13 - Substance Misuse Flashcards
What is the difference between crack and powder cocaine?
Once in blood stream it is the same
Crack = Smoked
Powder = Snorted
How is LSD taken?
- Brewed in bath
- Blotting paper soaked in LSD and tab put under tongue
What is the difference between brown and white heroin?
Brown: Smoke/Chase the Dragon or Injected in warm acid
White: Injected in water
Always ask what people mean when they are snorting lines, doesn’t just mean cocaine
What is the world’s biggest drug following alcohol and smoking?
Benzodiazepines
What drugs are more addictive?
Ones that are injected or smoked as higher reinforcement
Alcohol is biggest problem drug though!!
How does tolerance develop?
- Increased metabolism
- Dowregulation of receptors
Dopamine is cause of tolerance/addiction
What are some mental/behavioural disorders that are recognised in the ICD-10 as being secondary to substance misuse?
7 ways:
- Acute intoxication
- Harmful use (damage to health, either physical or mental)
- Dependence syndrome
- Withdrawal state
- Withdrawal state with delirium
- Psychotic disorder
- Amnesic syndrome
- Residual and late-onset psychotic disorder
How do you take a drug history?
- When do you feel like it became a problem?
- What happens if you don’t have it?
- Previous treatment episodes?
- Have you ever overdosed and what happened?
- BBV test and vaccine
TRAP: Trigger, Route, Amount, Pattern
What are features of opioid intoxication?
- Drowsiness
- Confusion
- Decreased respiratory rate
- Decreased heart rate
- Constricted pupils
- Track marks if heroin
- Collapsed veins
What are signs of cannabis intoxication?
- Drowsiness
- Impaired memory
- Slowed reflexes and motor skills
- Bloodshot eyes
- Increased appetite
- Dry mouth
- Increased heart rate
- Paranoia
What are signs of LSD intoxication?
- Labile mood
- Hallucinations
- Increased blood pressure
- Increased heart rate
- Increased temperature
- Sweating
- Insomnia
- Dry mouth
LSD primarily acts at dopamine receptors
What are signs of stimulant intoxication?
- Euphoria
- Increased blood pressure
- Increased heart rate
- Increased temperature
Stimulants such as cocaine or methamphetamine can, in low doses, produce a feeling of increased concentration and focus. Cocaine acts at dopamine receptors. Methamphetamine acts at TAAR1. Both increase the available amount of dopamine in the brain, producing the associated pleasurable effects of the drugs.
What are the features of dependence syndrome?
Requires 3 or more of the following:
1 A strong desire or sense of compulsion to take the substance (craving)
2 Difficulty in controlling substance use (onset, termination, level of use)
3 Physiological withdrawal when decreasing or ceasing
4 Tolerance: increased doses are required to produce the original effect
5 Progressive neglect of alternative pleasures or interests
6 Persisting use despite clear evidence of harmful consequence
What are some risk factors for substance misuse?
What is the difference between alcohol abuse and alcohol addiction?
Alcohol abuse implies that repeated drinking harms a person’s work or social life
Addiction implies dependence syndrome symptoms
What is the epidemiology, pathophysiology and risk factors for alcohol addiction?
Pathophysiology
Down regulation of inhibitory GABA receptors and upregulation of excitatory glutamate receptors so when alcohol is withdrawn it results in CNS hyperexcitability
Epidemiology:
4% prevalence of alcohol dependence
25% M and 15% F drink over recommended limit
What are the consequences of alcohol dependence to someone’s health?
- Fights/Falls
- Pancreatitis
- Chronic liver disease/failure
- Withdrawal
- Delirium Tremens
- Wernicke’s Encephalopathy
- Respiratory depression
How do you work out 1 unit of alcohol?
% x Volume
If someone is in ED and they are a drinker, what are some worrying symptoms?
Think about everything that can go wrong and then symptoms of those
What are some screening tools you can use to uncover at-risk drinking?
CAGE: 2 or more
TWEAK: Tolerance, Worried, Eye opener, Amnesia, Cut down >6
They do not pick up abuse or dependence
How can you assess the level that someone is drinking to?
- AUDIT questionnaire
- SADQ
What are the different stages of alcohol withdrawal and the time frames this occurs in?
- Acute withdrawal: 6-12 hours
- Hallucinations 12-24 hours
- Seizures: 36 hours
- DT After 72 hours
How does early withdrawal present and when do the withdrawals start?
6-12 hours post drink
- Insomnia
- Tremor
- Anxiety
- Agitation
- Nausea and vomiting
- Sweating
- Palpitations