Cannabis use disorder
Clinically significant problematic behavioral or psychological changes that develop during cannabis intoxication
anxiety, impaired judgment, impaired motor coordination, euphoria, social withdrawal
Cannabinoid receptor agonists
dronabinol, nabilone
How often can dronabinol be titrated
every 5-7 days
Decrease in cannabis use and improvement of withdrawal symptoms may be due to this tx but has conflicting evidence
gabapentin
MOA of topical capsaicin
interaction with TRVP1 or VR1
Which drugs should be avoided with use of Syndros (Dronabinol solution)
metronidazole or disulfiram within 14 days of dronabinol initiation
CNS risks with dronabinol
Exacerbate mental disorders (elderly especially), seizures
T/F: Cannabis withdrawal is life-threatening and needs to be aggressively treated
F
Target dose for gabapentin
1200 mg/day in divided doses
How many sx are needed and in what time frame to classify cannabis intoxication?
2 sx within 2 hrs of use
Cannabis withdrawal needs how many sx and in what time frame?
3 within and 1 physical sx causing significant discomfort ~1 week after use
How should dronabinol be taken
30 min prior to meal or on an empty stomach
Target daily dose for dronabinol for cannabis use disorder
30-120 mg/day (usually in divided doses)
Cannabinoid hyperemesis syndrome (CHS)
Cyclical vomiting in habitual marijuana users after cannabis discontinuation (typically daily users for years)
Difference between MET AND CBT
CBT- how to fix the problem MET- Motivation to make a change
Preparations of dronabinol
Capsule (marinol CIII) and solution (syndros CII)
Sx that may be present during cannabis intoxication
Conjunctival injection Increased appetite dry mouth tachycardia (DICT)
2nd line pcol tx for CHS
Dopamine agonists (haloperidol 5mg IV x1) topical capsaicin 0.1% applied to abdomen q4-6h PRN
If giving haloperidol for CHS, what needs to be monitored?
EKG
CV risks with dronabinol
Hypotension/HTN, syncope, tachycardia
First line Pcol tx for CHS
IV fluids for hydration and antiemetics, correct electrolytes if needed
Sx present during cannabis withdrawal may include
Irritability, anger, aggression nervousness or anxiety sleep difficulty Decreased appetite or weight loss restlessness depressed mood At least 1 physical sx: abdominal pain, shakiness/tremors, sweating, fever, chills, HA
Synthetic cannabinoids
K2 and spice
GI risks with dronabinol
N/V, abdominal pain, can induce CHS
Clinical presentation of CHS
Pts reporting taking long hot baths/showers to help)key sx) Severe N/V Vomiting recurs in a cyclic pattern over months Resolution of sx after stopping cannabis use
Which form of dronabinol can cause disulfiram rxns?
Solution
FDA approved uses for dronabinol
anorexia in pts with AIDS chemo-induced N/V
Clinical effects for cannabis use disorder include
reduce withdrawal sx reduce cravings improvement in sleep low abuse potential