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Substance misuse > 2 > Flashcards

2 Flashcards

1
Q

Alcohol abuse

A

• Consumption of alcohol at a level to cause physical, psychiatric a/o social harm

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2
Q

Binge drinking

A

drinking over 2x recommended level of alcohol per day in one session

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3
Q

Harmful alcohol use

A

drinking above safe levels w/ evidence of alcohol-related problems

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4
Q

Alcohol dependence syndrome

A
  • 25% M and 15% F drink over recommended level in UK

* Alcohol dependence: 4% (16-65)

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5
Q

Factors involved in and leading to dependence

A

Biogical
- Genetics (variation sn enzymes that metabolise drugs); neurochemical (abnormalities in Do, GABA, opioid systems)

Environmental
- Peer pressure, life stressorss, parental drug abuse, personal vulnerability (e.g. lack of resources to cope w/ stressors

Takes substance
- Cost, availability, effects of drug itself, route

+ve reinforcement

  • Psychosocial reinforcement (peers or pleasurable effects of drugs)
  • Biological reinforcement (activates dopaminergic mesolimbic reward pathways)

Dependence
+ve reinforcement over time –> dependence

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6
Q

RFs alcohol dependence

A

Male (increased metabolism → therefore can have higher quantities)
Younger adults
Lack of facial flushing
Antisocial behaviour
Genetics
Life stressors (E.g. divorce, unemployment…)
Lower socioeconomic groups
Certain occupations (e.g. Dr: stress, freedom from supervision, reluctance to seek help if there are problems)

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7
Q

Pathophysiology alcohol actions on CNS

A
  • Enhancement of GABA-A transmission (anxiolytic effects)
  • Inhibition of NMDA-mediated glutaminergic transmission (amnesic effects)
  • Release of dopamine in mesolimbic system (euphoriant + ‘reward’ effects)
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8
Q

Pathophysiology development of dependence

A
  • Sensitisation of dopaminergic pathway (mesolimbic system)
  • Down-regulation of inhibitory GABA receptors + up-regulation of excitatory glutamate receptors → when alcohol is withdrawn there is hyper-excitability
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9
Q

CFs alcohol intoxication

A
  • Slurred speech, labile affect, impaired judgement, poor co-ordination
  • Severe cases: hypoglycaemia, stupor, coma
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10
Q

CFs alcohol dependence mnemonic

A

SAW DRINk

  1. Subjective awareness of compulsion to drink
  2. Avoidance or relief of withdrawal symptoms by further drinking
  3. Withdrawal symptoms
  4. Drink-seeking behaviour predominates
  5. Reinstatement of drinking behaviour after abstinence
  6. Increased tolerance to alcohol (requires more for same desired effect)
  7. Narrowing of drinking repertoire (i.e. fixed times for drinking, same drink…) → important to ask in Hx about pattern of drinking
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11
Q

CFs alcohol withdrawal

A
  • Malaise, tremor, N+V, insomnia, transient hallucinations, autonomic hyperactivity, seizures
  • Delirium tremens (the severe end-spectrum of withdrawal)
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12
Q

DDx alcohol dependence

A
  • Psychiatric disorders: psychosis, mood disorders, anxiety disorders, delirium
  • Medical disorders: head injury, cerebral tumour, CVA
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13
Q

Ix alcohol dependence

A
  • Bloods: blood alcohol level, FBC, U+Es, LFTs (+GGT), Blood alcohol concentrarion, MCV (^), vitamin B12/Folate/TFTs (alternative causes of ^ MCV), amylase (pancreatitis), hepatitis serology, glucose (hypoglycaemia)
  • Alcohol questionnaires: e.g. AUDIT
  • CT head (if head injury suspected)
  • ECG (arrhythmias)
  • Blood tests to screen for alcohol dependence: RBC MCV, GGT, Carbohydrate deficient transferrin (all raised)
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14
Q

detox drugs

A

acamprosate or oral naltrexone

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15
Q

alcohol dependence driving

A

must inform dvla themselves

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16
Q

complications alcohol dependence - acute

A

Acute toxicity → clouding of consciousness, coma, risk of aspiration, hypoglycaemia, AKI

17
Q

medical chronic affects of alcohol dependence

A

Hepatic
• Alcoholic liver disease (Fatty liver → alcoholic hepatitis → cirrhosis)
• Hepatocellular carcinoma

GI
• Gastritis/PUD, oesophageal varices, chronic pancreatitis, oesophageal carcinoma, mallory-weiss tear, stomach cancer

CV
• HTN, cardiomyopathy, arrhythmias (esp. AF), CVA

Respiratory
• Tuberculosis
• Pneumonia (Klebsiella streptococcal)

Haematological
• Anaemia, thrombocytopaenia

Neurological
• Seizures, peripheral neuropathy, cerebellar degeneration, Wernicke’s Encephalopathy (→ Korsakoff’s psychosis/encephalopathy), head injury (secondary to falls)

Obstetrics
• Foetal alcohol syndrome

18
Q

psychological affects of alcohol dependence

A
  • Morbid jealousy
  • Self-harm and suicide
  • Mood disorders
  • Anxiety disorders
  • Alcohol-related dementia
  • Alcoholic hallucinosis
  • Delirium tremens
19
Q

social affects of alcohol dependence

A
  • Domestic violence
  • Drink driving
  • Employment difficulties
  • Financial problems
  • Homelessness
  • Accidents (RTA)
  • Relationship problems
  • Crime + violence
20
Q

prevention of alcoholism

A
  • ^ taxation
  • Restricting advertising + sales
  • More education in schools

Substance misuse (5 decks)

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