pharmacotherapy exam iii

• initial drug use is voluntary
• who are vulnerable, over time users lose control over drug use and become addicted
• repeated admin cuaseschagnes in functioning of the brain thus leading to addiction
• almost all drugs of abuse activate the mesolimbic dopamine system which mediates reward and appetitae behaviors

primary site of dysfunction is mesolimbic system

• self administration of drugs bypasses cognitive filters
• entire focus on drugs develop==unerlying change in cognitive reward centers
• most addicts desire to stop using
• addiction occurs in social, environmental and histroycal context
• hallmark of addiction--denial

• psychosocial--marriage, social networks, race/culture, childhood environment
• PSYCHIATRIC--genetics, linkage with alcoholics
• drugs/indiviudal factors--individual reactions and susceptibility
• BIOLOGICAL
• SOCIAL
• GENETIC

• 12 month period of time
• substance use resluting in faiutre to fulfill major role
• physically hazardous
• legal problems
• continued even with social/interpersonal problems related to substance

• 12 month period
• tolerance--need for markeldy increased amounts of substance to achieve intoxication or desired effect, OR markedly diminisehd effect with continued use of sam eamount of substance
• WITHDRAWAL--characteristic withdrawal sydnrom OR same substance is taken to relieve or avoid withdrawal symptoms
• SUbstance taken in larger amts or over longer peroid of time
• persistenet desire or unsuccessful efforst to cut down or control substance
• great deal of time spent to obtain substance
• important social/occupational or rec activies given up
• substance use continued despite knowledge of havign a persistent or recurrent physical or psych problem

• change in behavior
• late to work
• call in sick or not show
• inadequate record keeping
• decline in relations with coworkers
• job performance problems

• GENERAL POPULATION
• employment
• family (#2)
• lower severity of illness
• fewer psych problems
• no fam history of chemical dependency
• compliance with treatment and aftercare (#1)

• health professionals services program-- nurcing, medicine, pods, pharmd, dent, chiro, pt, emt, etc
• goals--protect the public, facilitate needed care without discipline, coordinate care long tearm

• agents for withdrawal management
• agents that attenuate the desire to drink
• agents that decrease drinking by treating associated psychiatric problems
• agents taht attenuate drinking itself

• sage withdrawal from alcohol/drugs
• provide humane withdrawal
• prepare patient for ongoing treamtnet

• prior history of severe withdrawal symptoms
• high BAL ithout sgns of intoxication
• withdrawal signs with high BAL
• concurrent use of sedatives andalcohol
• coxisting medical problems

• CNS arousal hyperactivity
• increased levels of NE and MHPG secondary to decreased inhibtitions of alpha 2 receptors on presynaptic receptors
• decreased inhibitory effect of GABA

anxiety, seizure, deliurium, depression, hallucinations, irritable, nausea, vomiting, hyperreflexia, diaphoresis, elevated P, RR, BP, T tremors

• DOSED: 250mg/day, 500mg TIW
• inhibits acetaldehyde dehydrogenase
• decrease frequence of drinking but no long term improvement
• hepatotoxicity and decrease in dopameine beta ydroxylase activity
• works best for impulsive drinkers or in high risk situation--makes you sick

• warmth, flusing
• increased heart rate
• palptations, dizziness,
• decreased bp
• nausea/vommiting
• SOB
• blurry vision
• confusion

• DI--reduce clearance rates of valium, librium, desipramine, imipramine, dilatin, coumadin
• SE--drowsiness, fatigue, opti neuritis, perifpheral neurpopathy, heptaotixicity
• increased psych and depressive signs and symptoms may be related to increased dopamine levels

• 50mg/day + psychosocial therapy
• mu receptor blockaade leads to decreased reward and lower craving and alcohol consumption
• less craiving,
• fewer driking days
• limited progression to full relapse
• delayed time to first drink
• CAN ALSO BE USED IN OPIATE ABUSERS--highly motivated ppl only ie healthcare workers

• when strong urges present
• chornic relapsers
• heavy problmeatic drinkers
• LIMITATIONS:
• cost, no response to opiates once on naltrexone
• potential for precipitating opiate withdrawal if on opiate
• compliance

• attenuates glutaminerfic surge after alcohol cessation
• amino acid derivative
• increased abstinence
• 666mg TID
• MORE HELPFUL IN MOTIVATED PATIENTS

• synthetic mu receptor agonist
• keeps heroin users in "straight" range instead of "high then sick"
• acute paint--2.5-10mg q 4 hrs
• dependence--40-180 mg QD
• good drug, highly regulated

• parital opiate agonist
• weak antagonist--kappa
• blocks effect of other opiates
• SL absorption--good
• decrease opiate use/craving
• long duration of action
• low doses --acutely produce minimal effects
• higher doses can precipitate withdrawal in persons physically dependedt on opiattes

• repeated admin of buprenorphine produces or maintains physical dependence
• degree of physical dependence is less than first prudced by full agoist opiods
• withdrawal syndrom less severe with buprenorphine--varies upon three things:
• level of physical dependence, higher-more risk for withdrawal
• time interval between last does of agonist and first does of administered buprenorphine---longer time=less risk
• dose of buprenorphine--lower=less risk

• maximize motivatio for abstinence
• rebulid a substance free lifestyle
• maximize functioning
• relapse prevention