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Y3 PSYCHIATRY > Addiction and Substance Misuse > Flashcards

Addiction and Substance Misuse Flashcards

1
Q

List the ICD-10 criteria for alcohol dependence

A 
Strong desire to take the substance
Difficulty in controlling substance use
Withdrawal state
Tolerance
Neglect other pleasures
Persistence despite evidence of harm
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2
Q

Which dopaminergic pathway, associated with reward, is involved in addiction?

A

Mesolimbic pathway

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3
Q

What is the effect of dopamine release upon behaviour?

A

Motivates us to repeat behaviour

Involved in pleasurable experience

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4
Q

What effect do drugs like amphetamine and cocaine have on dopamine?

A

Increase release of dopamine

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5
Q

If dopamine receptors are repeatedly stimulated, what can eventually develop?

A

Tolerance

due to downregulation/decreased sensitivity of receptors

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6
Q

What is the consequence of developing tolerance in addiction?

A

Threshold for feeling reward is increased; normal pleasurable experience don’t evoke enough of a reward response

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7
Q

Frontal lobe areas associated with executive functioning develop before those areas associated with emotion. True/False?

A

False

Other way around! This is why adolescents show minimal judgement and impulse control

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8
Q

Which parts of the brain are associated with memory learning?

A

Amygdala

Hippocampus

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9
Q

Which parts of the brain are associated with inhibitory motor control? What is the effect of addiction on these areas?

A

Prefrontal cortex
Anterior cingulate gyrus
Reduced activation

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10
Q

Which parts of the brain are associated with motivation/drive? What is the effect of addiction on these areas?

A

Orbito-frontal cortex
Subcallosal cortex
Increased activation

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11
Q

Which parts of the brain are associated with reward?

A

Nucleus accumbens
Ventral pallidum
[mesolimbic pathway]

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12
Q

How many ml of alcohol = 1 unit?

A

10ml

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13
Q

What is the equation for calculating no. of units of alcohol?

A

[% x volume]/10

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14
Q

What are the current guidelines for low risk alcohol drinking?

A

No more than 14 units per week, ideally spread over 3 or more days

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15
Q

What are the parameters of increased risk alcohol drinking?

A

Regular consumption of 15-35 units a week

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16
Q

What are the parameters of high risk alcohol drinking?

A

Regular consumption of over 35 units a week

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17
Q

Which marker can be an indicator of alcoholic liver injury?

A

GGT

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18
Q

Which marker identifies men who have been drinking 5+ units of alcohol a day for 2 or more weeks?

A

Carbohydrate deficient transferin

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19
Q

What is the most common cause of a raised MCV?

A

Alcoholism

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20
Q

What effect does alcohol have on excitatory glutamatory ion channels?

A

Inhibits action of NMDA glutamate receptors

21
Q

What effect does alcohol have on inhibitory GABA ion channels?

A

Potentiates action of GABA receptors

22
Q

Alcohol withdrawal leads to less/more glutamate activity and less/more GABA activity

A

Alcohol withdrawal leads to more glutamate activity and less GABA activity

23
Q

List clinical features of alcohol withdrawal. How long does it take for symptoms to resolve?

A 
Restlessness, tremor
Sweating
Anxiety
Nausea, vomiting
Loss of appetite and sleep
Tachycardia
Seizure, delirium tremens
5-7 days
24
Q

Which drugs are used to manage alcohol withdrawal?

A

Benzodiazepine e.g. diazepam, chlorodazepoxide

Thiamine (parenteral) - ‘Pabrinex’

25
Q

Which drug is the 1st line agent for alcohol detox relapse prevention? What is it’s mechanism of action?

A

Naltrexone

Opiod anatagonist and reduces reward from alcohol

26
Q

Which drug should be started as soon as alcohol detox is complete? What is it’s mechanism of action? List some side effects

A

Acamprosate
Acts centrally on glutamate and GABA systems to reduce cravings
Headache, diarrhoea, nausea

27
Q

Which alpha-2-receptor agonist can help with opiate detox?

A

Lofexidine

28
Q

What are the 2 main detox agents used for opiate substitution therapy and detox?

A

Methadone (long-acting full agonist)

Buprenorphine (long-acting partial agonist)

29
Q

What effect does mephedrone have on neurotransmitters?

A

Inhibits reuptake of serotonin, noradrenaline and dopamine

30
Q

What are the user effects of taking mephedrone?

A

Feeling of ecstasy, openness

Increased confidence and desires

31
Q

Taking mephedrone increases susceptibility to ladybird attacks. True/False?

A

True

32
Q

List the main categories of legal highs

A 
Stimulants
Empathogens
Psychedelics
Dissociatives
Cannabinoids
Depressants
Opioids
33
Q

What is sympathetic toxidrome and which drug is it related to?

A

Amphetamines

Range of toxic autonomic effects e.g. tremor, sweating, pain, confusion, vomiting etc.

34
Q

What is serotonin syndrome?

A

Excess serotonin causes hypomania, agitation, myoclonus and hyperactive autonomic state

35
Q

Which drugs can cause serotonin syndrome?

A 
Antidepressants
Cough medication
Tramadol
Antibiotics
Herbal products
36
Q

What effect on neurotransmission does methamphetamine have?

A

Inhibits reuptake of noradrenaline and dopamine

37
Q

Synthetic cannabinoids can be more potent than cannabis. True/False?

A

True

800x more potent!

38
Q

Which legal high causes a detachment from reality, including depersonalisation and derealisation?
[dissociative]

A

Ketamine

39
Q

What are the two main screening tools used to identify alcohol user disorders?

A 
AUDIT tool (10 questions)
FAST tool
40
Q

List clinical features of delirium tremens

A

Peak onset within 2 days of abstinence
Presents insidiously with night time confusion
Confusion, disorientation, agitation, hypertension, fever, hallucinations, paranoia

41
Q

List management options for alcohol withdrawal

A 
Reassurance and advice
Detoxification:
(+ Hydration, analgesia, antiemetics, environment)
Psychotherapy inc. CBT
Relapse prevention
42
Q

What is the mechanism of action of benzodiazepines?

A

Act on GABA A receptors

43
Q

What is the administration of thiamine in alcohol withdrawal prophylaxis against? What is the triad of symptoms seen in this disease?

A

Wernicke’s encephalopathy

Ataxia, opthalmoplegia, nystagmus

44
Q

Which drug for relapse prevention requires compliance to be effective? What is it’s mechanism of action? List some side effects.

A

Disulfram (antabuse)
Inhibts acetyl dehydrogenase (acetylaldehyde increases if alcohol consumed )
Flushed skin, tachycardia, nausea and vomiting, arrhythmias, hypotension

45
Q

List drugs used in relapse prevention

A

Disulfram
Acamprosate
Naltrexone

46
Q

List the clinical features of opiate misuse

A 
Euphoria
Analgesia
Respiratory depression
Constipation
Reduced conscious level
Hypotension and bradycardia
Pupillary constriction
47
Q

List the withdrawal symptoms from opiate misuse

A 
Dysphoria and cravings
Agitation
Tachycardia and hypertension
Piloerection
Diarrhoea, nausea, vomiting
Dilated pupils
Joint pains
Rhinorrhea
Lacrimation
48
Q

List complications of administering opiates IV

A

Infections: local e.g. cellulitis, abscess, thrombophlebitis, necrotizing fasciitis, distant: endocarditis, systemic: Hep B, HIV, Hep C

Thrombotic/embolic: DVT, PE, ischaemic limb

49
Q

Outline the four main management options for opiate misuse

A

Opiate substitution therapy: replace short acting with long acting opiate
Opiate detoxification: achieve complete abstinence from all opiates
Heroin assisted treatment: prescribe heroin with methadone to be administered under supervision
Psychosocial intervention e.g. CBT

Y3 PSYCHIATRY (23 decks)

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