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Mental Health > Addiciton > Flashcards

Addiciton Flashcards

1
Q

Moderate dependence alcohol withdrawal management

A

20 mg chlordiazepoxide QDS
Day 2 - 15
3 - 10mg
4 + 5 - 5mg

Severe dependence = inpatient, up to 250mg a day

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2
Q

What to do when someone is withdrawing

A

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

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3
Q

What symptoms require urgent assessment in withdrawal

A

delirium, confusion, seizures, sev vomitting, high levels of distress

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4
Q

When is there high risk of complicated withdrawal requiring a hospital admission?

A

Severe dependence
Previous delrium tremens
Prev alcohol withdrawal sei\ures
Prev failed detox in community
Poor support at home
Cognitive impairment

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5
Q

Symptoms of wernicke encephalopthay

A

Acute confusional state,ocular signs and ataxic gait

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6
Q

What causes wernicke-korsakoffs syndrome

A

THiamine deficiency

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7
Q

Treatment for wernicke encephalopathy

A

High dose parental vit B1

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8
Q

Prognosis of wernicke encephalopathy

A

Untreated high % develop korsakoff psychosis an risk of death

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9
Q

Korsakoff syndrome symptoms

A

Memory loss
Anterograde and retrograde amnesia

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10
Q

Treatment for korsakoff syndrome

A

High dose oral thiamine for at least 2 years

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11
Q

Prognosis of korsakoff syndrome

A

20% complete recovery, 25% significatn recovery

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12
Q

Psychosical interventions aftercare of withdrawal

A

CBT/pronlem solving/social skills training
Relapse planning
Group support eg alcoholics anonymous
Residential rehabilitation

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13
Q

Psychosical interventions aftercare of withdrawal

A

CBT/pronlem solving/social skills training
Relapse planning
Group support eg alcoholics anonymous
Residential rehabilitation

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14
Q

Pharmacological interventions after recovery from alcogol addiction

A

Aversice drugs - disulfiram
Anticraving drugs - acamprosate, naltrexone

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14
Q

Pharmacological interventions after recovery from alcogol addiction

A

Aversice drugs - disulfiram
Anticraving drugs - acamprosate, naltrexone

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15
Q

Aversive drugs for recovered alcoholics

A

Disulfiram

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16
Q

Anti-craving drugs for recovered alcoholics

A

Acamprosate
Naltrexone

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17
Q

When is it especially important to ask about alcohol and drugs use>

A

Patient registration
Mental health presentations
Regular A+E attendance

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18
Q

Depressants

A

Barbituates
Benzodiazapines
Z-hypnotics
Opioids
Alcohol
Solvents
Ketamin
PCB

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19
Q

Hallucinogenic drugs

A

LSD
Mescalin
Fungi
Plants

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20
Q

What drugs are depressants, stimulants and hallucinogenics?

A

Ket
PCB

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21
Q

What drugs are stimulants and hallucinogens?

A

Ecstasy
PMMA
mCPP

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22
Q

Hallucinogens and depressant drugs?

A

Cannabis
Spice

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23
Q

Stimulant drugs

A

Khat
Cocaine
Amphetamine
Catinones

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24
Q

Opioid substitution treatment

A

Methadone
Buprenorphine

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25
Q

What do drug deaths often involve?

A

Opiate
Another drug

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26
Q

How long do ypu have methadone for

A

Supervised consumption 3-6 months

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27
Q

How protect methadone use

A

Daily pick up
Regular and spot urine testing

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28
Q

Overdose

A

The use of any drug such an amount that acute adverse physical or mental effects are produced

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29
Q

Withdrawal

A

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

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30
Q

What is harmful use of anything?

A

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)

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31
Q

Time period harmful vs dependence

A

Addiction > 12 months (or 3 months if continious)
>12 months or 1 month if continious for harmful use

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32
Q

Physiological symptoms of addiction

A

Tolerance, withdrawal, use to prevent/alleviate withdrawal

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33
Q

Where do opioids target?

A

Opioid receptors in th ebrain, spinal cord, peripheral neurons and digestive tract

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34
Q

Effect of opiates

A

Slow down body functioning and are strong painkillers
Feeling of warmth, relaxation and detachment with lessening anxiety
Start quickly, last several hours

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35
Q

Symptoms opiate withdrawal

A

Diaphoresis
Mydriasis
Goosebumps - cutis ansarina
Muscle cramps
abdo pain and cramps

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36
Q

History for heroin use

A

Substance
Quantity, pattern, recent events
Control (initiation/cessation)
Impact on life
Other info sources

37
Q

Examination for drug use

A

Features of withdrawal/intoxication
Needle marks

38
Q

Features to consider when screening for drug addiction

A

Alcohol and other drugs
Needle sharing and other risky behaviours
Mental/physical/social health
General examination
BBV screening

39
Q

What pharmacological treatments of opioid dependence linked to agonism?

A

Short acting (heroin assisted treatment)
Long acting (methadone)

40
Q

What drugs have partial agonism for opioid dependece treatment?

A

Long actihng - buprenorphine
V long acting (extended release buprenorphine)

41
Q

Antagonism drugs in treating opioid dependence?

A

Short acting (naloxone)
Long acting (naltrexone)
V long actnig (extended release naloxone)

42
Q

Duration of heroin

A

3-6 hours

43
Q

Peak effect of heroin

A

Peaks in minutes

44
Q

Half life of heroin

A

15-30 minutes

45
Q

Routes can take methadone

A

ral/IV/IM

46
Q

Onset of methadone

A

30-60 mins

47
Q

Duration of mehtadone

A

24-36 hours

48
Q

Half life of methadone

A

20-37 hours

49
Q

Buprenorphine route

A

Sub-lingual

50
Q

Onset of buprenorphine

A

2-3 days

51
Q

duration of buprenorphine

A

2-3 dyas

52
Q

peak effects of buprenorphine

A

1-4 hours

53
Q

Half life of buprenorphine

A

20-70 hours

54
Q

What is cocaine?

A

Acid - cocaine hydrochloride - insufflated or injected

55
Q

Effect of cocaine

A

Starts in mins ‘Ful high at 15-30 mins
Gradual come down

56
Q

Crack effect

A

Few secodns - very short, rapid come down

57
Q

How is cocaine and crack ingested

A

Cocaine - snorted (powder)
Crack - smoked
both can be injected

58
Q

What is crack vs cocaine?

A

Cocaine - powder (acid)
crack - crystalloid (alkaloid)

59
Q

MOA of cocaine

A

Dopamine
Serotonin
Noradrenaline

60
Q

How does MDMA target receptors and what does it therefore do?

A

Relatively higher affinity for serotonin transporters
Thereby a mild hallucinogens
Neurotoxic to serotonin axon terminals

61
Q

What causes cravings?

A

Trigger - emotion, meet someone, money
Physiological reaction
Anticipation of high
Mission to rise

62
Q

How to do harm reduction for drug

A

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

63
Q

Education around taking drigs

A

Risks of specific combinations
Not dangerous to stop suddenly
Health risks

64
Q

Health risks of taking drugs

A

Stroke
MI
Cognitive Impairment
Parkinsons disease
Seizures
Psychotic illness
Anxiety/depression

65
Q

Purpose of motivational interviewing

A

Basisi of brief intervention or longer piece of work
-Express empath y
-Develop discrepancy
-Roll with resistnace
-Support self efficacy

66
Q

Psychosocial interventions for drug taking

A

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

67
Q

Effect of cocaine short term

A

Excited, confident and/or anxious, happy, panicky, risk taking
Tachycardia, tachypnoea, HPTN, hyperthermia, nausea, sweating, shaking

67
Q

Effect of cocaine short term

A

Excited, confident and/or anxious, happy, panicky, risk taking
Tachycardia, tachypnoea, HPTN, hyperthermia, nausea, sweating, shaking

68
Q

Continued use of cocaine effects

A

Decreased need for sleep, appetite suppression, paranoia, hallucinations, mood swings/depression

69
Q

What is important in the limbic system of cocaine

A

Dopamine transporters highly concentrated in this system
Nucleus accumbens thought particuarly important in cocaine high

70
Q

What does opioid intoxication look like in behaviour?

A

Dysfunctional behaviour in at least one of:
-Apathy and sedation
-Disinhibition
Psychomotor retardation
Impaired attention
Impaired judgement

71
Q

Signs of opioid intoxication

A

Drowsiness
Slurre speech
Pupillary constriction
Decerased LOC - stupor or coma

72
Q

When does dilation occur in opioid intoxication?

A

Anoxia from severe overdose

73
Q

What to cover in a drugs hisoty?

A

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

74
Q

What to cover in a drugs hisoty?

A

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

75
Q

AIm of treatment of drug addiction

A

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

76
Q

Treatment options recovery addiciton

A

Advice/info
Harm reduction
Self help eg AA, NA, SMART
Precribing
Goal directed counselling and psychological support
Structured day programmes
Detoz
Rehabilitation
Aftercare

77
Q

Treatment options recovery addiciton

A

Advice/info
Harm reduction
Self help eg AA, NA, SMART
Precribing
Goal directed counselling and psychological support
Structured day programmes
Detoz
Rehabilitation
Aftercare

78
Q

Aim of harm reduction

A

Stop drug using
Reduce/stop injecting
If injecting stop sharing equipment and avoid contaminated
Sharing - clean equipment

79
Q

Aim of harm reduction

A

Stop drug using
Reduce/stop injecting
If injecting stop sharing equipment and avoid contaminated
Sharing - clean equipment

80
Q

Strategies for harm reduction

A

Education - risks
Needle exchange, condom provision
Hep B immunisations
BBV testing
Substitute oral drugs

81
Q

Strategies for harm reduction

A

Education - risks
Needle exchange, condom provision
Hep B immunisations
BBV testing
Substitute oral drugs

82
Q

Strategies for harm reduction

A

Education - risks
Needle exchange, condom provision
Hep B immunisations
BBV testing
Substitute oral drugs

82
Q

Strategies for harm reduction

A

Education - risks
Needle exchange, condom provision
Hep B immunisations
BBV testing
Substitute oral drugs

83
Q

How to commence methadone?

A

Titrate against withdrawal symptoms
Observe hourly/daily appointments
Build up over 3 days
Mixture used - not tablets
In specialist treatment centres (drug services)

84
Q

Functions of perscriptions for opioid users

A

Retention in treatment
Reduce risks ass inject
Reduce/prevent withdrawal symptoms
Stabilise lifestyle
Maintain contact with vulnerable
Reduce criminal activity

84
Q

Functions of perscriptions for opioid users

A

Retention in treatment
Reduce risks ass inject
Reduce/prevent withdrawal symptoms
Stabilise lifestyle
Maintain contact with vulnerable
Reduce criminal activity

85
Q

Treatment for stimulant dependence

A

Psychogical - CBT
Benzodiazapines - short course
Antidepressants - NTO anticraving or dopamine agonists
Dexamphetamine - substitution in amphetamine dependence

86
Q

Issues drug related to read around

A

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

Mental Health (57 decks)

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