Addictions Flashcards
What is intoxication?
Transient syndrome of psychological or physical impairment after substance ingestion which disappears when substance is eliminated from the system
What is withdrawal state?
Group of symptoms when a drug is reduced in amount or stopped entirely
What is tolerance?
Biological neuroadaptations after repeated administration lead to drug producing decreased effect. Higher dose rq for the same effect
What is harmful use
Pattern of psychoactive substance use causing damage to health (physical/mental)
ICD 10/11 Dependence syndrome
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
ICD 10/11 Harmful use
11 includes harm to the health of others e.g. society, partner etc
What are the main differences with DSM-5 to the other criteria?
Separates opioid use disorder and alcohol use disorder
Spectrum of diagnosis from mild, moderate, severe
used in america
Main features of all diagnostic criteria
Loss of control
Functional impairment
neuroadaptation
What are the 6 elements that should be taken in a history for substance misuse?
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)
What are the main causes of morbidity and mortality in substance misuse?
Trauma, Suicide, Overdose, road accidents///
Other medical conditions - cirrhosis from alcohol, infective endocarditis from IV, blood-borne viruses HIV, Hep B
Excretion rate of alcohol
1 unit per hour
What is the recommended limit for alcohol consumption for men and women?
14 units a week
How would you calculate units in an alcoholic drink?
Percentage Strength x Volume [ml] / 1000
How many units are in: a glass of wine, a bottle of wine, a pint of beer and a 25ml spirit glass?
Glass of Wine - 2 units // Pint of Beer - 2 units // Bottle of Wine - 10 units // Spirit Glass - 1 unit
What is speech like in excessive alcohol users?
Normal rate, rhythm, volume
What is mood and affect like in excessive alcohol users?
Euthymic but irritable
What is perception like in excessive alcohol use?
No hallucinations reported (unless severe withdrawal)
Alcohol absorption
Max blood conc within 1hr of ingestion
slowed by food and increased by fizzy drinks
hydrophilic .: widely distributed in body tissues
What is the pharmacodynamics of alcohol like?
Effect on the body:
Agonist of GABA-A (inhibitory -> anxiolysis)
Agonist of dopamine in mesolimbic system (reward)
Antagonist of NMDA glutamate receptors (causing amnesia)
How is alcohol metabolised and at what rate?
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.
How can you assess alcohol related conditions from abdominal examination?
Inspect for jaundice, easy bruising, oedema, ascites
What neurological signs can you see from alcohol related conditions?
Wernicke’s Encephalopathy (ataxia, confusion, ophthalmoplegia) //
Korsakoff’s Syndrome (memory impairment)
Caused by vit b1 deficiency (thiamin)
Which one of these neurological signs is irreversible?
Korsakoff’s Syndrome
What investigations would you do for alcohol patients?
Liver ultrasound, Bloods (LFT), Urine Drug Screen, Breathalyser
What should you note in the history of an alcohol assessment
history of alc related seizures
delirium tremens/ alcoholic hallucinosis
haematemesis
melaena
What screening tools can you use for alcohol assessment?
CAGE Screening (testing patient awareness) //
AUDIT (Alcohol Use Disorders Identification Test - pattern of drinking)
CAGE screening
need to CUT DOWN drinking
ANNOYED by criticism
GUILT surrounding drinking
EYE-OPENER, drink first thing in the morning
Aspects of alcohol assessment
History
Examination
Neurological signs
Investigations
AUDIT screening
8+ brief advice to reduce risk for alcohol harm
20+ consider referral to specialist alcohol harm assessment
Which is more dangerous - alcohol withdrawal or opiate withdrawal?
Alcohol withdrawal - this can be fatal
What are examples of minor alcohol withdrawal symptoms?
Sweating, tremour, fever, anxiety & agitation, vomiting (up to 12 hours after)
What are more serious alcohol withdrawal effects?
Alcoholic Hallucinations (visual and auditory), 12-24 hrs Withdrawal Seizures (start as early as 2hrs)12-48 hrs
Delirium Tremens - 48 hrs after
When does delirium tremens present?
48-72 hours after alcohol cessation
What are the features of delirium tremens?
Tremor in hands and body, Tachycardia, Hypertension, Hallucinations, Death
When can hospital admission lead to delirium tremens?
Admission into hospital without doctors knowing patient was a regular drinker.
Alcohol withdrawal replacement treatment
Benzodiazepines
MSE of opioid users
Appearance - collapsed veins noted
Speech - Normal
Mood/affect - low mood
Thoughts - preoccupied with drug seeking
Perceptions - no hallucinations
Cognition - normal
insight - full insight
What are the effects of opioids?
Analgesic effects and euphoric effect
What is the difference between opiates and opioids?
Opiates are natural opioids.
Opioids are an overarching category containing natural and synthetic opioids
What are some natural opioids?
Morphine, Codeine, Opium
What are some synthetic opioids?
Fentanyl, Methadone
What are some semi-synthetic opioids?
Heroine, Oxycodone
What are endorphins
Endogenous opioids that regulate pain and mood
Aspects of opioid assessment
Examination - collapsed veins, endocarditis, abscesses, pneumonia, blood borne diseases
Investigations - bloods, breathalyser, urine drug screen
What are some of the symptoms of opiate withdrawal?
Tachycardia, Sweating, Dilated Pupils, Bone Pain, Diarrhoea, goosepimpled skin, temor
Assessment of opioid withdrawal
Clinical Opiate Withdrawal Scale (COWS)
What are the signs of opiate overdose?
Slow breathing, Constricted pupils, Blue lips, Clammy skin, unmoving
What drug do you administer if you suspect opiate overdose?
Naloxone - inject into thigh or arm, (provide airway support as well)
may be agitated/violent when they awake
What are the properties of naloxone that need to be considered?
Short half-life, Fast-acting
What main classes of treatment do you use drugs for substance misuse?
Abstinence - naltrexone (used for alcohol)
Detox Regimes - benzodiazepine
