Overactivity of what NT is responsible for mediating Etoh withdrawal symptoms?
- What NT is responsible for the CNS inhibitory affect of Etoh?
- Glutamate ( the main excitatory neurotransmitter of the brain.)
- GABA ( the main inhibitory NT)
Out of the FDA approved medications for Etoh use disorder (Acamprosate, Disulfiram, Naltrexone) which one is the only one contraindicated in severe RENAL disease?
Acamprosate (because completely renally excreted)
How is Acamprosate thought to help in Etoh use disorder?
As a structural analog of GABA, it MODIFIES GLUTAMATE AND GABA PATHWAYS, resulting in decreased reinforcement of etoh intake and decreases cravings.
What is the MOA of Naltrexone?
Opioid receptor antagonist
What are the four main advantages of Naltrexone IM vs Oral?
- Better compliance (monthly shot)
- More consistent steady state plasma levels
- Less GI side effects
- Bypass first pass hepatic metabolism.
How many days opioid free should one be in order to start Naltrexone?
7-10 days opioid free.
If urine drugs is positive, what is the “gold standard” for confirmatory testing?
GCMS
Gas chromatography mass spectrometry
What is the Utox detection window for the following drugs?
- Marijuana
- Amphetamines
- Barbiturates “-barbitals”
- BZDs
- Cocaine
- Methadone
- Opiates
- PCP
- Heroin
- Marijuana (3-30 days)
- Amphetamines (2-3 days)
- Barbiturates (1-3 days)
- BZDs (1-7 days)
- Cocaine (6hrs to 3 days)
- Methadone (7-9 days)
- Opiates (1-3 days)
- PCP (8 days)
- Heroin (3 days)
What is the difference between Methadone and Buprenorphine in safety profile in pregnancy?
Methadone = approved in pregnancy
Buprenorphine = Category C, but MOTHER study showed that it was safe and effective in pregnancy.
What is the MOA of Buprenorphine?
Potent partial (Mu) opioid Antagonist
Mixed agonist/antagonist of (kappa) opioid receptors.
