Addiciton Flashcards
Moderate dependence alcohol withdrawal management
20 mg chlordiazepoxide QDS
Day 2 - 15
3 - 10mg
4 + 5 - 5mg
Severe dependence = inpatient, up to 250mg a day
What to do when someone is withdrawing
Assess safety
Ensure daily support at home, if no relative at least twice daily visits by healthcare professional
Discuss [land with patient and relative
Tell them what symptoms would urgent reassessment
Carer - stop withdrawal drugs if drinking resumes
High dose vitamins - thiamine minmium 300mg/day
Leave written plan
What symptoms require urgent assessment in withdrawal
delirium, confusion, seizures, sev vomitting, high levels of distress
When is there high risk of complicated withdrawal requiring a hospital admission?
Severe dependence
Previous delrium tremens
Prev alcohol withdrawal sei\ures
Prev failed detox in community
Poor support at home
Cognitive impairment
Symptoms of wernicke encephalopthay
Acute confusional state,ocular signs and ataxic gait
What causes wernicke-korsakoffs syndrome
THiamine deficiency
Treatment for wernicke encephalopathy
High dose parental vit B1
Prognosis of wernicke encephalopathy
Untreated high % develop korsakoff psychosis an risk of death
Korsakoff syndrome symptoms
Memory loss
Anterograde and retrograde amnesia
Treatment for korsakoff syndrome
High dose oral thiamine for at least 2 years
Prognosis of korsakoff syndrome
20% complete recovery, 25% significatn recovery
Psychosical interventions aftercare of withdrawal
CBT/pronlem solving/social skills training
Relapse planning
Group support eg alcoholics anonymous
Residential rehabilitation
Psychosical interventions aftercare of withdrawal
CBT/pronlem solving/social skills training
Relapse planning
Group support eg alcoholics anonymous
Residential rehabilitation
Pharmacological interventions after recovery from alcogol addiction
Aversice drugs - disulfiram
Anticraving drugs - acamprosate, naltrexone
Pharmacological interventions after recovery from alcogol addiction
Aversice drugs - disulfiram
Anticraving drugs - acamprosate, naltrexone
Aversive drugs for recovered alcoholics
Disulfiram
Anti-craving drugs for recovered alcoholics
Acamprosate
Naltrexone
When is it especially important to ask about alcohol and drugs use>
Patient registration
Mental health presentations
Regular A+E attendance
Depressants
Barbituates
Benzodiazapines
Z-hypnotics
Opioids
Alcohol
Solvents
Ketamin
PCB
Hallucinogenic drugs
LSD
Mescalin
Fungi
Plants
What drugs are depressants, stimulants and hallucinogenics?
Ket
PCB
What drugs are stimulants and hallucinogens?
Ecstasy
PMMA
mCPP
Hallucinogens and depressant drugs?
Cannabis
Spice
Stimulant drugs
Khat
Cocaine
Amphetamine
Catinones
Opioid substitution treatment
Methadone
Buprenorphine
What do drug deaths often involve?
Opiate
Another drug
How long do ypu have methadone for
Supervised consumption 3-6 months
How protect methadone use
Daily pick up
Regular and spot urine testing
Overdose
The use of any drug such an amount that acute adverse physical or mental effects are produced
Withdrawal
Experience of a set of unpleasant symptoms following the abrupt cessation or reduction in dose of a psychoactive substance
Consumed in high enough doses and long enough duration for person to be physically or mentally dependent on it
Oppoaite to those produced by psychoactive substance itself
What is harmful use of anything?
Pattern of use caused damage t persons physical or mental health or resulted in behaviour leading to harm ot health of others
>12 months (or 1 month if continious)
Time period harmful vs dependence
Addiction > 12 months (or 3 months if continious)
>12 months or 1 month if continious for harmful use
Physiological symptoms of addiction
Tolerance, withdrawal, use to prevent/alleviate withdrawal
Where do opioids target?
Opioid receptors in th ebrain, spinal cord, peripheral neurons and digestive tract
Effect of opiates
Slow down body functioning and are strong painkillers
Feeling of warmth, relaxation and detachment with lessening anxiety
Start quickly, last several hours
Symptoms opiate withdrawal
Diaphoresis
Mydriasis
Goosebumps - cutis ansarina
Muscle cramps
abdo pain and cramps
History for heroin use
Substance
Quantity, pattern, recent events
Control (initiation/cessation)
Impact on life
Other info sources
Examination for drug use
Features of withdrawal/intoxication
Needle marks
Features to consider when screening for drug addiction
Alcohol and other drugs
Needle sharing and other risky behaviours
Mental/physical/social health
General examination
BBV screening
What pharmacological treatments of opioid dependence linked to agonism?
Short acting (heroin assisted treatment)
Long acting (methadone)
What drugs have partial agonism for opioid dependece treatment?
Long actihng - buprenorphine
V long acting (extended release buprenorphine)
Antagonism drugs in treating opioid dependence?
Short acting (naloxone)
Long acting (naltrexone)
V long actnig (extended release naloxone)
Duration of heroin
3-6 hours
Peak effect of heroin
Peaks in minutes
Half life of heroin
15-30 minutes
Routes can take methadone
ral/IV/IM
Onset of methadone
30-60 mins
Duration of mehtadone
24-36 hours
Half life of methadone
20-37 hours
Buprenorphine route
Sub-lingual
Onset of buprenorphine
2-3 days
duration of buprenorphine
2-3 dyas
peak effects of buprenorphine
1-4 hours
Half life of buprenorphine
20-70 hours
What is cocaine?
Acid - cocaine hydrochloride - insufflated or injected
Effect of cocaine
Starts in mins ‘Ful high at 15-30 mins
Gradual come down
Crack effect
Few secodns - very short, rapid come down
How is cocaine and crack ingested
Cocaine - snorted (powder)
Crack - smoked
both can be injected
What is crack vs cocaine?
Cocaine - powder (acid)
crack - crystalloid (alkaloid)
MOA of cocaine
Dopamine
Serotonin
Noradrenaline
How does MDMA target receptors and what does it therefore do?
Relatively higher affinity for serotonin transporters
Thereby a mild hallucinogens
Neurotoxic to serotonin axon terminals
What causes cravings?
Trigger - emotion, meet someone, money
Physiological reaction
Anticipation of high
Mission to rise
How to do harm reduction for drug
BBV testing and treatment
Safe injecting advice
Safe environment
Clean quipment and avoid home made pipes
Mucous membrane care - vaseline
Eat before using
Stay hydrated
Buy less - effect reduces after first hit
Education around taking drigs
Risks of specific combinations
Not dangerous to stop suddenly
Health risks
Health risks of taking drugs
Stroke
MI
Cognitive Impairment
Parkinsons disease
Seizures
Psychotic illness
Anxiety/depression
Purpose of motivational interviewing
Basisi of brief intervention or longer piece of work
-Express empath y
-Develop discrepancy
-Roll with resistnace
-Support self efficacy
Psychosocial interventions for drug taking
Psychoedu cation
Practical strategies to reduce safely
Harm reduction
Mutual help groups
Online self help
Carer support
Employment suppoirt
Accom support
Contingency manamgenet
CBT
family therapy
Effect of cocaine short term
Excited, confident and/or anxious, happy, panicky, risk taking
Tachycardia, tachypnoea, HPTN, hyperthermia, nausea, sweating, shaking
Effect of cocaine short term
Excited, confident and/or anxious, happy, panicky, risk taking
Tachycardia, tachypnoea, HPTN, hyperthermia, nausea, sweating, shaking
Continued use of cocaine effects
Decreased need for sleep, appetite suppression, paranoia, hallucinations, mood swings/depression
What is important in the limbic system of cocaine
Dopamine transporters highly concentrated in this system
Nucleus accumbens thought particuarly important in cocaine high
What does opioid intoxication look like in behaviour?
Dysfunctional behaviour in at least one of:
-Apathy and sedation
-Disinhibition
Psychomotor retardation
Impaired attention
Impaired judgement
Signs of opioid intoxication
Drowsiness
Slurre speech
Pupillary constriction
Decerased LOC - stupor or coma
When does dilation occur in opioid intoxication?
Anoxia from severe overdose
What to cover in a drugs hisoty?
Age initiation
Past and current drug use
Types + quantities
Frequency and routes of administration
Symptoms withdrawal/other signs of dependence
Periods of abstinence/relapse
Funding/risky behaciours
IMpact
How funding
What to cover in a drugs hisoty?
Age initiation
Past and current drug use
Types + quantities
Frequency and routes of administration
Symptoms withdrawal/other signs of dependence
Periods of abstinence/relapse
Funding/risky behaciours
IMpact
How funding
AIm of treatment of drug addiction
Reducing illicit/non-prescribed drug use
Reducing dangers associated with drug misuse
Reducing episodes of drug misuse
Reducing need for criminal activity to fund drug misuse
Reduce diversion
Stabilisation(where appropriate) onto substitute medication to alleviate withdrawal Sx
Improve overall health , personal,social and family functioning
Dealing with other problems relating to drug use
Treatment options recovery addiciton
Advice/info
Harm reduction
Self help eg AA, NA, SMART
Precribing
Goal directed counselling and psychological support
Structured day programmes
Detoz
Rehabilitation
Aftercare
Treatment options recovery addiciton
Advice/info
Harm reduction
Self help eg AA, NA, SMART
Precribing
Goal directed counselling and psychological support
Structured day programmes
Detoz
Rehabilitation
Aftercare
Aim of harm reduction
Stop drug using
Reduce/stop injecting
If injecting stop sharing equipment and avoid contaminated
Sharing - clean equipment
Aim of harm reduction
Stop drug using
Reduce/stop injecting
If injecting stop sharing equipment and avoid contaminated
Sharing - clean equipment
Strategies for harm reduction
Education - risks
Needle exchange, condom provision
Hep B immunisations
BBV testing
Substitute oral drugs
Strategies for harm reduction
Education - risks
Needle exchange, condom provision
Hep B immunisations
BBV testing
Substitute oral drugs
Strategies for harm reduction
Education - risks
Needle exchange, condom provision
Hep B immunisations
BBV testing
Substitute oral drugs
Strategies for harm reduction
Education - risks
Needle exchange, condom provision
Hep B immunisations
BBV testing
Substitute oral drugs
How to commence methadone?
Titrate against withdrawal symptoms
Observe hourly/daily appointments
Build up over 3 days
Mixture used - not tablets
In specialist treatment centres (drug services)
Functions of perscriptions for opioid users
Retention in treatment
Reduce risks ass inject
Reduce/prevent withdrawal symptoms
Stabilise lifestyle
Maintain contact with vulnerable
Reduce criminal activity
Functions of perscriptions for opioid users
Retention in treatment
Reduce risks ass inject
Reduce/prevent withdrawal symptoms
Stabilise lifestyle
Maintain contact with vulnerable
Reduce criminal activity
Treatment for stimulant dependence
Psychogical - CBT
Benzodiazapines - short course
Antidepressants - NTO anticraving or dopamine agonists
Dexamphetamine - substitution in amphetamine dependence
Issues drug related to read around
Drugs and pregnancy
Drugs and young people
Drugs and the Prison Service (DTTO)
Drugs and mental illness
Children of drug using parents
Drugs & driving
Drug related deaths
