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Across 4. these drugs are derived from opium including morphine, codeine and other semisynthetic congeners derived from them (including methadone) 7. ____ onset, or type A, alcoholics start abusing alcohol later in life, alcohol is likely a coping mechanism, and they may be more responsive to treatment 8. heroin (diacetylmorphine) is _________ to morphine 11. _____ onset, or type B, alcoholics start abusing alcohol early in life, have a strong family history, and there's likely a genetic component 12. fully __________ opiate w/drawal occurrs 1-3 days after last use; grade 3: tachycardia, tachypnea, HTN, fever, anorexia or nausea, exterme restlessness; grade 4: D and/or V, dehydration, hypoglycemia, hypotension, curled-up (fetal) position 13. this drug to treat alcohol dependence, brand name Antabuse, produces behavior modification by producing aversive stimuli from the ingestion of alcohol; blocks ADH which increases acetylaldehyde formation; results in HA, facial flushing, NV, tachycardia, palpitations, hypotension; AEs are seizures, drowsiness and hepatotoxicity; long term data doesn't show a beneficial effect but those w/witnessed administration respond quite well 14. this drug to treat opiate withdrawal, brand name Subutex, is given 4-8 mg SL 16. the goal of therapy in opiate dependence is to reduce _______ opiate use resulting in increased pt opportunities to escape addiction lifestyle, reduces medical comorbidities and criminal comorbidity, reduces societal cost of addictive disorder/behavior 17. most withdrawal symptoms last a ___ days and rarely more than 1 week 19. this class of anticonvulsants is used to treat alcohol w/drawal; 21. long-term _____________ associated w/alcohol abuse are: cirrosis, pancreatitis, uclers, inc. in esophageal and stomach cancer, HTN, inc. in LDL, dec. in testosterone, amenorrhea, peripheral neuropathy, memory impairment, Wenickes encephalophathy, Korsakoff syndrome 22. MVI, thiamine, folic acid, Mg, glucose are given in alcohol withdrawal to protect against ____________ complications and b/c of high incidence of malnutrition; give vit B before glucose to prevent Wernickes syndrome 23. ___________ treatment, or dependence therapy, is when pts consume a long-acting prescription opiod medication as a substitute for the illegal short-acting street opioid; leads to lower rates of heroin use, decreased crime rate, improvements in physical and mental health, and is more cost effective 24. this class of medication used to treat alcohol withdrawal also reduces autonomic manifestations 26. this drug used for opiate dependence is a full opioid agonist; FDA regulations to receive it are 1 yr of opiate use, physiologically dependent, if under 18 must have had 2 attempts at short-term detox or drug free treatment; start at 10-40 mg qd, must come to clinic and take in front of dispenser; dose adjusted based on pts reports of cravings to trained substance abuse counselor; can range from 5-150 mg/day and doses over 50 mg show increased success 28. other effects of an ______ ingestion of alcohol is vasodilation, gastric secretions increased, diuresis due to inhibition of ADH, small elevations in catecholamines 29. this drug to treat opiate withdrawal, brand name Methadose, is an opioid agonist; start at 30 mg then give another 10 mg prn; slowly taper receptor stimulation down based on response and symptoms 30. _____________ associated w/opiate use are psych disorders, HIV, hep-B and C, TB, malnutrition, head trauma, abscesses 31. the ____ of therapy for treating alcohol dependence is to decrease the frequency of substance use days and the amount of substance ingested per setting and per month 36. this stage of alcohol w/drawal occurs in 48 hrs up to 10 days; have delirium tremens 37. this is charachterized by someone going thru detox and will make something up to answer question; brain remembers something that happens when it doesn't 38. ________ reinforcement is when withdrawal symptoms or disease symptoms that the abused substance was treating apperar 40. other drugs to treat opiate __________ are guanfacine, midazolam and naltrexone, benzodiazepines, propoxyphene 43. __________ 50 mg/day used to prevent opioid effects if pt uses opioids during recovery; blocks heroin high and other effects; pt must be narcotic free 7 to 10 days before starting therapy; noncompliance and low pt acceptance an issue 45. the ________ of therapy is as long as the pt needs it; the longer the treatment is the less likely the pt will relapse 46. ________ reinforcement is the introduction of euphoria 47. _____ opiate w/drawal occurrs 8-24 hrs after last use; grade 1: lacrimation and/or rhinorrhea, diaphoresis, yawning, restlessness, insomnia; grade 2: dilated pupils, piloerection, muscle twitching, mayalgia and arthralgia, abdominal pain 48. signs of alcohol ________ are confusion, ataxia, coma, death; seizures due to hypoglycemia; nystagmus 49. this drug to treat alcohol dependence, brand name Vivitrol, decreases the positive effects of alcohol by inhibiting opiate receptors; still see negative effects of alcohol, safer than disulfiram; dosed 25 mg qd x 4 days b/c can go thru w/drawal since have endogenous stimulation of opioid receptors then 50 mg qd; should be combined w/group therapy AEs are N, HA, dizziness but should resolve w/in 3 wks; treats those seeking reward via alcohol, hepatically metabolized, also reduces heroin relapses 51. buprenorphine may be _____ than methadone since DI w/diazepam not as severe and has less QTc changes

Down 1. this stage of alcohol w/drawal occurs in a few to 48 hrs; has autonomic hyperactivity 2. this other option for alcohol dependence treatment should only be used in non depressed late onset (type A) males b/c early onset (type B) get worse 3. this drug to treat opiate withdrawal, brand name Catapres, decreases CV effects; start at 0.1-0.3 mg TID but adjust as necessary; can add 12.5 mg of naltrexone to shorten withdrawal but makes symptoms worse 5. this drug to treat alcohol dependence, brand name Campral, is believed to minimize the negative cravings associated w/withdrawal; MOA is GABA enhancement (calm person down), Ca channel blockade, reduces glutamate activity; dosed 666mg TID or 100 mg BID; diarrhea most common AE; better efficacy if combined w/group therapy, % abstinent after 6 mos ~25-45%, days abstinent and time to relace twice as good as placebo, time to first relapse 8 wks; safe in overdose; treats those craving alcohol for relief of symptoms, renally cleared, no effect on opiate receptors 6. medical maintenance is _______ care has less societal and professional stigma, more pts may enroll, medical comorbidities can be addressed, increased access for pts, more appropriate allocation of resources BUT don't have support and MDs aren't very well trained 9. after physical symptoms of withdrawal have ended, emotional symptoms can persist for months and is a sign of alcohol __________; is pervasive and leads to dramatic increases in medical and psychiatric complications 10. this class of anticonvulsants isn't used often due to the safety of benzodiasepines 14. this drug to treat opiate dependence is a partial opioid agonist; brand name is Subutex; ceiling effect so heroin doesn't effect it; can't OD on; can be dosed qod; pts more likely to be: male, full time employed, fewer yrs of opioid dependence, lower rates of inj use 15. Wernickes ______________ is characterized by ataxia, confusion, ocular muscle disturbances 18. ___________ therapy delays time to relapse and % relapse is less than in monotherapy 20. this class of medication is used to reduce agitation of alcohol withdrawal 25. this drug to treat opiate dependence is a combination of buprenorphine and naloxone; given SL; AEs include cramps, N, constipation; used in less severe/intense addicts; has a shorter frequency; can dose qod 27. this class of drugs used to treat alcohol withdrawal reduces autonomic manifestations and protects the heart by decreasin BP and HR 32. _____ and ultra-rapid detox is done w/IV midazolam and IV naloxone; original success was very high and had high abstinence rates; highly motivated individuals more likely to remain abstinent regardless of treatment 33. Korsakoff ________ is characterized by amnesia, poor recall, confabulation; causes permanent impairment 34. buprenorphine is preferred in ________ b/c infants had milder opiate withdrawal syndrome when compared to methadone b/c methadone mothers have longer pregnancies, fewer complications, and larger birth weight babies 35. treatment of alcohol dependence involves __________ medical/psychiatric inducers, social/psychological inducers, anticraving compounds 39. this stage of alcohol w/drawal occurs in 12 to 48 hrs; have grand mal seizures 41. alchol's _____ effect is: augmentation of GABA, NMDA glutamate receptor antagonism, mild opiate receptor agonism, and 5-HT3 receptor augmentation 42. this area of treatment can be cued internally or externally 44. other _______ to treat alcohol dependence are topiramate (Topamax), ondansetron (Zofran), buspirone (Buspar), atypical antipsychotics, and antidepressants 50. those ___ to opiate dependence tx more likely to be: younger, caucasian, history of dependence, and hep C positive