feat(ad+narc): 4 TCA + 4 AUD anti-craving drug cards (batch 6)#15
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TCA (4, post-Soviet/Avrutskiy classics, in Ukrainian formulary): - drug_amitriptyline — sedative tertiary amine, neuropathic pain + insomnia + depression, ⚠ cardiotoxicity, ⚠ Beers-Avoid in elderly - drug_clomipramine — most serotonergic TCA, FDA OCD pivotal, ⚠ seizures >250 mg - drug_nortriptyline — secondary amine (active metabolite of amitriptyline), cleaner profile, TCA OF CHOICE in elderly, unique therapeutic window (50-150 ng/mL, paradoxical worsening above) - drug_imipramine — first TCA ever (Kuhn 1958), FDA childhood enuresis ≥6, panic disorder pioneer (Klein 1962) AUD ANTI-CRAVING (4, often used post-detox): - drug_naltrexone — μ-opioid antagonist, FDA AUD+OUD, COMBINE study positive, Vivitrol depot q4w, ⚠ ABSOLUTE CONTRAINDICATION with opioids, hepatotoxicity - drug_acamprosate — NMDA modulator, abstinence-supporting, EXCELLENT safety profile, no CYP interactions, ⚠ horrible compliance (TID dosing) - drug_disulfiram — ALDH inhibitor, aversion-based, FDA 1949, ⚠ requires supervised use; covers post-Soviet 'esperal/torpedo' subcutaneous implant practice with clinical caveats - drug_nalmefene — μ/δ-antagonist + κ-partial agonist, EU only, as-needed dosing for high-DRL pacients (NICE TA325) Stats: 161 → 169 entries (+8), 645 → 699 citations.
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Sixth batch: TCAs (Avrutskiy classics, in Ukrainian formulary) + AUD anti-craving meds (already mentioned in alg_alcohol_withdrawal but now with full drug-card detail).