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Mental Health > Addiction + Drug and Alcohol > Flashcards

Addiction + Drug and Alcohol Flashcards

1
Q

Define SUBSTANCE USE.

A

SUBSTANCE USE - the use of any drug that is approved by medical and social patterns.

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2
Q

Define SUBSTANCE ABUSE.

A

SUBSTANCE ABUSE - the use of any drug (self-administered) for purposes other than what is prescribed within medical and social norms (e.g. to achieve euphoria or an impaired level of consciousness).

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3
Q

Define SUBSTANCE MISUSE.

A

SUBSTANCE MISUSE - the use of a drug prescribed by a medical physician in a way that it was not intended to be used for.

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4
Q

Define SUBSTANCE DEPENDENCE.

A

SUBSTANCE DEPENDENCE - a neurological adaptation in response to repeated exposure to a substance, resulting in the individual experiencing “normal functioning” only in the presence of the drug; results in tolerance and withdrawal symptoms when the drug is ceased.

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5
Q

Outline the features present in SUBSTANCE USE DISORDER.

A

✔️ hazardous substance use
✔️ social or interpersonal problems related to use of the substance
✔️ neglect of major roles due to use of the substance (e.g. parenting or work duties)
✔️ withdrawal symptoms present if the drug is ceased
✔️ tolerance develops (i.e. more drug is required to achieve the same effect)
✔️ craving symptoms
✔️ repeated failed attempts to quit or reduce use
✔️ activities of daily living are given up due to use
✔️ increased duration or quantity of use (more than intended)

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6
Q

Outline the severity grading for SUBSTANCE USE DISORDER.

A

Mild - 2 to 3
Moderate - 4 to 5
Severe - 6 to 7

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7
Q

Identify the FOUR characteristic features of addiction (4 C’s).

A
  1. craving
  2. loss of control
  3. compulsion
  4. negative consequences
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8
Q

Outline the components of the CAGE questionnaire for alcohol dependence.

A

C - have you ever felt the need to CUT DOWN on how much you drink?

A - have you ever felt ANNOYED when people try to talk to you about your drinking?

G - have you ever felt GUILTY about things you have done whilst drinking?

E - have you ever needed an EYE OPENER to function the day after drinking?

A score of >2 suggests dependence and requires further investigation / psychological workup.

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9
Q

Outline the components of the AUDIT-C questionnaire for alcohol dependence.

A
  1. How often do you consume alcohol?
  2. How many units do you typically consume whilst drinking?
  3. How often do you have > 6 standard drinks (if female) or > 8 standard drinks (if male) in one sitting?

AUDIT-C determines the risk of alcohol dependence based on the following cut-off scores:
✔️ mild risk: 0 to 4
✔️ moderate risk: 5 to 10
✔️ high risk: 11 to 12

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10
Q

Outline the four stages of alcohol withdrawal.

A

Alcohol withdrawal typically occurs in FOUR stages:

  1. STAGE ONE - “the shakes” (e.g. tremour, ataxia, agitation, insomnia, muscle cramps)
  2. STAGE TWO - tonic clonic seizure
  3. STAGE THREE - hallucinations (e.g. olfactory, tactile visual, auditory).
  4. STAGE FOUR - delirium tremens

Alcohol withdrawal tends to last 5 to 7 days.

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11
Q

What is the name of the tool used to assess severity of alcohol withdrawal?

A

Clinical Institute Withdrawal Assessment for Alcohol (CIWA-A).

Areas of assessment include: 
✔️ nausea and vomiting
✔️ tremor
✔️ agitation / aggression
✔️ muscle cramps
✔️ tactile hallucinations
✔️ headache
✔️ orientation and clouding of sensorium

The CIWA-A classifies the severity of alcohol withdrawal as follows:
< 10 - mild withdrawal
10 to 20 - moderate withdrawal
> 20 - severe withdrawal

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12
Q

Outline key features of the management of alcohol withdrawal.

A

The management of alcohol withdrawal is dependent on the severity of the withdrawal according to CIWA-A scoring.

Basic management protocol includes:
✔️ diazepam 20mg PO every 1 to 2 hours until CIWA-A score < 10
✔️ thiamine 100mg IM / IV then 100mg PO for 3 days
✔️ fluid / supportive care

If hallucinations are present, give haloperidol.

If seizures are present, use a short-acting benzodiazepine, such as lorazepam (on top of diazepam)

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13
Q

Outline criteria for hospital admission in alcohol withdrawal.

A

✔️ withdrawal symptoms still experienced after > 80 mg diazepam
✔️ delirium tremens, recurrent arythmie, multiple seizures
✔️ medically ill or unsafe to discharge home

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14
Q

Explain the mechanism of WERNICKE’S ENCEPHALOPATHY.

A

Thiamine (Vitamin B1) is synthesised within the liver.

Excessive alcohol consumption can deplete thiamine stores within the body due to impaired absorption, diminished levels and impaired conversion of inactive to active thiamine.

Thiamine has a key role in the TCA cycle by acting as a co-enzyme to three enzymes:

  1. transketolase
  2. alpha-ketoglutarate dehydrogenase
  3. pyruvate dehydrogenase

When thiamine levels are insufficient, these enzymes cannot function adequately, thus, glucose levels within the brain become significantly depleted. This results in Wernicke’s Encephalopathy (reversible) OR Korsakoff’s Psychosis (irreversible).

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15
Q

Chronic alcoholism is the predominant cause for Korsakoff’s Psychosis and WE. What are some other causes?

A 
✔️ anorexia nervosa / prolonged starvation
✔️ malnutrition
✔️ bariatric surgery
✔️ malabsorptive conditions (e.g. Coeliac Disease)
✔️ IV feeding
✔️ GI surgery
✔️ renal dialysis
✔️ hyperemesis gravadium
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16
Q

Identify the three key features of WERNICKE’S ENCEPHALOPATHY.

A
  1. gait ataxia
  2. nystagmus
  3. confusion
17
Q

Identify the key features of KORSAKOFF’S PSYCHOSIS.

A
  1. confabulation
  2. retrograde and anterograde amnesia
  3. reduced cognition and social skills
18
Q

Outline the principles of THIAMINE REPLACEMENT therapy.

A

Any patient with chronic alcoholism / suspected thiamine deficiency should be given 100mg thiamine IV / IM following by 100mg PO for three days.

Any patient that presents with WE or KP should be given:
✔️ 300mg IV for 3 to 5 days followed by
✔️ 300mg PO daily for several weeks

Glucose should always be administered prior to thiamine.

19
Q

What are three drugs that can be used in the management of alcohol dependence? Briefly describe the MoA for each.

A
  1. naltrexone –> complete opioid receptor antagonist; prevents “feel good” feelings of alcohol and prevents dependence
  2. disulfram –> inhibits oxidation of acetyl aldehyde, resulting in a “severe hangover:
  3. acamprosate –> NMDA receptor antagonist; reduces cravings
20
Q

Identify the TWO strongest determinants of nicotine dependence.

A
  1. time to first cigarette of the day

2. number of cigarettes smoked per day

21
Q

Outline components of the FAGERSTROM TEST FOR DEPENDENCE.

A
  1. How many cigarettes do you smoke per day?
  2. How soon after waking do you smoke your first cigarette?
  3. If you had to give up any cigarette of the day, which one would you give up: first cigarette OR any other cigarette
  4. Do you smoke more in the early hours of the day compared to later hours of the day?
  5. Do you find it difficult to not smoke in places where smoking is prohibited?
  6. If you were stuck in bed sick all day, would you still smoke?
The test is graded as follows: 
✔️ mild dependence - 1 to 2
✔️ moderate dependence - 3 to 4
✔️ high dependence - 5 to 6 
✔️ severe dependence - greater than 7
22
Q

Outline clinical features suggestive of NICOTINE WITHDRAWAL.

A 
✔️ agitation / irritability 
✔️ inability to concentrate
✔️ anxiety 
✔️ increased appetite 
✔️ restlessness
✔️ depressed mood
✔️ insomnia
23
Q

Identify the 5 A’s of motivational interviewing.

A
  1. Ask - enquire about substance use
  2. Assess - assess severity of dependence / withdrawal
  3. Advise - advise the individual of the recommended health guidelines
  4. Assist - provide pharmacological or psychological assistance
  5. Arrange - arrange referral or follow-up
24
Q

Identify the components of the STAR METHOD for smoking cessation.

A

S - set a quit date
T - tell family and friends
A - anticipate challenges
R - remove tobacco-related products

25
Q

Identify TWO drugs that can be used to treat / manage nicotine dependence.

A
  1. bupropion –> inhibits re-uptake of adrenaline and dopamine
  2. nortryptyline –> inhibits adrenergic re-uptake

Mental Health (10 decks)

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