Substance Dependence

Question 1

alcohol dependence treatment

Answer 1

• psychological intervention (CBT)
• acamprosate or naltrexone
• 2nd = disulfiram

Question 2

What is the recommended maximum weekly intake for alcohol?

Answer 2

14 units per weeks spread evenly over 3 days or more

Question 3

Which tool can be used to assess alcohol misuse?

Answer 3

AUDIT-C

Question 4

alcohol dependence delirium treatment

Answer 4

1st = lorazepam
2nd = haloperidol

Question 5

alcohol dependence withdrawal seizures treatment

Answer 5

lorazepam
- a fast acting benzodiazepine

Question 6

alcohol dependence withdrawal symptoms treatment

Answer 6

chlordiazepoxide/diazepam
- a LONG acting benzo

Question 7

Wernicke’s encephalopathy treatment

Answer 7

Thiamine (vitamin B1)
- symptoms include confusion, eye movements and difficulty balancing/ co-ordinating

Question 8

NRT treatment combination

Answer 8

• short acting: gum, inhalators, lozenges, oral or nasal spray, sublingual tablets
• long acting (16 hours if having nightmares, 24 hours if pregnant and waking with cravings

Question 9

varenicline side-effects

Answer 9

nausea, headache, insomnia
- caution in CVD, psychiatric illness, renal impairment and epilepsy

Question 10

bupropion warnings

Answer 10

• caution in epilepsy and psychiatric illness
• MHRA warning: serotonin syndrome

Question 11

opioid detoxification

Answer 11

Patient should be offered methadone or buprenorphine
- personally tailored but can take up to 12 weeks

Question 12

How long must a patient be supervised for

Answer 12

Supervised consumption for first three months

Question 13

opioid detoxification- with methadone

Answer 13

methadone is reduced by 5mg every 1-2 weeks

Question 14

opioid detoxification- with buprenorphine

Answer 14

buprenorphine reduced by 2mg every 2 weeks (400mcg reduction at the end)

Question 15

opioid detoxification withdrawal symptoms

Answer 15

D&V, stomach cramps, agitation, headaches, insomnia

Question 16

buprenorphine benefits over methadone

Answer 16

• lower risk of fatal overdose
• can be given with naloxone (discourages injecting)
• has less mental clouding and sedation than methadone
• MR may be suitable for poor adherence

Question 17

opioid dependence in pregnancy

Answer 17

Continue in pregnancy
If vomiting occurs, can cause withdrawral for foetus

Question 18

What is max days supply of methadone or buprenorphine?

Answer 18

14 days
must specify
- number of instalments
- the interval between instalments

Question 19

What type of script is methadone and buprenorphine prescribed on?

Answer 19

fp10MDA (blue script)