratory status before and during therapy; monitor for sedation and signs of respiratory depression.

Methadone – Administration

How is methadone administered?

Oral, IV, IM, or subcutaneous routes.

Methadone – Common Side Effects

What side effects may occur?

Hypotension, constipation, sedation, and confusion.

Methadone – Adverse Effects

Which adverse effects require immediate attention?

Respiratory depression and QT prolongation (especially with injection), which can lead to fatal arrhythmias.

Methadone – Drug Interactions

Which medications interact with methadone?

MAOIs, tricyclic antidepressants, SSRIs, SNRIs, other opioids, and St. John’s wort (increased risk of CNS depression and serotonin-related toxicity).

Methadone – Contraindications

Who should avoid methadone?

Clients with respiratory depression, acute asthma, paralytic ileus, or known alcohol intolerance.

Methadone – Precautions

Which clients require caution?

Older adults, pregnancy, and breastfeeding clients (use carefully due to high risk of CNS and respiratory depression in infants).

Methadone – Client Teaching

What should clients be taught?

Learn to recognize respiratory depression (slow, shallow breathing, extreme drowsiness). Seek emergency help immediately if it occurs. Take only as prescribed and avoid alcohol or other CNS depressants.

It is an opioid agonist that binds to & activates opioid receptors in the CNS, reducing withdrawal symptoms & cravings.

Naltrexone – Class & Action

A client is prescribed naltrexone for opioid or alcohol use disorder. How does this medication work?

Naltrexone – Therapeutic Use

What is naltrexone used for?

Treatment of opioid dependence and alcohol use disorder (AUD).

Naltrexone – Nursing Assessment

Before giving naltrexone, what should the nurse assess?

Mental status, mood changes, suicidality, and respiratory status. Confirm the client is not currently in opioid withdrawal.

Naltrexone – Administration

How is naltrexone administered?

Oral tablets or extended-release (depot) IM injection (Vivitrol).

Naltrexone – Common Side Effects

What side effects may occur?

Headache, anxiety, abdominal pain, nausea, vomiting, and muscle/joint pain.

Naltrexone – Adverse Effects

Which adverse effects require immediate attention?

Depression and suicidality.

Naltrexone – Drug Interactions

Which medications interact with naltrexone?

Bremelanotide and thioridazine (clinically relevant interactions noted in practice materials).

Naltrexone – Contraindications

Who should avoid naltrexone?

Clients with acute opioid withdrawal, positive opioid urine screen, or history of seizures.

Naltrexone – Precautions

Which clients require caution?

Clients with liver or renal disorders and those with respiratory conditions such as dyspnea or hypoxia.

Naltrexone – Client Teaching

What should clients be taught?

Monitor for mood changes or suicidality and report immediately; do not use opioids while taking this medication due to risk of withdrawal and loss of effect.

It is an opioid antagonist that blocks opioid receptors, preventing the euphoric & sedative effects of opioids & reducing cravings.