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m4 psych > 7. Substance > Flashcards

7. Substance Flashcards

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1
Q

Clinical criteria for alcohol use disorder

A

3 or more of the following manifestations that occur together for at least 1 month (or if less than 1 month, then repeatedly within 1 year)

  1. Compulsion
  2. Control (inability to control)
  3. Withdrawal
  4. Tolerance
  5. Preoccupation (other interests given up due to drinking)
  6. Persistence (despite knowing the harmful consequences)
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2
Q

DSM 5 diagnostic criteria for alcohol use disorder

A

Problematic usage of alcohol that has led to significant impairments occurring over a total of 12 months duration, manifested by at least 2 of the following:

  1. Increasing usage of alcohol, or over a longer period than originally intended
  2. Control: Repeated unsuccessful efforts to cut down or control
  3. Compulsion to drink
  4. Withdrawal
    - Characteristic symptoms
    - Drinking to avoid symptoms
  5. Tolerance
    - Need for more to achieve same effects
    - Reduced effects with same amount
  6. Pre-occupation: Give up on other interests due to drinking
  7. Pre-occupation: A lot of time spent trying to obtain, use or recover from alcohol
  8. Pre-occupation: Resulting in significant failure to fulfil major roles
  9. Persistent use despite having social/interpersonal issues due to drinking
  10. Persistent use despite effect on physical health
  11. Persistent use despite having physical or psychological problems
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3
Q

Early remission vs sustained remission

A

None of the criteria for alcohol use has been met for 3 months or more but less than 12 months vs 12 months or longer

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4
Q

DSM 5 diagnostic criteria for acute alcohol intoxication

A

SAMS GIN

Slurred speech
Attention impaired
Memory impaired
Stupor/coma
Gait unsteady
Incoordination
Nystagmus

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5
Q

Acute deficiency of thiamine will lead to

A

Wernicke’s encephalopathy

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6
Q

Triad of wernicke’s encephalopathy

A
  1. Gait ataxia
  2. Ophthalmoplegia (first sign to respond to meds)
  3. Confusion
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7
Q

Chronic deficiency of thiamine will lead to

A

Korsakoff psychosis (confabulation, retrograde amnesia)

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8
Q

DSM 5 diagnostic criteria for alcohol withdrawal syndrome

A

Cessation or reduction in alcohol usage that was previously heavy and prolonged.

At least 2 of the following signs must have developed within several hours to few days after stopping the usage of alcohol:

PASTNITES+Delirium/Clouded consciousness (DT)

Psychomotor agitation
Anxiety
Seizures
Transient hallucinations (visual hallucinations - liliputian)
Nausea/vomiting
Insomnia
Tremor
Excitability
Sweating

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9
Q

Peak for delirium tremens is within

A

48-72 hours of last drink

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10
Q

What is delirium tremens?

A

Toxic confusion state when AWS is severe

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11
Q

Triad of delirium tremens

A
  1. Clouding of consciousness and confusion
  2. Vivid visual hallucinations
  3. Marked tremor
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12
Q

Why is delirium tremens life threatening?

A

Due to autonomic instability

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13
Q

Management of alcohol withdrawal

A
  • Long acting benzodiazepine (diazepam)**: alleviates withdrawal symptoms and prophylaxis for seizure
    Route of administration: ORAL
    (IM diazepam has poor absorption)
  • Short acting benzodiazepine (IM lorazepam): if there is liver impairment or oral diazepam not tolerated
  • Thiamine**: prophylaxis/treatment for wernicke encephalopathy
    Route of administration: IM/IV
  • Antipsychotics: treat hallucinations and agitation
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14
Q

How will benzodiazepine help with alcohol withdrawal symptoms?

A

GABA is a CNS depressant = Glutamate is CNS excitatory

When CNS depression increases, CNS excitatory will also increase to maintain equilibrium
Alcohol is also a CNS depressant
In alcohol withdrawal, the excitatory will exceed the depressants -> disequilibrium

Therefore give GABA to restore equilibrium

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15
Q

Non-pharmacological for alcohol use disorder

A

Cognitive Psychotherapy
- Motivational Interviewing
- Stages of Change Model
Cue exposure
Alcoholic Anonymous
Cognitive Behavioural Therapy

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16
Q

Pharmacotherapy for alcohol use disorder (abstinence medications)

A
  1. Naltrexone (usually 1st line)
  2. Acamprosate
  3. Disulfiram (not avail in SG)
    - aversive agent: cannot take alcohol before starting onwards
    - inhibits aldehyde dehydrogenase -> leads to acetaldehyde accumulation if taken with alcohol -> leads to aversion effect
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17
Q

Aversive effects with ingestion of alcohol

A

Small amount of alcohol ingested: Flushing, headache, tachycardia, nausea, vomiting
Large amount of alcohol ingested: Air hunger, arrhythmia, severe hypotension

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18
Q

DSM 5 diagnostic criteria for Opioid use disorder

A

Problematic usage of opioid that has led to significant impairments in terms of functioning over a 12 months period.

(remaining criteria are similar to that of alcohol use disorder)

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19
Q

Opioid intoxication

A

Recent usage of opioid with the presence of pupillary constriction (pinpoint pupil) + at least 1 of the following sx:

SAD+

  1. Slurred speech
  2. Attention or memory impairment
  3. Drowsy or losing consciousness
    + miosis

+ significant problematic behavioural or psychological changes that have arisen during or shortly after the usage

20
Q

Opioid withdrawal

A

Either (a) recent cessation of the usage of opioid that was previously heavy and prolonged or (b) recent administration of an opioid antagonist after a period of opioid usage

Manifested by at least 3 of the following, which develops within minutes to several days:

AMRY FINDS+

Aches
Rhinorrhea/lacrimation
Mood (dysphoric)
Yawning
Fever
Insomnia
Nausea/vomiting
Diarrhoea
Sweating
+mydriasis, piloerection

21
Q

Pharmacotherapy for opioid overdose

A

IV Naloxone

22
Q

Pharmacotherapy for opioid use disorder

A

Methadone (mu receptor agonist)
Buprenorphine

23
Q

Pharmacotherapy for nicotine use ie SMOKING

A

Bupropion
Nicotine replacement therapy

24
Q

DSM 5 Diagnostic criteria for Gambling disorder

A

Persistent and recurrent problematic gambling behaviour over the past 12 months that has led to significant impairment and distress, accompanied by at least 4 of the following:

  1. Need to gamble with an increasing amount of money to achieve the same level of excitement
  2. Restlessness or irritability when attempting to cut down or stop gambling
  3. Repeated unsuccessful attempts at cutting down or stopping
  4. Preoccupation with gambling
  5. Tendency to gamble when feeling distressed
  6. Tendency to return to chase one’s losses even after losing money
  7. Tendency to lie to minimise the extent of involvement with gambling
  8. Gambling has affected significant relationships and has caused the individual to miss opportunities
  9. Relying on others to help bail out of a difficult financial situation
  10. Clinicians to exclude the possibility of an underlying bipolar disorder
25
Q

Internet addiction criteria

A

Similar to substance misuse disorder

26
Q

LFT suggesting alcoholic hepatits

A

Serum AST > 2x ALT in an alcoholic patient

27
Q

What is serum GGT used for?

A

Objectively assess relapse as serum GGT is increased in acute/chronic alcohol use
- remains elevated for 2-5 weeks afterwards

*another objective test is carbohydrate deficient transferring (CDT) - very expensive

28
Q

Visual hallucinations in delirium tremens are classically described as

A

‘Pink elephants’ or lilliputian in nature

29
Q

Stages of change model

A
  1. Pre-contemplation
  2. Contemplation
  3. Decision
  4. Action
  5. Maintenance
  6. Relapse
30
Q

Why must you give dextrose with thiamine (instead of just dextrose) in AWS patient with hypoglycaemia?

A

Glucose metabolism will further deplete thiamine stores

31
Q

Nicotine withdrawal symptoms

A

Cough, mouth ulcers, marked irritability

32
Q

Heroin withdrawal symptoms

A

Yawning, sneezing, sweating

33
Q

Benzodiazepines withdrawal symptoms

A

IF DAD HIP HAT

Insomnia
Fit (withdrawal fit)

Dreams
Autonomic hyperactivity
Depression

Hyperaesthesia (extreme sensitivity to touch, pain, pressure, and thermal sensations)
Irritable
Photophobia

Hyperacusis
Anxiety
Tremors - shakes

34
Q

Detoxification of benzodiazepines

A

Switch to a long acting benzodiazepine (diazepam)***
Reduce by 30% subsequently once stabilised
Use adjuncts
Psychotherapy and psychological interventions

35
Q

Cannabis intoxication

A

MAID-H

Marked increase in heart rate
Appetite that is better than normal
Injection of conjunctiva
Dry mouth
Hallucinations

36
Q

Acute cocaine or amphetamine intoxication can include

A

Hyperawareness, hypersexuality, hyper vigilance, agitation, paranoia and delusions
-> resembles mania

37
Q

Which ethnicity in Singapore is most vulnerable to alcohol dependence?

A

Indian

(malay men have lowest risk)

38
Q

MOA of naltrexone

A

Blocks opioid receptors to decrease alcohol craving

39
Q

MOA of acamprosate

A

GABA agonist + glutamate antagonist
-> decreases alcohol craving

40
Q

What primary neurotransmitter is associated with Lysergic acid diethylamide (LSD)?

A

Serotonin
-> LSD increases the level of serotonin and overdose of LSD is a/w serotonin syndrome

41
Q

Both acute intoxication of cannabis and cocaine resemble mania, what signs to differentiate?

A

Cocaine:
- Cardiac arrhythmia
- Pupillary dilation

Cannabis (just rmb these 4)
- Increased appetite
- Dry mouth
- Conjunctival injection (reddening of eye)
- Tachycardia

42
Q

S/E of methadone

A

Prolonged QTc -> cardiac arrhythmia-> syncope

43
Q

Cocaine (stimulant) withdrawal symptoms

A

Low mood, hypersomnia, increase in appetite, lethargy, poor motivation

(depressive features with increase in appetite)

44
Q

Benzos use symptoms

A

same as alcohol into sx

SAMS GIN

45
Q

What receptor does cocaine work on?

A

Dopamine transporter

m4 psych (18 decks)

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