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Addictions Flashcards

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1
Q

What is intoxication?

A

Transient syndrome of psychological or physical impairment after substance ingestion which disappears when substance is eliminated from the system

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2
Q

What is withdrawal state?

A

Group of symptoms when a drug is reduced in amount or stopped entirely

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3
Q

What is tolerance?

A

Biological neuroadaptations after repeated administration lead to drug producing decreased effect. Higher dose rq for the same effect

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4
Q

What is harmful use

A

Pattern of psychoactive substance use causing damage to health (physical/mental)

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5
Q

ICD 10/11 Dependence syndrome

A

11 - 3 pairs of criteria (CNN) impaired Control + compulsion, Neglect of other aspects of life, Neuroadaptation to the substance (incl. tolerance + withdrawal) continuous over 3mths/1 year
1 required for diagnosis

10 - 3/more in the past year
Control, impaired control, withdrawal, tolerance, neglect of alternative pleasures, persistent use despite effects

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6
Q

ICD 10/11 Harmful use

A

11 includes harm to the health of others e.g. society, partner etc

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7
Q

What are the main differences with DSM-5 to the other criteria?

A

Separates opioid use disorder and alcohol use disorder
Spectrum of diagnosis from mild, moderate, severe
used in america

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8
Q

Main features of all diagnostic criteria

A

Loss of control
Functional impairment
neuroadaptation

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9
Q

What are the 6 elements that should be taken in a history for substance misuse?

A

Presenting Complaint,
History of Presenting Complaint,
Substance Misuse History (length, pattern, amount, mode of admin, triggers),
Family History,
Psychiatric History (trauma, developmental disorders ADHD, comorbidities)
Personal History (relationships, stress)

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9
Q

What are the main causes of morbidity and mortality in substance misuse?

A

Trauma, Suicide, Overdose, road accidents///
Other medical conditions - cirrhosis from alcohol, infective endocarditis from IV, blood-borne viruses HIV, Hep B

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10
Q

Excretion rate of alcohol

A

1 unit per hour

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11
Q

What is the recommended limit for alcohol consumption for men and women?

A

14 units a week

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12
Q

How would you calculate units in an alcoholic drink?

A

Percentage Strength x Volume [ml] / 1000

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13
Q

How many units are in: a glass of wine, a bottle of wine, a pint of beer and a 25ml spirit glass?

A

Glass of Wine - 2 units // Pint of Beer - 2 units // Bottle of Wine - 10 units // Spirit Glass - 1 unit

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14
Q

What is speech like in excessive alcohol users?

A

Normal rate, rhythm, volume

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15
Q

What is mood and affect like in excessive alcohol users?

A

Euthymic but irritable

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16
Q

What is perception like in excessive alcohol use?

A

No hallucinations reported (unless severe withdrawal)

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17
Q

Alcohol absorption

A

Max blood conc within 1hr of ingestion
slowed by food and increased by fizzy drinks
hydrophilic .: widely distributed in body tissues

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18
Q

What is the pharmacodynamics of alcohol like?

A

Effect on the body:
Agonist of GABA-A (inhibitory -> anxiolysis)
Agonist of dopamine in mesolimbic system (reward)
Antagonist of NMDA glutamate receptors (causing amnesia)

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19
Q

How is alcohol metabolised and at what rate?

A

Ethanol oxidised eventually to carbon dioxide and water at a linear rate of 1 unit (8g of pure alcohol) per hour
ethanol - acetaldehyde - co2 + h20 via dehydrogenase enzymes
moonshine may contain methanol which forms formaldehyde, causing retinal toxicity.

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20
Q

How can you assess alcohol related conditions from abdominal examination?

A

Inspect for jaundice, easy bruising, oedema, ascites

21
Q

What neurological signs can you see from alcohol related conditions?

A

Wernicke’s Encephalopathy (ataxia, confusion, ophthalmoplegia) //
Korsakoff’s Syndrome (memory impairment)

Caused by vit b1 deficiency (thiamin)

22
Q

Which one of these neurological signs is irreversible?

A

Korsakoff’s Syndrome

23
Q

What investigations would you do for alcohol patients?

A

Liver ultrasound, Bloods (LFT), Urine Drug Screen, Breathalyser

24
Q

What should you note in the history of an alcohol assessment

A

history of alc related seizures
delirium tremens/ alcoholic hallucinosis
haematemesis
melaena

25
Q

What screening tools can you use for alcohol assessment?

A

CAGE Screening (testing patient awareness) //
AUDIT (Alcohol Use Disorders Identification Test - pattern of drinking)

26
Q

CAGE screening

A

need to CUT DOWN drinking
ANNOYED by criticism
GUILT surrounding drinking
EYE-OPENER, drink first thing in the morning

27
Q

Aspects of alcohol assessment

A

History
Examination
Neurological signs
Investigations

28
Q

AUDIT screening

A

8+ brief advice to reduce risk for alcohol harm
20+ consider referral to specialist alcohol harm assessment

29
Q

Which is more dangerous - alcohol withdrawal or opiate withdrawal?

A

Alcohol withdrawal - this can be fatal

30
Q

What are examples of minor alcohol withdrawal symptoms?

A

Sweating, tremour, fever, anxiety & agitation, vomiting (up to 12 hours after)

31
Q

What are more serious alcohol withdrawal effects?

A

Alcoholic Hallucinations (visual and auditory), 12-24 hrs Withdrawal Seizures (start as early as 2hrs)12-48 hrs
Delirium Tremens - 48 hrs after

32
Q

When does delirium tremens present?

A

48-72 hours after alcohol cessation

33
Q

What are the features of delirium tremens?

A

Tremor in hands and body, Tachycardia, Hypertension, Hallucinations, Death

34
Q

When can hospital admission lead to delirium tremens?

A

Admission into hospital without doctors knowing patient was a regular drinker.

35
Q

Alcohol withdrawal replacement treatment

A

Benzodiazepines

36
Q

MSE of opioid users

A

Appearance - collapsed veins noted
Speech - Normal
Mood/affect - low mood
Thoughts - preoccupied with drug seeking
Perceptions - no hallucinations
Cognition - normal
insight - full insight

37
Q

What are the effects of opioids?

A

Analgesic effects and euphoric effect

38
Q

What is the difference between opiates and opioids?

A

Opiates are natural opioids.
Opioids are an overarching category containing natural and synthetic opioids

39
Q

What are some natural opioids?

A

Morphine, Codeine, Opium

40
Q

What are some synthetic opioids?

A

Fentanyl, Methadone

41
Q

What are some semi-synthetic opioids?

A

Heroine, Oxycodone

42
Q

What are endorphins

A

Endogenous opioids that regulate pain and mood

43
Q

Aspects of opioid assessment

A

Examination - collapsed veins, endocarditis, abscesses, pneumonia, blood borne diseases
Investigations - bloods, breathalyser, urine drug screen

44
Q

What are some of the symptoms of opiate withdrawal?

A

Tachycardia, Sweating, Dilated Pupils, Bone Pain, Diarrhoea, goosepimpled skin, temor

45
Q

Assessment of opioid withdrawal

A

Clinical Opiate Withdrawal Scale (COWS)

46
Q

What are the signs of opiate overdose?

A

Slow breathing, Constricted pupils, Blue lips, Clammy skin, unmoving

47
Q

What drug do you administer if you suspect opiate overdose?

A

Naloxone - inject into thigh or arm, (provide airway support as well)
may be agitated/violent when they awake

48
Q

What are the properties of naloxone that need to be considered?

A

Short half-life, Fast-acting

49
Q

What main classes of treatment do you use drugs for substance misuse?

A

Abstinence - naltrexone (used for alcohol)
Detox Regimes - benzodiazepine

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