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Year 4 Psych- A > Substance misuse: need to add overdose > Flashcards

Substance misuse: need to add overdose Flashcards

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1
Q

substance misuse hierarchy

A
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2
Q

Substance dependence requires at least two of the following:

A
  1. Impaired control over substance use
  2. Increasing priority over other aspects of life or responsibility
  3. Psychological features suggestive of tolerance and withdrawal
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3
Q

Pathophysiology of addiction including withdrawal

A
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4
Q

ccording to UK guidance, the threshold for alcohol consumption is

A

14 units a week spread evenly over three days or more

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5
Q

the difference between hazardous drinking, harmful drinking, and alcohol dependence.

A
  • Hazardous drinking: individual consumes more than 14 units of alcohol a week, which may increase their risk of harm.
  • Harmful drinking is when the pattern of alcohol consumption directly causes physiological complications and illnesses as discussed below.
  • alcohol dependence is characterised by craving and tolerance of alcohol consumption despite the negative complications experienced.
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6
Q

Alcohol misuse clinical features

A
  • short term harm: alcohol poisoning and accidents
  • liver cirrhosis, alcoholic liver disease.
  • chronic alcohol misuse can present with bleeding oesophageal varices, hepatic failure, and stigmata of liver diseases.

Withdrawal symptoms
* Within 6-12 hours: tremors, and autonomic arousal (e.g. tachycardia, fever, pupillary dilation, and increased sweating).
* 34h: peak seizures
* Between 12-48 hours of cessation, patients can experience alcohol hallucinosis (typically auditory or tactile).
* Between 72-96 hours, patients can present with delirium tremens. They may experience altered mental status, agitation, and tactile hallucination.

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7
Q

Screening questionnnaire alcohol misuse

A

The AUDIT-C questionnaire is a common screening tool that looks at the risk of dependency of alcohol misuse.7

Other questionnaires include the SAD-Q questionnaire which looks at the severity of alcohol dependence and the CAGE questionnaire.

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7
Q

investigations in alcohol misuse

A
  • Full blood count: raised MCV, raised platelets, anaemia
  • Liver function tests: increased GGT, AST:ALT > 2:1
  • Haematinics (B12/folate): alcohol can cause folate deficiency
  • Thyroid function tests
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8
Q

Alcohol misuse management

A
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9
Q

Alcohol misuse complications

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10
Q

Opioid misuse includes the use of

A

morphine, heroin, and codeine.

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11
Q

opiod MOA

A

central nervous system depressants that slow brain activity and relax muscles.

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12
Q

Clinical features of opiod misuse

A
  • Physiological: euphoria and reduced pain, sedation, respiratory depression, meiosis, constipation, skin warmth and flushing
  • Psychological: apathy, disinhibition, drowsiness, impaired judgment and attention, slurred speech

When withdrawing from opioids, increased sympathetic nervous system activity causes rhinorrhoea, lacrimation, diarrhoea, pupillary dilation, piloerection, tachycardia, and hypertension.

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13
Q

Investigations of opiod misuse

A
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14
Q

opioid misuse management

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15
Q

Opioid misuse complications

A
  • Opioid misuse also increases the risk of blood-borne diseases such as HIV, hepatitis B, and C
  • Overdose, death
16
Q

Benzodiazepine misuse includes the use of

A

use of diazepam, oxazepam and lorazepam.

17
Q

Benzodiazepines MOA

A

central nervous system depressants.

18
Q

The clinical features of benzodiazepine misuse include:

A
19
Q

Investigations for benzodiazapines misuse

A

The clinical institute withdrawal assessment scale – benzodiazepines (CIWA-B) can be used to determine the severity of withdrawal from the substance.

20
Q

benzodiazapines misuse management

A

assisted withdrawal and supportive treatments.

21
Q

CNS stimulants examples

A

Amphetamine use (e.g. Adderall and methylphenidate) and cocaine are:

22
Q

CNS stimulants clinical features including withdrawal

A

CNS stimulants activate the sympathetic nervous system which causes symptoms such as tachycardia, hypertension, and mydriasis.

Patients using cocaine may develop tactile hallucinations and chest pain.

Clinical features of CNS stimulant withdrawal include dysphoria, lethargy, psychomotor agitation, craving, increased appetite, insomnia, and bizarre dreams.

23
Q

Screening tools used for CNS stimulants

A

Screening tools used for CNS stimulants are the drug abuse screening test (DAST), CAGE-AID (adapted to include drugs) and addiction severity index (ASI).

24
Q

CNS stimulants management

A

There is no specific drug treatment available for CNS stimulant use. Treatment is supportive and aimed at managing withdrawal symptoms.

25
Q

Hallucinogens include

A

lysergic acid diethylamide (LSD – ‘acid’), marijuana, ecstasy and phencyclidine or phenylcyclohexyl piperidine (PCP)

26
Q

Hallucinogens can cause:

A

euphoria, visual and auditory hallucinations and psychosis.

27
Q

Clinical features of hallucinogens: inlcuding specific symptoms relating to the specific drugs

A

Hallucinogens mainly cause visual or auditory hallucinations and the feeling of euphoria.

Specific clinical features depend on the substance used:

  • LSD: lethargy, psychomotor agitation, craving, insomnia, and unpleasant dreams
  • Marijuana: increased appetite and conjunctival injection
  • Ecstasy: bruxism, hyperthermia, hyponatremia, and hepatotoxicity
  • PCP: loss of painful stimuli, vertical nystagmus, psychosis with hallucination, violence, and agitation
28
Q

screening tools for hallucinogens misuse

A

Screening tools used for hallucinogens are the drug abuse screening test (DAST), CAGE-AID (adapted to include drugs) and addiction severity index (ASI).

29
Q

hallucinogens misuse management

A

no specific interventions for hallucinogen misuse, and the mainstay treatment is supportive. This includes medically supervised detox by slowly tapering the dose, referral to a rehabilitation centre, cognitive behavioural therapy, and treatment of withdrawal symptoms.

30
Q

Opioid replacement therapy that can be use sublingually

A

Buprenorphine is a mixed opioid agonist/antagonist. It is typically given as a sublingual tablet and provides an alternative opiate replacement therapy to methadone. Patient’s often describe buprenorphine as less sedating, which can be a benefit or drawback depending on the context and patient.

Prescribers must also be aware that because of the opioid antagonist properties of methadone it can render regularly prescribed analgesia, such as co-codamol, ineffective.

31
Q

SSRIs overdose symptoms

A

fever
hyperreflexia
tremor
sweating
diarrhoea
(serotonin syndrome)

32
Q

TCA overdose

A

fever
mydriasis
confusion
seizures
cholinergic features (e.g. blurred vision)

33
Q

MAOIs overdose can cause what?

A

MAOIs plus tyramine can cause hypertensive crisis

34
Q

heroin acts on which receptors?

A

heroin, an opiate which acts at opioid receptors

35
Q

WIthdrawal and Overdose summary for all substances

A

heroin intoxication = constricted pupils -> naloxone for OD

heroin withdrawal = dilated pupils -> supportive Tx, symptom relief -»> methadone, buprenorphine

stimulate intoxication (MDMA, cocaine, meth) = dilated pupils -> cooling, antihypertensives e.g. nitroprusside or GTN

36
Q

Methyphenidate is used for what?

A

Methylphenidate, more commonly known as ‘Ritalin’, is a stimulant prescription drug usually used in the treatment of Attention Deficit Hyperactivity Disorder. However, it has potential for illicit abuse and can be found among student populations who believe it improves their concentration and focus. This woman presents with insomnia, restlessness, increased temperature, increased blood pressure and increased heart rate, all likely to be caused by the illicit use of Methylphenidate

Year 4 Psych- A (20 decks)

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