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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
Which drug is the 1st line agent for alcohol detox relapse prevention? What is it's mechanism of action?
Naltrexone | Opiod anatagonist and reduces reward from alcohol
26
Which drug should be started as soon as alcohol detox is complete? What is it's mechanism of action? List some side effects
Acamprosate Acts centrally on glutamate and GABA systems to reduce cravings Headache, diarrhoea, nausea
27
Which alpha-2-receptor agonist can help with opiate detox?
Lofexidine
28
What are the 2 main detox agents used for opiate substitution therapy and detox?
Methadone (long-acting full agonist) | Buprenorphine (long-acting partial agonist)
29
What effect does mephedrone have on neurotransmitters?
Inhibits reuptake of serotonin, noradrenaline and dopamine
30
What are the user effects of taking mephedrone?
Feeling of ecstasy, openness | Increased confidence and desires
31
Taking mephedrone increases susceptibility to ladybird attacks. True/False?
True
32
List the main categories of legal highs
``` Stimulants Empathogens Psychedelics Dissociatives Cannabinoids Depressants Opioids ```
33
What is sympathetic toxidrome and which drug is it related to?
Amphetamines | Range of toxic autonomic effects e.g. tremor, sweating, pain, confusion, vomiting etc.
34
What is serotonin syndrome?
Excess serotonin causes hypomania, agitation, myoclonus and hyperactive autonomic state
35
Which drugs can cause serotonin syndrome?
``` Antidepressants Cough medication Tramadol Antibiotics Herbal products ```
36
What effect on neurotransmission does methamphetamine have?
Inhibits reuptake of noradrenaline and dopamine
37
Synthetic cannabinoids can be more potent than cannabis. True/False?
True | 800x more potent!
38
Which legal high causes a detachment from reality, including depersonalisation and derealisation? [dissociative]
Ketamine
39
What are the two main screening tools used to identify alcohol user disorders?
``` AUDIT tool (10 questions) FAST tool ```
40
List clinical features of delirium tremens
Peak onset within 2 days of abstinence Presents insidiously with night time confusion Confusion, disorientation, agitation, hypertension, fever, hallucinations, paranoia
41
List management options for alcohol withdrawal
``` Reassurance and advice Detoxification: (+ Hydration, analgesia, antiemetics, environment) Psychotherapy inc. CBT Relapse prevention ```
42
What is the mechanism of action of benzodiazepines?
Act on GABA A receptors
43
What is the administration of thiamine in alcohol withdrawal prophylaxis against? What is the triad of symptoms seen in this disease?
Wernicke's encephalopathy | Ataxia, opthalmoplegia, nystagmus
44
Which drug for relapse prevention requires compliance to be effective? What is it's mechanism of action? List some side effects.
Disulfram (antabuse) Inhibts acetyl dehydrogenase (acetylaldehyde increases if alcohol consumed ) Flushed skin, tachycardia, nausea and vomiting, arrhythmias, hypotension
45
List drugs used in relapse prevention
Disulfram Acamprosate Naltrexone
46
List the clinical features of opiate misuse
``` Euphoria Analgesia Respiratory depression Constipation Reduced conscious level Hypotension and bradycardia Pupillary constriction ```
47
List the withdrawal symptoms from opiate misuse
``` Dysphoria and cravings Agitation Tachycardia and hypertension Piloerection Diarrhoea, nausea, vomiting Dilated pupils Joint pains Rhinorrhea Lacrimation ```
48
List complications of administering opiates IV
Infections: local e.g. cellulitis, abscess, thrombophlebitis, necrotizing fasciitis, distant: endocarditis, systemic: Hep B, HIV, Hep C Thrombotic/embolic: DVT, PE, ischaemic limb
49
Outline the four main management options for opiate misuse
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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