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Psychiatry > Addiction/Substance misuse > Flashcards

Addiction/Substance misuse Flashcards

1
Q

How would you define tolerance?

A

desired CNS effects of a substance diminish and increasing doses are needed to achieve the same effect

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2
Q

What is psychological dependence?

A

substance produces feeling of satisfaction and psychological drive that requires periodic or continuous administration to

i) produce pleasure
ii) avoid psychological discomfort

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3
Q

What is physical dependence?

A

intense physical disturbance when administration of substance is suspended

need to take substance to avoid withdrawal state

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4
Q

What is the dependence criteria?

A

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

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5
Q

How would you qualify the risk of alcohol consumption for a man in terms of units?

A

low - 21

increasing hazard - 21-50

dangerous - >50

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6
Q

How would you qualify the risk of alcohol consumption for a woman in terms of units?

A

low - 14

increasing hazard - 14-35

dangerous - >35

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7
Q

What are physiological problems seen with alcohol dependency?

A

nausea and vomiting

gastritis, peptic ulcers, Mallory-weis

malnutrition

fatty liver > hepatitis > cirrhosis

pancreatitis

anaemia

vit K deficiency

peripheral neuropathy

cerebellar degenration

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8
Q

What psychological presentations of alcohol dependency?

A

low mood

increased risk of suicide

amnesia

withdrawal/delirium tremens

alcoholic hallucinations

Korsakovs - thiamine deficiency

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9
Q

What are symptoms of alcohol withdrawal?

A

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

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10
Q

How would you manage alcohol withdrawal?

A

chlordiazepoxide

carbamazepine

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11
Q

What is the triad of Wernicke’s?

A

ophthalmoplegia/nystagmus, ataxia and confusion

also peripheral sensory neuropathy

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12
Q

What causes Wernicke’s? Besides alcohol dependency what else can cause this?

A

thiamine deficiency

persistent vomiting, stomach cancer, dietary deficiency

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13
Q

If Wernicke’s is not treated, what could develop?

A

Wernicke-Korsakoff syndrome and is characterised by the addition of antero- and retrograde amnesia and confabulation

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14
Q

What are some criteria for alcohol dependence?

A

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

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15
Q

What are some assessment tools you can use for alcohol dependence?

A

AUDIT

FAST

CAGE

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16
Q

What is the acute management of alcohol dependence?

A

rehydration and correction of electrolyte imbalance

oral thiamine

chlordiazepoxide

IV or rectal diazepam for withdrawal fits

17
Q

What is long term management for alcohol dependence?

A

drinking diary

disulfram

Acamprosate

AA meetings

18
Q

What are symptoms of nicotine withdrawal?

A

craving nicotine

irritability

frustration

anger

anxiety symptoms

poor conc

19
Q

What 3 methods can be offered as smoking cessation?

A

nicotine replacement therapy

varenicline

buproprion

20
Q

What are the prescribing instructions for smoking cessation?

A

to last 2 weeks after target stop date

if unsuccessful don’t repeat within 6 months

do not offer in combination

21
Q

Which method of smoking cessation is CI in pregnancy?

A

varenicline

bupropion

22
Q

When should a pregnant mother be referred to a service for smoking? What is it called?

A

CO reading >7 ppm

NHS stop smoking services

CBT NRT

23
Q

What are the forms of nicotine replacement therapy?

A

Nicotine patches

hum

inhalator

lozenge

24
Q

What would you do for management of Paracetamol OD?

A

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)

25
Q

What bloods would you run for someone with suspected alcohol dependency?

A

FBC

Clotting screen (PT, APTT, fibrinogen)

LFTs

B12 and Folate

Gamma-GT

Carbohydrate deficient transferring

26
Q

Peak incidence of seizures following alcohol withdrawal?

A

36 hrs

symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours

27
Q

What scoring system is appropriate to assess alcohol withdrawal?

A

Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale

Psychiatry (3 decks)

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