Addiction/Substance misuse Flashcards
How would you define tolerance?
desired CNS effects of a substance diminish and increasing doses are needed to achieve the same effect
What is psychological dependence?
substance produces feeling of satisfaction and psychological drive that requires periodic or continuous administration to
i) produce pleasure
ii) avoid psychological discomfort
What is physical dependence?
intense physical disturbance when administration of substance is suspended
need to take substance to avoid withdrawal state
What is the dependence criteria?
strong/desire compulsion to take substance
difficulties in controlling onset, termination and levels of use
physiological withdrawal state when substance use has ceased
evidence of tolerance
neglect of alt. pleasures
persisting with substance despite evidence of harmful consequences
How would you qualify the risk of alcohol consumption for a man in terms of units?
low - 21
increasing hazard - 21-50
dangerous - >50
How would you qualify the risk of alcohol consumption for a woman in terms of units?
low - 14
increasing hazard - 14-35
dangerous - >35
What are physiological problems seen with alcohol dependency?
nausea and vomiting
gastritis, peptic ulcers, Mallory-weis
malnutrition
fatty liver > hepatitis > cirrhosis
pancreatitis
anaemia
vit K deficiency
peripheral neuropathy
cerebellar degenration
What psychological presentations of alcohol dependency?
low mood
increased risk of suicide
amnesia
withdrawal/delirium tremens
alcoholic hallucinations
Korsakovs - thiamine deficiency
What are symptoms of alcohol withdrawal?
6-12 hours: tremor, sweating, tachycardia, anxiety
peak incidence of seizures at 36 hours
48-72 hours, delirium tremens : coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
How would you manage alcohol withdrawal?
chlordiazepoxide
carbamazepine
What is the triad of Wernicke’s?
ophthalmoplegia/nystagmus, ataxia and confusion
also peripheral sensory neuropathy
What causes Wernicke’s? Besides alcohol dependency what else can cause this?
thiamine deficiency
persistent vomiting, stomach cancer, dietary deficiency
If Wernicke’s is not treated, what could develop?
Wernicke-Korsakoff syndrome and is characterised by the addition of antero- and retrograde amnesia and confabulation
What are some criteria for alcohol dependence?
drinking over other activities
awareness of compulsion and difficulty controlling drink
narrowing of drinking repertoire
increased tolerance
repeated withdrawal symp (tremor, insomnia, nausea, increased sweating)
Relief of withdrawal by drinking
What are some assessment tools you can use for alcohol dependence?
AUDIT
FAST
CAGE
What is the acute management of alcohol dependence?
rehydration and correction of electrolyte imbalance
oral thiamine
chlordiazepoxide
IV or rectal diazepam for withdrawal fits
What is long term management for alcohol dependence?
drinking diary
disulfram
Acamprosate
AA meetings
What are symptoms of nicotine withdrawal?
craving nicotine
irritability
frustration
anger
anxiety symptoms
poor conc
What 3 methods can be offered as smoking cessation?
nicotine replacement therapy
varenicline
buproprion
What are the prescribing instructions for smoking cessation?
to last 2 weeks after target stop date
if unsuccessful don’t repeat within 6 months
do not offer in combination
Which method of smoking cessation is CI in pregnancy?
varenicline
bupropion
When should a pregnant mother be referred to a service for smoking? What is it called?
CO reading >7 ppm
NHS stop smoking services
CBT NRT
What are the forms of nicotine replacement therapy?
Nicotine patches
hum
inhalator
lozenge
What would you do for management of Paracetamol OD?
Gastric Lavage
Activated Charcoal
(Gastric lavage and activated charcoal only used as treatment if OD taken within last hour)
Bloods - paracetamol and salicylate levels, LFT, FBC, INR, ethanol
Parvolex (acetylcysteine)
