DOCSLIB.ORG

Opioid Detoxification

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Opioid Detoxification Guidance on the Treatment of Alcohol and Benzodiazepine Dependence in Adults for Inpatient Units - version 1.1 Incorporating Guidance on the Management of Alcohol Withdrawal and the Prevention of Wernicke-Korsakoff Syndrome RATIFYING COMMITTEE Drugs and Therapeutics Group DATE RATIFIED 24.04.17 with a minor amendment to the We3rnicke's prevention advice - January 2020 NEXT REVIEW DATE April 2020 AUTHORS Dr James Fallon - Consultant Psychiatrist Helen Manuell – Clinical Pharmacist Originally written by Dr Hugh Williams - Consultant Psychiatrist, Hon. Clinical Senior Lecturer (no longer working for the Trust) Summary: This guidance aims to assist inpatient staff in the safe and appropriate prescribing and administration of medicines for adults undergoing treatment for alcohol problems This document is compliant with the NICE clinical guidelines 100 and 115 on alcohol dependence and alcohol-use disorders. If you require this document in another format, ie easy read, large text, audio, Braille or a community language please contact the Pharmacy Team on 01243 623349 (Text Relay calls welcome) 1 CONTENTS Page 1. Management of Alcohol Withdrawal and the Prevention of Wernicke / Korsakoff syndrome. 1.1 Alcohol Withdrawal Syndrome 3 1.2 Pharmacological management of alcohol detoxification 3 1.3 Prevention of Wernicke Korsakoff syndrome 5 1.4 General management 6 2. Pharmacological Management used in Relapse Prevention in alcohol dependence 2.1 Prescribing advice for acamprosate 6 3. Benzodiazepine withdrawal 3.1 Benzodiazepine stabilisation 7 3.2 Doses of benzodiazepines equivalent to 5mg diazepam 8 3.3 Benzodiazepine detoxification 8 4. References 9 Appendices 10 2 1. Management of Alcohol Withdrawal and the Prevention of Wernicke / Korsakoff syndrome. 1.1 Alcohol Withdrawal Syndrome Not all heavy drinkers will experience withdrawal phenomena and there is a wide range in the severity of withdrawal symptoms. In some cases withdrawal may be life threatening. It is therefore important to recognise early clinical features and treat them appropriately. Early withdrawal symptoms occur up to 12 hours after the last drink. They include tremor, sweating, anorexia, nausea, insomnia and anxiety. In moderate withdrawal the signs are more marked and transient auditory hallucinations in clear consciousness may also occur. Withdrawal fits (“rum fits”) can occur at 12 to 48 hours and are more likely if there is a previous history of withdrawal fits or epilepsy. Fits tend to be generalised tonic- clonic (if focal, suspect other causes e.g.head injury) and may occur in bouts. In 30% of cases, fits are followed by delirium tremens. Severe withdrawal / delirium tremens usually develop after 72 hours but can be sooner. Clinical features include; marked tremor, confusion, disorientation, agitation, restlessness, fearfulness, visual and auditory hallucinations, delusions, autonomic disturbances, tachycardia, sweating, fever and dehydration. Persons consuming more than 16 units per day (half to one bottle of spirits per day or equivalent) are particularly at risk. Other risk factors include severe dependence, previous history of DTs, older age and coexisting medical conditions such as infection. 1.2 Pharmacological management of alcohol detoxification Which drug to use? Benzodiazepines are the treatment of choice in the management of alcohol withdrawal. Management Guidelines Alcohol dependent patients that exhibit withdrawal features or are at risk of developing withdrawal should be prescribed benzodiazepines, (i.e. diazepam or chlordiazepoxide). Dosage should be individually titrated and will depend on severity of dependence, withdrawal severity, gender, size, weight, general health and liver function. The following regime for inpatient detoxification is a guideline only: A typical inpatient regime for a severely dependent adult male would be: Day 1: Diazepam, 20 mg qds Day 2: Diazepam, 15-20 mg qds Day 3: Diazepam, 15 mg qds Day 4: Diazepam, 10 mg qds Day 5: Diazepam, 10 mg tds Day 6: Diazepam, 10 mg bd Day 7: Diazepam, 10 nocte Females, the elderly and those with milder dependence / withdrawal should be commenced on a lower starting dose, e.g. diazepam 10-15 mg qds, and reduced accordingly. 3 Alternatively, chlordiazepoxide can be used - (5 mg diazepam is approximately equivalent to 10 - 15 mg chlordiazepoxide). A sample regime for a moderately dependent adult male would be: Day 1: Chlordiazepoxide 30 mg qds Day 2: Chlordiazepoxide, 25 mg qds Day 3: Chlordiazepoxide, 20 mg qds Day 4: Chlordiazepoxide, 15 mg qds Day 5: Chlordiazepoxide, 10 mg tds Day 6: Chlordiazepoxide, 10 mg bd Day 7: Chlordiazepoxide, 10 nocte There may be need for dose flexibility especially during the first 48hrs as dosage is titrated against withdrawal symptoms / over-sedation. Patients should therefore be regularly and closely monitored. In very severe withdrawal, (e.g. DTs), additional ‘as required’ oral doses of diazepam (or IM lorazepam) may be necessary for the first few days. Similarly, dosage will need to be reduced in response to excessive drowsiness or over-sedation. Special caution is necessary in the case of severe liver impairment (eg cirrhosis) as the metabolism of benzodiazepines may be reduced and lead to over-sedation. (Lorazepam or oxazepam may be suitable alternatives to diazepam and chlordiazepoxide in these cases). For withdrawal fits or status epilepticus use rectal diazepam (Stesolid®) 10 mg (in view of risk of respiratory depression with IV route). This dose may be repeated at 15-minute intervals where necessary. In the case of severe behavioural disturbance use oral haloperidol 5-10 mg. However, be aware that use of antipsychotics may lower the seizure threshold. For severe vomiting use metoclopramide 10 mg IM for up to 5 days or cyclizine 50 mg IM. NB. Haloperidol also has anti-emetic action and therefore if used for behavioural disturbance might also combat any nausea and vomiting. If it does not, it should not be used in combination with metoclopramide as this greatly increases the risk of extrapyramidal side effects, instead of cyclizine. What dose to start on? Scores on the Severity of Alcohol Dependence Questionnaire (SADQ) and / or units of alcohol per week can provide a rough guide to deciding the starting dose of benzodiazepines, (i.e. what point to start on the Alcohol Detoxification Prescription Chart *). However, this is no substitute for careful, regular observation and monitoring, especially in the first day or two. *Special prescription forms for prescribing benzodiazepines and vitamin supplements for alcohol detoxification are available. 4 Table 5: Guide to starting dose of benzodiazepines for alcohol detoxification (adult male) MILD MODERATE SEVERE V SEVERE SADQ 15 15-30 30-40 40+ UNITS/WEEK 100 100-200 200+ 250+ Diazepam 5-10mg 10-15mg 20mg 20mg QDS QDS QDS QDS Chlordiazepoxide 10-15 mg 25-30mg 40-50 mg 50mg QDS QDS QDS QDS Severity of Alcohol Dependence Questionnaire (SADQ) (See appendix 1). The Severity of Alcohol Dependence Questionnaire is a self-administered and reliable instrument to measure the severity of alcohol dependence. It can also be used to predict the degree of withdrawal symptoms and help in judging medication. The amount of alcohol consumed per week (units/week) can also give estimate of dependence and likelihood of withdrawal. (See appendices 2 and 3). Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar). This scale can sometimes be used to assist in the assessment of withdrawal symptoms and their severity. A simplified version of it can be found on the reverse of the special prescription forms for inpatient alcohol detoxification. Patients should be breathalysed and the first dose of benzodiazepine given if serial readings show a falling alcohol concentration and there is no evidence of gross alcohol intoxication. Caution is needed if the patient shows a high alcometer level (e.g. 0.35mg/L breath alcohol, BrAC). 1.3 Prevention of Wernicke-Korsakoff syndrome Wernicke’s encephalopathy is a common and potentially fatal consequence of alcoholism. Failure to prevent or successfully treat Wernicke’s encephalopathy can lead to the development of Korsakoff’s psychosis, which may be extremely difficult to manage and represents a huge healthcare burden. Wernicke’s encephalopathy (acute confusion, ataxia, ophthalmoplegia) may be difficult to recognise /diagnose as all 3 features are only present in 10% of cases. Vitamin Supplements: It is important to note that oral thiamine is poorly absorbed in alcohol dependent patients. Therefore all patients undergoing inpatient detoxification should receive IM/IV high potency vitamin B complex preparations (Pabrinex®) for five days. On admission, the first dose should be administered before any food is offered. This should be followed by oral thiamine (vitamin B1) 100mg TDS for a minimum of six weeks before reviewing if Wernicke’s encephalopathy and Korsakoff’s psychosis (amnesia, time disorientation and confabulation) are to be prevented. Anaphylactic reactions are rare (1 in 5 million for IM, 1 in 250,000 for IV) but facilities for treating anaphylactic reactions must be readily available whenever IM / IV preparations of vitamin B complex preparations (Pabrinex®) are used. Note: the first dose of parenteral vitamins should be given before the first meal of the day. IM is the more common and preferred route of administration. Pabrinex® IM should be given in divided doses and no more than 4ml volume per injection site. If the IV 5 route is used then drip infusion using 50-100
Load more

Recommended publications
  • Appendix a Common Abbreviations Used in Medication
    UNIVERSITY OF AMSTERDAM MASTERS THESIS Impact of Medication Grouping on Fall Risk Prediction in Elders: A Retrospective Analysis of MIMIC-III Critical Care Database Student: SRP Mentor: Noman Dormosh Dr. Martijn C. Schut Student No. 11412682 – SRP Tutor: Prof. dr. Ameen Abu-Hanna SRP Address: Amsterdam University Medical Center - Location AMC Department Medical Informatics Meibergdreef 9, 1105 AZ Amsterdam Practice teaching period: November 2018 - June 2019 A thesis submitted in fulfillment of the requirements for the degree of Master of Medical Informatics iii Abstract Background: Falls are the leading cause of injury in elderly patients. Risk factors for falls in- cluding among others history of falls, old age, and female gender. Research studies have also linked certain medications with an increased risk of fall in what is called fall-risk-increasing drugs (FRIDs), such as psychotropics and cardiovascular drugs. However, there is a lack of consistency in the definitions of FRIDs between the studies and many studies did not use any systematic classification for medications. Objective: The aim of this study was to investigate the effect of grouping medications at different levels of granularity of a medication classification system on the performance of fall risk prediction models. Methods: This is a retrospective analysis of the MIMIC-III cohort database. We created seven prediction models including demographic, comorbidity and medication variables. Medica- tions were grouped using the anatomical therapeutic chemical classification system (ATC) starting from the most specific scope of medications and moving up to the more generic groups: one model used individual medications (ATC level 5), four models used medication grouping at levels one, two, three and four of the ATC and one model did not include med- ications.
    [Show full text]
  • Medication Assisted Treatment MAT
    Medication Assisted Treatment MAT The Root Center provides medication assisted treatment (MAT) for substance use disorders to those who qualify. MAT uses medications in combination with counseling and behavioral therapies to provide a “whole-patient” approach. The ultimate goal of MAT is full recovery, including the ability to live a self-directed life. This treatment approach has been shown to: improve patient survival, increase retention in treatment, decrease illicit opiate and other drug use as well as reduce other criminal activity among people with substance use disorders, increase patients’ ability to gain and maintain employment, and improve birth outcomes among women who have substance use disorders and are pregnant. These approved medications assist with urges, cravings, withdrawal symptoms, and some act as a blocking mechanism for the euphoric effects of alcohol and opioids. Currently, Root offers methadone for opioid use disorder and is considering adding other medications listed below. Opioid Use Disorder Overdose Prevention Methadone Methadone is an opioid treatment medication that reduces withdrawal Naloxone symptoms in people addicted to heroin or other narcotic drugs without Naloxone is a medication which causing the “high” associated with the drug. saves lives by reversing the effects of an opioid overdose. Root Center Methadone is used as a pain reliever and as part of drug addiction patients, their friends and family detoxification and maintenance programs. It is available only from members, can receive a prescription a certified pharmacy. for Naloxone as early as the initial evaluation and throughout treatment. Buprenorphine The medication is administered Buprenorphine is an opioid treatment medication and the combination at the time of the overdose.
    [Show full text]
  • Evidence-Based Guidelines for the Pharmacological Management of Substance Abuse, Harmful Use, Addictio
    444324 JOP0010.1177/0269881112444324Lingford-Hughes et al.Journal of Psychopharmacology 2012 BAP Guidelines BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, Journal of Psychopharmacology 0(0) 1 –54 harmful use, addiction and comorbidity: © The Author(s) 2012 Reprints and permission: sagepub.co.uk/journalsPermissions.nav recommendations from BAP DOI: 10.1177/0269881112444324 jop.sagepub.com AR Lingford-Hughes1, S Welch2, L Peters3 and DJ Nutt 1 With expert reviewers (in alphabetical order): Ball D, Buntwal N, Chick J, Crome I, Daly C, Dar K, Day E, Duka T, Finch E, Law F, Marshall EJ, Munafo M, Myles J, Porter S, Raistrick D, Reed LJ, Reid A, Sell L, Sinclair J, Tyrer P, West R, Williams T, Winstock A Abstract The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short- and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people. Keywords Substance misuse, addiction, guidelines, pharmacotherapy, comorbidity Introduction guidelines (e.g.
    [Show full text]
  • Michael F. Weaver, MD, DFASAM PRESENT TITLE
    February 1, 2021 CURRICULUM VITAE NAME: Michael F. Weaver, M.D., DFASAM PRESENT TITLE: Professor of Psychiatry WORK ADDRESS: Center for Neurobehavioral Research on Addiction Department of Psychiatry & Behavioral Sciences McGovern Medical School The University of Texas Health Science Center at Houston 1941 East Road, BBSB 1222 Houston, TX 77054 713-486-2558 UNDERGRADUATE EDUCATION: B.S., Natural Sciences, 1991 University of Akron Akron, OH GRADUATE EDUCATION: Doctor of Medicine, 1993 Northeast Ohio Medical University Rootstown, OH POSTGRADUATE TRAINING: Residency, Internal Medicine, 1993-1996 Virginia Commonwealth University Health System Richmond, VA Hoff Fellowship in Substance Abuse Medicine, 1996-1997 Virginia Commonwealth University Health System Richmond, VA ACADEMIC AND ADMINISTRATIVE APPOINTMENTS: Instructor, 1996-1997 Internal Medicine and Psychiatry VCU Richmond, VA Assistant Professor, 1997-2006 Internal Medicine, Psychiatry and Pharmacy VCU Richmond, VA Program Director, Addiction Medicine Fellowship, 2001-2003 Virginia Commonwealth University School of Medicine, Richmond, Virginia 1 February 1, 2021 Associate Professor with Tenure, 2006-2012 Internal Medicine, Psychiatry and Pharmacy VCU Richmond, VA Professor with Tenure, 2012-2014 Internal Medicine, Psychiatry and Pharmacy Virginia Commonwealth University (VCU) Richmond, VA Medical Director, 2013-2014 Virginia Health Practitioners Monitoring Program Richmond, VA Professor, 2014-present Department of Psychiatry & Behavioral Sciences McGovern Medical School The University
    [Show full text]
  • Treatment of Patients with Substance Use Disorders Second Edition
    PRACTICE GUIDELINE FOR THE Treatment of Patients With Substance Use Disorders Second Edition WORK GROUP ON SUBSTANCE USE DISORDERS Herbert D. Kleber, M.D., Chair Roger D. Weiss, M.D., Vice-Chair Raymond F. Anton Jr., M.D. To n y P. G e o r ge , M .D . Shelly F. Greenfield, M.D., M.P.H. Thomas R. Kosten, M.D. Charles P. O’Brien, M.D., Ph.D. Bruce J. Rounsaville, M.D. Eric C. Strain, M.D. Douglas M. Ziedonis, M.D. Grace Hennessy, M.D. (Consultant) Hilary Smith Connery, M.D., Ph.D. (Consultant) This practice guideline was approved in December 2005 and published in August 2006. A guideline watch, summarizing significant developments in the scientific literature since publication of this guideline, may be available in the Psychiatric Practice section of the APA web site at www.psych.org. 1 Copyright 2010, American Psychiatric Association. APA makes this practice guideline freely available to promote its dissemination and use; however, copyright protections are enforced in full. No part of this guideline may be reproduced except as permitted under Sections 107 and 108 of U.S. Copyright Act. For permission for reuse, visit APPI Permissions & Licensing Center at http://www.appi.org/CustomerService/Pages/Permissions.aspx. AMERICAN PSYCHIATRIC ASSOCIATION STEERING COMMITTEE ON PRACTICE GUIDELINES John S. McIntyre, M.D., Chair Sara C. Charles, M.D., Vice-Chair Daniel J. Anzia, M.D. Ian A. Cook, M.D. Molly T. Finnerty, M.D. Bradley R. Johnson, M.D. James E. Nininger, M.D. Paul Summergrad, M.D. Sherwyn M.
    [Show full text]
  • Acamprosate in the Treatment of Binge Eating Disorder: a Placebo-Controlled Trial
    CE ACTIVITY Acamprosate in the Treatment of Binge Eating Disorder: A Placebo-Controlled Trial Susan L. McElroy, MD1* ABSTRACT obsessive-compulsiveness of binge eat- 1 Objective: To assess preliminarily the ing, food craving, and quality of life. Anna I. Guerdjikova, PhD effectiveness of acamprosate in binge Among completers, weight and BMI 1 Erin L. Winstanley, PhD eating disorder (BED). decreased slightly in the acamprosate 1 group but increased in the placebo Anne M. O’Melia, MD Method: In this 10-week, randomized, 1 group. Nicole Mori, CNP placebo-controlled, flexible dose trial, 40 1 Jessica McCoy, BA outpatients with BED received acampro- Discussion: Although acamprosate did Paul E. Keck Jr., MD1 sate (N 5 20) or placebo (N 5 20). The not separate from placebo on any out- James I. Hudson, MD, ScD2 primary outcome measure was binge eat- come variable in the longitudinal analy- ing episode frequency. sis, results of the endpoint and completer analyses suggest the drug may have Results: While acamprosate was not some utility in BED. VC 2010 by Wiley associated with a significantly greater Periodicals, Inc. rate of reduction in binge eating episode frequency or any other measure in the Keywords: acamprosate; binge eating primary longitudinal analysis, in the end- disorder; obesity; glutamate point analysis it was associated with stat- istically significant improvements in binge day frequency and measures of (Int J Eat Disord 2011; 44:81–90) Introduction The treatment of BED remains a challenge.5 Cogni- tive behavioral and interpersonal therapies and selec- Binge eating disorder (BED), characterized by recur- tive serotonin-reuptake inhibitor (SSRI) antidepres- rent binge-eating episodes without inappropriate sants are effective for reducing binge eating, but usu- 1 compensatory weight loss behaviors, is an impor- ally are not associated with clinically significant tant public health problem.
    [Show full text]
  • The Use of Central Nervous System Active Drugs During Pregnancy
    Pharmaceuticals 2013, 6, 1221-1286; doi:10.3390/ph6101221 OPEN ACCESS pharmaceuticals ISSN 1424-8247 www.mdpi.com/journal/pharmaceuticals Review The Use of Central Nervous System Active Drugs During Pregnancy Bengt Källén 1,*, Natalia Borg 2 and Margareta Reis 3 1 Tornblad Institute, Lund University, Biskopsgatan 7, Lund SE-223 62, Sweden 2 Department of Statistics, Monitoring and Analyses, National Board of Health and Welfare, Stockholm SE-106 30, Sweden; E-Mail: [email protected] 3 Department of Medical and Health Sciences, Clinical Pharmacology, Linköping University, Linköping SE-581 85, Sweden; E-Mail: [email protected] * Author to whom correspondence should be addressed; E-Mail: [email protected]; Tel.: +46-46-222-7536, Fax: +46-46-222-4226. Received: 1 July 2013; in revised form: 10 September 2013 / Accepted: 25 September 2013 / Published: 10 October 2013 Abstract: CNS-active drugs are used relatively often during pregnancy. Use during early pregnancy may increase the risk of a congenital malformation; use during the later part of pregnancy may be associated with preterm birth, intrauterine growth disturbances and neonatal morbidity. There is also a possibility that drug exposure can affect brain development with long-term neuropsychological harm as a result. This paper summarizes the literature on such drugs used during pregnancy: opioids, anticonvulsants, drugs used for Parkinson’s disease, neuroleptics, sedatives and hypnotics, antidepressants, psychostimulants, and some other CNS-active drugs. In addition to an overview of the literature, data from the Swedish Medical Birth Register (1996–2011) are presented. The exposure data are either based on midwife interviews towards the end of the first trimester or on linkage with a prescribed drug register.
    [Show full text]
  • Treating Substance Abuse •
    • Treating Substance rain Abuse Theory and Technique usance Third Edition Theor.y and USeTechmque Edited by Scott 1. Walters Frederick Rotgers THIRD EDITIO ~ THE GUILFORD PRESS . New York London 2B2 TREATING SUBSTANCE ABUSE Chapter 11 This chapter first presents the basics of brain function, including the neurotransmitters and pathways involved in substance abuse. This under­ standing provides the foundation for the subsequent presentation of medi­ Neurobiological Bases cations used to treat addictive disorders. This chapter focuses on medi­ cations approved by the U.S. Food and Drug Administration (FDA) for of Addiction Treatment alcohol dependence and opioid dependence with an overview of promis­ ing new developments for stimulant and cannabis dependence. (Carroll & Kiluk. Chapter 12, this volume) in this book talks more specifically about Philip H. Chung integrating psychotherapy with pharmacotherapy. Julie D. Ross Sidarth Wakhlu Brain Basics Bryon Adinoff Neurons and the Brain MicroscopicaHy, the brain is composed of a collection of cells, or neurons, that signal one another both chemically and electrically. Electrical signals are lIsed to communicate within cells, and chemical signals are used to com­ municate between cells. Most neurons have a characteristic structure that consists of a globular cell body with numerous long, spindly projections coming off the central cell body (Figure 11.1). These projections are used in the process of signaling between neurons and receive communications from their sometimes-distant cell bodies. The axon of a signaling cell projects to ovcr the past two decades stunning progress has been made in the dendrite of the receiving cell, and the twO projections come into dose understanding the psychopathology of addiction.
    [Show full text]
  • W08. Update in Addiction Medicine
    Canadian Society of Internal Medicine Annual Meeting 2017 Toronto, ON Update in Addiction Medicine Rajesh Gupta University of Toronto Division of GIM, St. Michael’s Hospital CSIM Annual Meeting 2017 The following presentation represents the views of the speaker at the time of the presentation. This information is meant for educational purposes, and should not replace other sources of information or your medical judgment. Learning Objectives: 1. Advise patients of the effectiveness and risks of buprenorphine and methadone in the treatment of opioid use disorder 2. Develop a process for providing safe transitions for patients on buprenorphine or methadone 3. Select an appropriate pharmacologic agent for treating alcohol use disorder . CSIM Annual Meeting 2017 Conflict Disclosures I have no conflicts to declare CSIM Annual Meeting 2017 Some of the drugs, devices, or treatment modalities Mentioned in this presentation are: Buprenorphine/naloxone, methadone Naltrexone, gabapentin, acamprosate Baclofen, ondansetron, topiramate I intend to make off-label therapeutic recommendations for medications Scope of Hospital-based OAST • Survey • Development of the SMH addiction team Case 1 30 yo woman with IV hydromorphone addiction presents with pneumonia requiring IV antibiotics and supplemental O2. She uses hydromorphone 8 mg IV q3h, bought on the street. She complains of vague chest pain over the area of the pneumonia. She is requesting IV hydromorphone 8 mg q3h for the chest pain. She suggests she will have to get it somehow, to prevent withdrawal and ongoing pain, etc. What do you recommend? Case 2 50 yo man with opioid use disorder in remission x 3 years on methadone 75 mg daily.
    [Show full text]
  • View the Scientific Program Abstracts of the ACAAM 2020 Annual Meeting
    Scientific Program Abstracts of the ACAAM 2020 Annual Meeting AMERICAN COLLEGE OF ACADEMIC ADDICTION OF ACADEMIC MEDICINE AMERICAN COLLEGE ADDICTION OF ACADEMIC MEDICINE AMERICAN COLLEGE ADDICTION OF ACADEMIC MEDICINE AMERICAN COLLEGE ADDICTION OF ACADEMIC MEDICINE AMERICAN COLLEGE AMERICAN COLLEGE OF ACADEMIC ADDICTION MEDICINE OF ACADEMIC AMERICAN COLLEGE March 24, 2020 On behalf of the Poster Sub-Committee for the Annual Meeting of The American College of Academic Addiction Medicine I am writing with several updates about the canceled 2020 Annual Meeting poster session to which you had been accepted. 2020 Meeting & Poster Session The 2020 meeting previously scheduled for April in Denver will not be rescheduled as an in- person meeting. We are currently re-imagining the meeting as a series of bi-monthly online gatherings to stay in touch and share important information. One possibility is to use the June gathering to showcase your posters and celebrate the graduates. Expect to receive more information after the current public health issues become clearer and we work out the logistics. 2020 Poster Session Winners Poster session winners were selected prior to cancellation of the meeting and we would like to recognize them here: Emily Buirkle, MD - Rutgers University Co-Author: Erin Zerbo, MD Buprenorphine induction with microdosing: A review of the literature Haileigh Ross, OD - Ohio Health Grant Medical Center Co-Author: Krisanna Deppen, MD A novel case of injectable buprenorphine for opioid use disorder in pregnancy Kumar Vasudevan, MD - NYU School of Medicine Co-Authors: Mia Malone; Ryan McDonald, MA; Anna Cheng; Michael Matteo, CASAC; Monica Katyal, JD MPH; Jasdeep Mangat, MD; Jonathan Giftos, MD; Ross MacDonald, MD; Joshua D.
    [Show full text]
  • CAMPRAL (Acamprosate Calcium)
    CAMPRAL® (acamprosate calcium) Delayed-Release Tablets Rx Only DESCRIPTION CAMPRAL® (acamprosate calcium) is supplied in an enteric-coated tablet for oral administration. Acamprosate calcium is a synthetic compound with a chemical structure similar to that of the endogenous amino acid homotaurine, which is a structural analogue of the amino acid neurotransmitter γ-aminobutyric acid and the amino acid neuromodulator taurine. Its chemical name is calcium acetylaminopropane sulfonate. Its chemical formula is C10H20N2O8S2Ca and molecular weight is 400.48. Its structural formula is: O C CH2 CH2 _ H3C NH CH2 SO3 Ca2+ _ H3C NH CH2 SO3 C CH2 CH2 O Acamprosate calcium is a white, odorless or nearly odorless powder. It is freely soluble in water, and practically insoluble in absolute ethanol and dichloromethane. Each CAMPRAL tablet contains acamprosate calcium 333 mg, equivalent to 300 mg of acamprosate. Inactive ingredients in CAMPRAL tablets include: crospovidone, microcrystalline cellulose, magnesium silicate, sodium starch glycolate, colloidal anhydrous silica, magnesium stearate, talc, propylene glycol and Eudragit® L 30 D or equivalent. Sulfites were used in the synthesis of the drug substance and traces of residual sulfites may be present in the drug product. CLINICAL PHARMACOLOGY Pharmacodynamics The mechanism of action of acamprosate in maintenance of alcohol abstinence is not completely understood. Chronic alcohol exposure is hypothesized to alter the normal balance between neuronal excitation and inhibition. In vitro and in vivo studies in animals have provided evidence to suggest acamprosate may interact with glutamate and GABA neurotransmitter systems centrally, and has led to the hypothesis that acamprosate restores this balance. Reference ID: 2876691 Pharmacodynamic studies have shown that acamprosate calcium reduces alcohol intake in alcohol-dependent animals in a dose-dependent manner and that this effect appears to be specific to alcohol and the mechanisms of alcohol dependence.
    [Show full text]
  • Currently Prescribed Psychotropic Medications
    CURRENTLY PRESCRIBED PSYCHOTROPIC MEDICATIONS Schizophrenia Depression Anxiety Disorders 1st generation antipsychotics: Tricyclics: Atarax (hydroxyzine) Haldol (haloperidol), *Anafranil (clomipramine) Ativan (lorazepam) Haldol Decanoate Asendin (amoxapine) BuSpar (buspirone) Loxitane (loxapine) Elavil (amitriptyline) *Inderal (propranolol) Mellaril (thioridazine) Norpramin (desipramine) Keppra (levetiracetam) Navane (thiothixene) Pamelor (nortriptyline) *Klonopin (clonazepam) Prolixin (fluphenazine), Prolixin Sinequan (doxepin) Librium (chlordiazepoxide) Decanoate Spravato (esketamine) Serax (oxazepam) Stelazine (trifluoperazine) Surmontil (trimipramine) Thorazine (chlorpromazine) *Tenormin (atenolol) Tofranil (imipramine) MEDICATIONS PSYCHOTROPIC PRESCRIBED CURRENTLY Trilafon (perphenazine) Tranxene (clorazepate) Vivactil (protriptyline) Valium (diazepam) 2nd generation antipsychotics: Zulresso (brexanolone) Vistaril (hydroxyzine) Abilify (aripiprazole) Aristada (aripiprazole) SSRIs: Xanax (alprazolam) Caplyta (lumateperone) Celexa (citalopram) *Antidepressants, especially SSRIs, are also used in the treatment of anxiety. Clozaril (clozapine) Lexapro (escitalopram) Fanapt (iloperidone) *Luvox (fluvoxamine) Geodon (ziprasidone) Paxil (paroxetine) Stimulants (used in the treatment of ADD/ADHD) Invega (paliperidone) Prozac (fluoxetine) Invega Sustenna Zoloft (sertraline) Adderall (amphetamine and Perseris (Risperidone injectable) dextroamphetamine) Latuda (lurasidone) MAOIs: Azstarys(dexmethylphenidate Rexulti (brexpiprazole) Emsam (selegiline)
    [Show full text]