1: Addiction Flashcards
What is addiction
Maladaptive pattern of substance abuse leading to clinically significant distress
What is the DSM-5 criteria for addiction
Requires 3 of the following:
- Tolerance
- Using Large amounts or long time period
- Use despite knowledge of harm
- Craving
- Withdrawal
- Unsuccessful attempts at control
- Time spent in activities to obtain, use or recover
- Important activités given up
What are the 4 syndromes ICD-10 describe for addiction
- Acute intoxication
- Harmful Use
- Dependence Syndrome
- Withdrawal state
Define acute intoxication
Transient condition following administration of alcohol or substance causing disturbed consciousness or other psychophysiological functions
Define harmful use
Use of substance abuse that is damage to health. Can be physical or mental;
Define dependence syndrome
Cluster of physiological, behavioural and cognitive phenomenon in which use of a substance takes higher priority that other values that once had greater value
Define withdrawal state
Symptoms occurring on absolute or relative withdrawal of a substance
Define tolerance
Using more of a substance to achieve same effects
Define hazardous drinking
Binge drinking and consumption of:
- 22-50 units in men
- 15-35 units in females
What defines hazardous drinking in men
Consumption 22-50 units
What defines hazardous drinking in females
Consumption 15- 35 units in females
Define harmful drinking in males
Consumption >50 Units in males
Define harmful drinking in females
Consumption >35 Units in females
What is normal advice regarding alcohol
- Do not consume more than 14-units per week
- Try to spread alcohol consumption over 3-days
- Do not drink if pregnant
What is used to measure drinks strength
ABV (Alcohol By Volume)
How is units calculated
(ABV x mL)/1000
What are 5 risk factors for alcohol misuse
- Young
- Male
- FH
- Low socio-economic group
- Occupation - doctors
What are 5 features of alcohol mis-use disorder
- Tolerance
- Narrowing repotoir of drinks
- Failure abstinence
- Withdrawal symptoms
- Maintaining intake is a priority
What can alcohol withdrawal lead to
Delirium tremens
When does delirium tremens usually occur
48-96h after
Define delirium tremens
State of impaired consciousness and sympathetic over-activity due to alcohol withdrawal
What are the symptoms of delirium tremens
- Impaired consciousness
- Generalised tonic-clonic seizures
- Visual and tactile hallucinations - insects crawling
over them - Hyper-reflexia
- Intention tremor
Sympathetic Over-Activity:
- Sweating
- Tachycardia
- HTN
- Nausea
What is a common hallucination in delirium tremens
Insects crawling over them (tactile of visual)
What is wenicke’s Encephalopathy
Neuropsychiatric disorder caused by deficiency in thiamine
What is the triad of symptoms in Wernicke’s encephalopathy
- Ophthalmoplegia
- Confusion
- Ataxia
If untreated what does Wernicke’s encephalopathy progress to
Korsakoff syndrome
What is Korsakoff’s syndrome
Symptoms of Wernicke’s (ophthalmoplegia, confusion, ataxia) with:
- Anterograde or retrograde amnesia
- Confabulation
What are screening tests for alcohol misuse disorder
- CAGE
- AUDIT
What is the CAGE questionnaire
Cut down
Annoyed at drinking
Guilty about drinking
Eye-opener
What score on CAGE indicates hazardous consumption
> 2/4
What score in AUDIT tool should indicate referral to specialist alcohol services
> 15
What does AUDIT stand for
Alcohol Use Disorder Identification Test
What is used in assessment for alcohol misuse disorder
Alcohol history and psychiatric assessment
What conservative measures are offered for alcohol mis-use disorder
- SMART therapy
- Motivational Interviewing
- If wernicke-korsakoff’s offer supported living
Harmful drinking:
- CBT
- Behavioural Therapies
- Social network and environment therapies
What is used for acute alcohol withdrawal
- Benzodiazepines
- Pabrinex
- 10% Glucose
How much pabrinex is given
2 ampoules IV over 2-days
If an alcoholic is hypoglycaemia what is given
Give pabrinex
Then give glucose
What is given to treat alcohol-withdrawal seizures
Chlordiazepoxide or diazepam
What is preferred if alcoholic has liver impairment
Lorazepam
When is inpatient program for withdrawal indicated
> 30 SADQ
30 Units
Concurrent benzodiazepine withdrawal
History epilepsy
Explain legal aspects of alcohol misuse disorder
Alcohol mis-use disorder is not classified under mental health act - so individuals cannot be detained
What are 3 medications that help long-term with withdrawal
Disulfram
Acamprosate
Naltrexone
What is the MOA of acamprosate
NMDA antagonist. Reduces Craving
What is the MOA of naltrexone
Opioid receptor antagonist - reduces reward of drinking
What needs to be checked prior to starting disulfram
U+E, LFT
What is MOA of disulfram
Acetaldehyde dehydrogenase - which causes accumulation of acetaldehyde
What can vitamin B12 deficiency cause
Microcytic anaemia
Subacute combined degeneration of spinal cord
What is alcohol ketoacidosis
Raised anion gap metabolic acidosis - due to impaired glucose metabolism (alcohol, malnutrition)
How does alcoholic ketoacidosis present
Abdominal pain
Nausea and vomiting
Tachypneoa
What are 5 features of foetal alcohol syndrome
- Hypoplastic upper lip
- Smooth philtrum
- Microcephaly
- VSD
- Down-slanting palpabrae fissures
What are the 5 ICD-10 criteria to define nicotine dependence
- Tolerance
- Withdrawal
- Impaired Control
- Ongoing use despite risks
- Social adverse effects
What do NICE recommend for assessing nicotine dependence
Nicotine dependence should be assessed at each appointment using pack years, then very brief advice should be use
How are pack years calculated
(Number Packs Smoked Per Day x Years)/ 20
How are pack years calculated
(Number Packs Smoked Per Day x Years Smoked)/ 20
What are the two questions to assess nicotine dependence
- How many cigarettes smoker per day
- How soon after waking up do you smoke
What are 4 conservative manages to stop smoking
- Refer to stop smoking services
- Behavioural support
- Set a quite date
- Advice
What advice is given to stop smoking
- Not a puff rule
- Discuss methods to stop cravings
- Avoid people smoking
- Discuss barriers
What are three medications for smoking cessation
Varencline
Buproprion
NRT
What nicotine replacement therapy should be used
Use long-acting such as nicotine patch and short-acting such as gum to treat cravings
What is the MOA of varencline
Partial nicotine receptor agonist
How do you remember the MOA of varencline
V(arencline) is V similar to nicotine
What is the brand name of varnecline
Champix
What is the MOA of buproprion
Dopamine and Noradrenaline re-uptake inhibitor
Explain NICE recommendation on smoking in pregnancy
- Test with CO detector
- Any women who stopped smoking, stopped in 2W or CO >7 refer to stop smoking services
What medications are CI in pregnancy for smoking cessation
Varencline
Buproprion
What is experimental use of drugs
Using drugs to try effects
What is situational drug use
Using drugs in certain situations
What is recreational drug use
Regular, non-dependent use
What is dependent use
Fits criteria for dependence syndrome
What opioid is usually abused
Heroine
What is clinical presentation of opioids
Euphoria
Relaxation
What are side effects of opioids
N+V
Constipation
Injection has risk of abscess, cellulitus, HIV, Hep B and Hep C
What are 4 symptoms of OD in opioids
- Pin point pupils
- Resp distress
- Bradycardia
- Hypotension
How will pupils present in opioid over-dose
Pin-point
What symptoms does withdrawal of opioids cause
- Sweating
- Rhinorrhoea
- Anxiety
- Cold sweats
- Severe muscle pain
- Diarrhoea
What is a key symptoms of opioid withdrawal
Severe muscle pain
Describe symptom-onset in opioid withdrawal
Symptoms onset 6-24h
Persist 5-7d
Explain harm-reduction for opioid abuse
Describes methods to ensure users take opioids in safer way
What are 5 methods of harm-reduction in opioid abuse
- Needle Program
- Safe Injecting Advice: sterile water, rotate sites, avoid neck and groin
- Methadone - come to clinic to take
- Naloxone - give rescue naloxone incase they OD
What are two medications that can be used to aid withdrawal of opioids
Methadone
Buprenorphine
What is the mechanism of methadone in opioid withdrawal
Methadone is a long-acting opioid, is saturates opioid receptors causing no additional benefit to injecting
What is the mechanism of action of buprenorphine
Partial opioid receptor agonist
What can be given to treat OD of opioids
Naloxone
