M10A - Substance Use Disorders expanded

What is the therapeutic use of Disulfiram?

Alcohol Use Disorder (AUD)

What is a mild adverse effect of Disulfiram when taken with alcohol?

Nausea, vomiting, flushing, palpitations, headache, sweating, thirst, chest pain, weakness, blurred vision, hypotension

What is a severe adverse effect of Disulfiram when taken with alcohol?

Respiratory depression, cardiovascular collapse, dysrhythmias, seizures, death

What are some adverse effects of Disulfiram without concurrent alcohol?

Rash, drowsiness, liver dysfunction (rare), peripheral and optic neuritis (rare)

What individual variations should be considered when prescribing Disulfiram?

Heart disease, hepatic dysfunction, psychiatric disorders

What are some drug-drug interactions (DDIs) with Disulfiram?

Alcohol, metronidazole, warfarin

What safety measure should be taken when using Disulfiram?

Avoid alcohol-containing products

How long after the last drink should Disulfiram be administered?

No sooner than 12 hours

What is crucial for patient education regarding Disulfiram?

Discuss hazards of treatment and effects persist for 2 weeks after stopping medication

What should patients wear to indicate their treatment with Disulfiram?

A medical alert bracelet

What should patients avoid while taking Disulfiram?

Alcohol-containing products (e.g., mouthwash, cough syrup, cologne)

What should patients be warned about regarding Disulfiram?

Risk of drug-drug interactions (DDIs)

What are the therapeutic uses of Naltrexone?

Alcohol Use Disorder (AUD) and Opioid Use Disorder (OUD) after detoxification.

In which conditions is Naltrexone contraindicated?

Acute hepatitis or liver failure; high risk if actively using opioids.

What are the dosage forms of Naltrexone?

Tablets administered daily (ReVia) and IM injection administered once monthly (Vivitrol).

What are the common adverse effects (AEs) of Naltrexone?

GI effects (abdominal pain, nausea, diarrhea), headache, sedation, anxiety, injection-site reactions (IM form), liver toxicity.

What drug interactions (DDIs) should be considered with Naltrexone?

Opioids.

What nursing implications should be followed when administering Naltrexone?

Administer after patients stop drinking and do not administer if the patient is also taking opioids.

What should patients be educated about when taking Naltrexone?

They should watch for and report signs and symptoms of liver injury and understand that medication effectiveness improves with concurrent counseling.

What is a challenge in pain management for patients taking Naltrexone?

Pain management may be difficult given the drug properties.

What is the therapeutic use of Acamprosate?

Alcohol Use Disorder (AUD)

What is the recommended dosage form of Acamprosate?

Tablets taken three times daily

In which conditions should Acamprosate be avoided?

In patients with End-Stage Renal Disease (ESRD) or Creatinine Clearance (CrCl) < 30 mL/min and during pregnancy

What are common adverse effects of Acamprosate?

Diarrhea (17%) and rare suicide-related events

What nursing implications should be considered when administering Acamprosate?

Give with meals three times daily and evaluate renal function

When should patients start taking Acamprosate?

After detoxification is over, approximately 5 days after alcohol has stopped

How can the effectiveness of Acamprosate be improved?

By concurrent counseling

What are the therapeutic uses of Methadone?

OUD withdrawal/detoxification, OUD maintenance and suppressive therapy, pain management

What is a key pharmacokinetic characteristic of Methadone?

It has a long half-life and duration of action, and it can cause cross-tolerance to other opioids.

What individual variations should be considered when prescribing Methadone?

Past medical history or family history of QT prolongation syndrome; it may be used in pregnancy.

What are some common adverse effects (AEs) of Methadone?

Standard opioid AEs, QT prolongation, respiratory depression, hepatic injury.

What drug-drug interactions (DDIs) should be considered with Methadone?

CNS depressants, QT-prolonging drugs, CYP3A4 inhibitors.

What safety considerations are important when prescribing Methadone?

Repeated dosing can lead to accumulation and respiratory depression; it should only be prescribed for OUD through an opioid treatment program (OTP), except for inpatient use for 72 hours.

What are the nursing implications when administering Methadone?

It is a controlled substance (CII) requiring chain of custody; obtain baseline ECG before starting and monitor routinely; educate patients on liver injury signs; monitor vital signs and withdrawal suppression; warn about potential DDIs; inform about relapse risks after discontinuation; explain that effectiveness improves with concurrent counseling.

What are the therapeutic uses of Buprenorphine?

OUD withdrawal/detoxification, OUD maintenance and suppressive therapy, pain management

What individual variation should be considered when prescribing Buprenorphine?

PMH or FH of QT prolongation syndrome; buprenorphine alone preferred in pregnancy

What are some common adverse effects (AEs) of Buprenorphine?

Headache, GI upset, anxiety, sleep disturbances, lower extremity edema, sweating

What are the drug-drug interactions (DDIs) associated with Buprenorphine?

Strong inducers/inhibitors of CYP3A4, CNS depressants

What is a safety feature of Buprenorphine compared to full agonists?

Ceiling effect - lower abuse potential, lower risk of respiratory depression

What increases the risk of respiratory depression when using Buprenorphine?

Concomitant use of CNS depressants

What are the nursing implications when administering Buprenorphine?

Controlled substance (CIII), requires chain of custody, administer sublingually, warn about relapse risk, explain improved effectiveness with counseling

What are the therapeutic uses of Naltrexone?

Alcohol Use Disorder (AUD) and Opioid Use Disorder (OUD) after detoxification.

What are the contraindications for Naltrexone?

Contraindicated in acute hepatitis or liver failure; not used in pregnancy.

What is the preferred dosage form of Naltrexone for OUD?

IM injection administered once monthly (Vivitrol).

What are common adverse effects (AEs) of Naltrexone?

GI effects (abdominal pain, nausea, diarrhea), headache, sedation, anxiety, injection-site reactions, liver toxicity.

What drug interactions (DDIs) are associated with Naltrexone?

Opioids (no other significant DDIs).

What is a nursing implication regarding opioid use before administering Naltrexone?

Patient must be opioid-free (negative urine screen); do not administer if patient is also taking opioids.

What should be done when administering Naltrexone intramuscularly?

Use manufacturer-provided customized needles and alternate injection sites in the gluteal muscle each month.

What should patients be educated to watch for when taking Naltrexone?

Watch for and report signs and symptoms of liver injury.

What risk is associated with discontinuing Naltrexone?

If the patient relapses, they are at greater risk for opioid-related death.

How can the effectiveness of Naltrexone be improved?

Effectiveness is improved with concurrent counseling.

What is the therapeutic use of Naloxone?

Reversal agent for opioid overdose, post-opioid effects, and neonatal respiratory depression.

What is the half-life of Naloxone?

Short, with effects beginning within 2 - 5 minutes and persisting for several hours.

Why can't Naloxone be given orally?

Due to high first pass effect.

What are the dosage forms of Naloxone?

Solution (SubQ/IM/IV), Auto-injector (SubQ/IM), and Nasal spray (intranasal).

What are the adverse effects of Naloxone?

Reversal of pain control and/or withdrawal if physically dependent on opioids.

What drug interactions should be noted with Naloxone?

Opioids.

What nursing implications are important when administering Naloxone?

Dose needs to be titrated carefully, monitor for a minimum of 4 hours after overdose, and teach proper administration technique.