SUBSTANCE USE MEDICATIONS.

Medications for Substance Use Disorders

General Overview

  • Substance Use Disorders (SUD) are conditions characterized by a compulsive pattern of use leading to significant impairment or distress.

Key Terminology

  • Abstinence: The act of refraining from the use of a substance.

  • Syndrome: A set of symptoms indicating the presence of a particular disorder.

  • Tolerance: A condition where increasing amounts of a substance are required to achieve the same effect due to progressive adaptation to it.

  • Withdrawal: A group of symptoms that occur upon the abrupt discontinuation of a substance.

Medications for Alcohol Withdrawal

  • Benzodiazepines: Commonly used to manage alcohol withdrawal.

    • Examples:

    • Diazepam: Used to reduce withdrawal symptoms.

    • Lorazepam: A medication for managing anxiety and alcohol withdrawal symptoms.

  • Nursing Actions:

    • Administer benzodiazepines around the clock or as needed (PRN).

    • Monitor vital signs (VS) and neurological status of the patient.

    • Implement seizure precautions due to the risk of seizures during withdrawal.

Adjunct Medications for Alcohol Withdrawal

  • Carbamazepine: Often used as an anticonvulsant in withdrawal management.

  • Clonidine: A medication that may help reduce withdrawal symptoms such as hypertension.

  • Propranolol: A beta-blocker that can help with physical symptoms of anxiety during withdrawal.

  • B Vitamins: Important for patients during alcohol withdrawal to prevent Wernicke's encephalopathy.

  • Nursing Actions:

    • Continue to implement seizure precautions.

    • Monitor vital signs (VS).

    • Hold propranolol if the heart rate (HR) is below 60 beats per minute (bpm).

Alcohol Abstinence Maintenance

  • Disulfiram (trade name Antabuse):

    • A medication used as a part of a behavioral therapy known as aversion therapy, which works by making the patient sick if alcohol is consumed after taking the medication.

  • Nursing Actions:

    • Provide patient education regarding the importance of avoiding all products containing alcohol, including common household items and medications.

Opioid Withdrawal and Maintenance Therapy

  • Methadone: An oral opioid agonist used for both withdrawal management and long-term maintenance therapy.

  • Suboxone: An oral medication that contains an opioid agonist and an antagonist, used for maintenance.

  • Nursing Actions:

    • Educate the patient on the importance of medication adherence.

    • Ensure proper medication administration protocols are followed.

Opioid Withdrawal Adjunct Medications

  • Clonidine:

    • Assists with symptoms such as nausea, vomiting, and diarrhea experienced during opioid withdrawal.

  • Nursing Actions:

    • Provide patient education about possible side effects such as dry mouth and drowsiness.

    • Continuously monitor vital signs (VS).

Opioid Overdose Management

  • Naloxone (Narcan):

    • A specific opioid antagonist used to reverse the effects of opioid overdose.

    • Routes of administration:

    • Intramuscular (IM)

    • Subcutaneous (SQ)

    • Intravenous (IV)

    • Inhalation.

    • Purpose: Reverse signs of opioid toxicity effectively within moments after administration.

Nicotine Withdrawal and Abstinence Syndrome

  • Symptoms of Nicotine Withdrawal:

    • Irritability, nervousness, insomnia, difficulty concentrating.

  • Bupropion:

    • A medication that reduces nicotine cravings and alleviates manifestations of withdrawal.

  • Nursing Actions:

    • Educate the patient on how to manage side effects, such as dry mouth.

Nicotine Replacement Therapy Options

  • Various forms of therapy available:

    • Lozenge

    • Gum

    • Patch

    • Nasal Spray

    • Inhaler

    • E-cigarettes

  • Purpose: To reduce nicotine withdrawal symptoms and cravings, assisting in smoking cessation efforts.