PSYCHIATRY > Substance Misuse > Flashcards

Substance Misuse Flashcards

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1
Q

define the features of alcohol dependence

A
  • daily alcohol consumption
  • strong urges
  • cravings for alcohol
  • difficulty controlling consumption
  • tolerance to effects
  • withdrawal symptoms when stopping
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2
Q

explain the mechanism of long term alcohol consumption

A

depressant
- stimultes GABA (relaxing effect on brain)
- inhibits glutamate receptor (fruther relaxation on electrical activity)
- GABA downregulates + glutamate upregulrated to balance effects of alcohol

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3
Q

what are the recommendations for alcohol consumption according to Department of Health

A
  • Not more than 14 units per week
  • Spread evenly over 3 or more days
  • Not more than 5 units in a single day
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4
Q

how is binge drinking defined

A
  • 6 or more units for women
  • 8 or more units for men
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5
Q

what are 4 complications of alcohol in early pregnancy

A
  • Miscarriage
  • Small for dates
  • Preterm delivery
  • Fetal alcohol syndrome
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6
Q

give 5 complications of alcohol excess

A
  • Alcohol-related liver disease
  • Cirrhosis and its complications (e.g., oesophageal varices, ascites and hepatocellular carcinoma)
  • Alcohol dependence and withdrawal
  • Wernicke-Korsakoff syndrome (WKS)
  • Pancreatitis
  • Alcoholic cardiomyopathy
  • Alcoholic myopathy, with proximal muscle wasting and weakness
  • Increased risk of cardiovascular disease (e.g., stroke or myocardial infarction)
  • Increased risk of cancer, particularly breast, mouth and throat cancer
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7
Q

what is the AUDIT questionnaire

A

screen for harmful alcohol use
- involves ten questions with multiple-choice answers and gives a score
- score of 8 or more indicates harmful use.

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8
Q

CAGE questions

A
  • C – CUT DOWN? Do you ever think you should cut down?
  • A – ANNOYED? Do you get annoyed at others commenting on your drinking?
  • G – GUILTY? Do you ever feel guilty about drinking?
  • E – EYE OPENER? Do you ever drink in the morning to help your hangover or nerves?
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9
Q

what are examination findings of excess alcohol

A
  • Smelling of alcohol
  • Slurred speech
  • Bloodshot eyes
  • Dilated capillaries on the face (telangiectasia)
  • Tremor
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10
Q

give 4 possible blood results of alcohol excess

A
  • Raised mean corpuscular volume (MCV)
  • Raised alanine transaminase (ALT) and aspartate transferase (AST)
  • AST:ALT ratio above 1.5 particularly suggests alcohol-related liver disease
  • Raised gamma-glutamyl transferase (gamma-GT) (particularly notable with alcohol-related liver disease)
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11
Q

what are withdrawal symptoms within 6-12 hours

A
  • sweating
  • headache
  • craving
  • anxiety
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12
Q

what are withdrawal symptoms within 12-24 hours

A

hallucinations

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13
Q

what are withdrawal symptoms within 24-48 hours

A

seizures

peak time of seizure onset - 36 hrs

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14
Q

what are withdrawal symptoms within 24-72 hours

A

delirium tremens

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15
Q

explain the mechanism of delirium tremens

A

Long-term alcohol use results in the GABA system becoming down-regulated and the glutamate system becoming up-regulated to balance the effects of alcohol
- When alcohol is removed, the GABA system under-functions and the glutamate system over-functions, causing extreme excitability and excessive adrenergic (adrenaline-related) activity

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16
Q

how does delirium tremens present

A
  • Acute confusion
  • Severe agitation
  • Delusions and hallucinations
  • Tremor
  • Tachycardia
  • Hypertension
  • Hyperthermia
  • Ataxia (difficulties with coordinated movements)
  • Arrhythmias
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17
Q

what tool is used to score a patient and guide treatment in alcohol withdrawal

A

CIWA-Ar

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18
Q

what are the medication options for managing alcohol withdrawal

A
  • chlordiazepoxide (Librium): benzo
  • high dose vitamin B (Pabrinex) + long term oral thiamine

thiamine to prevent wernicke-korsakoff

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19
Q

how is chlordiazepoxide administered

A
  • given orally as reducing regime titrated to required dose based on local alcohol withdrawal protocol
  • dose reduced over 5-7 days
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20
Q

what are interventions involved in the long term management of alcohol dependence

A
  • Specialist alcohol service involvement
  • Alcohol detoxification programme
  • Oral thiamine to prevent Wernicke-Korsakoff syndrome
  • Psychological therapy (e.g., cognitive behavioural therapy)
  • Acamprosate, naltrexone or disulfiram are medications used to help maintain abstinence
  • Informing the DVLA (their driving licence will be revoked until an extended period of abstinence)
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21
Q

why does alcohol exces lead to thiamine/B1 deficiency

A

thiamine is poorly absorbed in the presence of alcohol
- alcoholics have poor diets and get many calories from alcohol

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22
Q

give 3 features of wernicke’es encephalopathy

Study These Flashcards
A
  • Confusion
  • Oculomotor disturbances e.g. nystagmus
  • Ataxia

medical emergency with a high mortality rate

23
Q

give 2 features of korsakoff syndrome

Study These Flashcards
A
  • Memory impairment (retrograde and anterograde)
  • Confabulation (makes up 2 different stories)

often irreversible and results in patients requiring full-time institutional care

24
Q

what are the 3 main features of substance dependence disorder

Study These Flashcards
A
  1. impaired control: cravings, using longer than needed
  2. salience: substance use takes priority
  3. physiological features: tolerance, withdrawal syndrome
25
what is the pathophysiology of wernicke-korsakoff
lesions around the third ventricle and aqueduct - includes dorsomedial thalamus, mamillary bodies and hypothalamus
26
how does excess alcohol lead to brain injury
- loss of white matter - increase in ventricular size - frontal lobes esp at risk
27
what are the 3 main features of alcohol brain injury
1. **frontal lobe syndrome**: impairment of judgement, loss of perseverance 2. **cerebellar degeneration**: unsteady gate, difficulties in coordination 3. **alcoholic amblyopia**: gradual blurred vision, central scotoma
28
how is an alcohol detox prescribed
- use SADQ to guide level of prescribing BZD detox regime - clarify time since last drink - use breathalyser if available
29
what should be prescribed in an alcohol detox
reducing schedule of benzodiazepines
30
what are subtle signs of alcohol dependence O/E
- hypertension & pulse > 120bpm - vertical nystagmus - hypotension & hypothermia - loss of ankle reflex - left flank/back pain
31
how is alcohol dependence classified according to ICD10
F10.2 F10: mental and behavioural disorders due to alcohol use
32
to qualify for alcohol dependence, what crtiera must a person exhibit
at least three of the following criteria within a 12-month period 1. strong desire or compulsion to drink 2. impaired self-control, a physiological withdrawal state (e.g., tremors, anxiety) 3. tolerance (requiring more alcohol for the same effect) 4. progressive neglect of other interests 5. continued drinking despite harm
33
what are appropriate blood tests that should be done before prescribing alcohol detox
- FBC - INR, - Urea and electrolytes - Liver function tests inc Gamma-glutamyl transferase - Thyroid function tests - Lipid profile - Vitamin B12, folate - Calcium, Magnesium, Phosphate, Glucose
34
what are observations that should be done regularly as part of alcohol detox
* temperature * pulse * respiratory rate * blood pressure
35
what are the features of opioid misuse
* rhinorrhoea * needle track marks * pinpoint pupils * drowsiness * watering eyes * yawning
36
what are the complications of opioid misuse
* **viral infection** secondary to sharing needles: HIV, hepatitis B & C * bacterial infection secondary to injection: infective endocarditis, septic arthritis, septicaemia, necrotising fasciitis * **VTE** * overdose may lead to **respiratory depression and deat**h * **psychological problems**: craving * **social problems**: crime, prostitution, homelessness
37
what is the emergency management of opioid overdose
**IV or IM naloxone** rapid onset and relatively short duration of action
38
give 2 examples of harm reductions interventions
* needle exchange * offering testing for HIV, hepatitis B & C
39
who is involved with managing opioid dependence
specialist drug dependence clinics although some GPs with a specialist interest offer similar services ## Footnote patients may be offered maintenance therapy or detoxification
40
what does NICE recommend as 1st line treatment in opioid detoxification
methadone or buprenorphine ## Footnote methadone LESS ADDICTIVE
41
describe the MOA of methadone
**full agonist of the mu-opioid receptor** - binds to these receptors in the brain and fully activates them - action can **relieve withdrawal symptoms and cravings** - **long half life**
42
describe the MOA of buprenorphine
**partial agonist of the mu-opioid receptor & antagonist of the kappa-opioid** - binds to the mu-opioid receptors in the brain but only partially activates them - partial activation is enough to **alleviate cravings and withdrawal symptoms** in individuals with opioid dependence - binding of buprenorphine to the mu-opioid receptor is very strong, or '**high affinity**,' meaning it can **displace other opioids** from these receptors and prevent them from exerting their effects - kappa-opioid receptor antagonist, buprenorphine may contribute to its ability to **reduce symptoms of opioid withdrawal** and potentially **reduce depressive and dysphoric states**
43
how is compliance to opioid detox monitored
urinalysis
44
how long does opioid detox last
up to **4 weeks in an inpatient**/residential setting and up to **12 weeks in the community**
45
what are the signs of opiate misuse
- pinpoint pupils - decreasing consciousness - slow breathing - death
46
what are the early signs and symptoms of opiate withdrawal (12 hrs)
- Sweaty clammy skin - Persistent yawning - Rhinorrhoea - Tachycardia - Restlessness - dilated pupils - lacrimation - goosebumps
47
what are the late signs and symptoms of opiate withdrawal (day 2-3)
- N&V - diarrhoea - insomnia - abdo cramps - muscle pains
48
give 2 examples of stimulants
amphetamine cocaine
49
what are 4 techniques used when discussing substance misuse
1. reflection 2. resistance 3. change talk 4. motivational interviewing
50
which illicit drugs may produce a schizophrenia-like state
- cocaine - methamphetamine - cannabis - heroin - LSD
51
how long after the last drink does delirium tremens present
48-72 hours
52
what is the use of acamprosate
shown to be effective in preventing alcohol relapse in combination with psychological support following detoxification in alcohol dependence syndrome - minimal side-effect and risk profile and is safe in combination with alcohol ## Footnote typically described as 'anti-craving medication'
53
what is alcoholic myopia
alcohol restricts both perception and cognition, causing intoxicated individuals to focus only on the most salient or prominent cues in their environment, leading to a range of potentially dangerous behaviors - reduced information processing, impaired decision-making, intensified emotional responses, and disinhibited actions like increased aggression or impulsivity
54
why do people who drink excessive amounts alcohol develop polyuria
ethanol **inhibits ADH secretion** by blocking channels in the **neurohypophyseal nerve terminal**
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