NURS 663 Test 4

NURS 663 Test 4 substance use disorder specifier criteria – Mild: 2-3 symptoms Moderate: 4-5 symtpoms Severe: >6 symptoms DSM for substance use disorder - over 12 months use increase amount persistant desire or can't cut down lots of time spent on substance craving failure to fill roles social/personal problems activities given up/reduced use when physically hazardous continue despite problem tolerence withdrawal abuse - use of any drug in a manner that deviates from approved social or medial patterns cross tolerence - the ability of one drug to be substituted for another each usually producing the same effects ex: diazepam and barbituates misuse - similar to abuse, but usually applies to drugs prescribed by physicians that are not used properly tolerence - after repeated administration, a given dose of a drug produces a decreased effect or larger doses must be administered to obtain the effect observed with the original dose withdrawal - a substance specific syndrome that occurs after stopping or reducing the amount of drug or substance that has been used regularly over a prolonged period acamprosate; what, side effects, dose - what: alcohol relapse prevention; "artificial alcohol" decreases glutamate and increases GABA side effects: anxiety, depression, diarrhea, decreased libido, flu like dose: 666mg TID must be abstinent from etoh first buprenorphine; moa, who can use - MOA: partial opioid agonist, prevents pleasurable effects, is a opiate analgesic who: pregnant okay, must be in mild withdrawal to start buprenorphine dosing - must be in withdrawal to start SL 8-32mg/d which medications are in Suboxone - buprenorphine and naloxone buproprion; dosing - for smoking cessation: begin 7-14d before stop date; 150mg SR in am x6 days then increase to 150mg SR BID tx for 7-9 weeks chlordiazepoxide; MOA, what for, dosing - MOA: enhances GABA for acute alcohol withdrawal 50-100mg injectable every 2hrs clonidine; MOA - alpha 2 receptors clonidine for opiate withdrawal - blocks autonomic symptoms; palpitations, sweating clonidine for etoh withdrawal - decrease bp, decrease HR, tremors disulfiram; MOA - inhibits acetalhydine and leads to buildup of acetaldehyde and causes immediate hangover effect after alcohol consumption disulfiram dosing - 250-500mg/d flumazenil; MOA, use, dosing, se - MOA: blocks benzo receptors at GABA use: benzo antidote dosing: 0.4mg-3mg se: dizzy, sweating, seizures, death disulfiram side effects - hepatitis, metallic taste, dermatitis lorazepam is used for - alcohol detox to control seizures, DTs, withdrawal psychosis methadone; MOA, dosing, for who - MOA: full opioid agonist dosing: 20-30mg/d, initiate immediately to avoid withdrawal standard of care for pregnant patients injectable treatment for alcohol abuse - naltrexone naloxone; what, for who - what: opiate antidote (heroin) blocks effects of buprenorphine when injected not for pregnancy naloxone and pregnancy - can cause spontaneous abortion, preterm labor, intrauterine fetal demise Naltrexone forms and dosing - pill and injection available must take 50mg x7d before getting shot; no opioids in last 7d before starting naltrexone MOA and side effects - MOA: opioid antagonoist; blocks euphoric effects of alcohol and prevents craving SE: withdrawal, nausea, dizzy, anxiety, fatigue paroxetine; use - tx of choice in PTSD veterans, sexual trauma paroxetine side effects - sedation, weight gain, sexual, anticholinergic paroxetine dosing - 10-20mg/d and increase by 10-20mg every 2 weeks to max of 60 prazosin; MOA, use - for nightmares due to PTSD, blocks norepinephrine prazosin; dosing, monitor fo - dosing: 1-15mg; start with 1mg monitor: blood pressure and pulse sertraline: dosing - start at 25-50mg x1wk and increase by 25-50 every 1-2wks to max of 200 sertraline side effects - nausea, decreased appetite, sleepiness, tremors, sweating, insomnia, sexual