Addictions

Question 1

How does ICD-10 define an alcoholic?

Answer 1

• 3 of clinical features of dependence apply to person

- Occurring at least once in a 12-month period

Question 2

What are the 7 clinical features of Alcohol Dependency?

Answer 2

1. Compulsion to drink
2. Priority of drinking over other activities
3. Stereotypical drinking pattern (narrowed repertoire)
4. Increased tolerance
5. Withdrawal symptoms
6. Relief drinking to avoid withdrawal symptoms - eye-opener
7. Reinstatement after abstinence

Question 3

What is GABA?

Answer 3

• Gamma-aminobutyric Acid

- Neuro-repressor

Question 4

What is the effect of Alcohol on GABA?

Answer 4

• Increased GABAergic activity

- Compensatory up-regulation of glutamate to counterbalance depressant symptoms of alcohol

Question 5

What blood components are raised in heavy alcohol drinkers?

Answer 5

• ALP
• GGT
• MCV

Question 6

What is a specific indicator of alcohol in the body? and why

Answer 6

• MCV, long half-time due to life of rbc so can tell more efficiently if person has drank or not

Question 7

What are symptoms of Delirium Tremens?

Answer 7

• Clouding of consciousness
• Disorientation
• Visual hallucinations
• Paranoid delusions
• Short-term memory impairment
• Vomiting/nausea
• Dehydration
• Imbalance
• Seizures

Question 8

What are differential Diagnoses of Delirium Tremens?

Answer 8

• UTI
• Hypoglycaemia
• Drug overdose
• Wernicke’s encephalopathy

Question 9

What are the 3 main symptoms of Wernicke’s Korsakov Syndrome?

Answer 9

• Ataxia
• Confusion
• Ocular palsy

Question 10

What causes Wernicke’s Korsakov Syndrome?

Answer 10

Vit B12 deficiency

Question 11

What other causes are there to thiamine deficiency?

Answer 11

• Hyperemesis
• Starvation/malabsorption
• CO poisoning

Question 12

What are differential diagnoses for Wernicke’s encephalopathy?

Answer 12

• Hypoglycaemia
• Hepatic encephalopathy
• Subdural Haemorrhage

Question 13

What causes Korsakov Syndrome?

Answer 13

• Neuronal loss
• Gliosis
• Haemorrhage in mammillary bodies
• Damage to dorso-medial nucleus of thalamus

Question 14

What are the features of Korsakov Syndrome?

Answer 14

• Confabulation

- Impairment to recent memory

Question 15

What is Othello Syndrome?

Answer 15

• Pathological jealousy

- Sexual problems/lack of interest in intoxicated partner

Question 16

What does CAGE stand for?

Answer 16

• Cutting Down
• Anger/Annoyance at criticising of drinking
• Guilt
• Eye-opener - drinking first thing in morning

Question 17

How is detoxification achieved?

Answer 17

• Prescribing Benzodiazepine over 5-7 days in reductive amounts with thiamine
• Complete abstinence

Question 18

How can abstinence be encouraged medically?

Answer 18

• Naltrexone
• Acamprosate
• Disulfiram

Question 19

What interacts with Alcohol? Give 5 examples

Answer 19

• NSAIDs
• Anti-epileptics
• Antidepressants
• Antibiotics
• Warfarin

Question 20

What are the symptoms of amphetamine overdose?

Answer 20

• Cardiac arrhythmias
• Severe HT
• Stroke
• Circulatory collapse
• Seizures/coma

Question 21

How do Amphetamines work?

Answer 21

• Block re-uptake of dopamine and noradrenaline

- CNS stimulant

Question 22

How do you treat amphetamine withdrawal?

Answer 22

• CBT - to treat co-morbid mental disorder

Question 23

How do you treat acute intoxication of Amphetamine and Cocaine?

Answer 23

• Benzodiazepines

- Antipsychotics

Question 24

What are the signs of a cocaine overdose (name 6)?

Answer 24

• Tremor
• Confusions
• Seizure
• Cardiac arrhythmia
• MI
• Respiratory arrest

Question 25

How do opioids work?

Answer 25

• Act at specific opioid receptors

- Morphine and heroin are relatively selective for the μ-opioid receptor subtype

Question 26

What are the desired effects of opioid use?

Answer 26

• Euphoria
• Analgesia
• Respiratory distress

Question 27

What are the negative effects of opioid use?

Answer 27

• Constipation
• Anorexia
• Loss of libido
• Pruritis

Question 28

What is the major issue with people who have been abstinent from opioids?

Answer 28

• Return to dose they stopped at and body cannot tolerate it

- overdose

Question 29

What are the withdrawal symptoms of opioid use? (11)

Answer 29

• Intense craving
• Restlessness
• Insomnia
• Muscle pains
• Tachycardia
• Mydriasis
• Running nose and eyes
• Piloerection
• Abdo cramps
• Vomiting
• Diarrhoea

Question 30

How long does it take to go through the ‘rattles’

Answer 30

• Start 8-12hrs from last
• Peak at 36-72hrs
• Subside over 7-10 days

Question 31

How do you manage opioid detoxification?

Answer 31

• Stop opioid and prescribe reducing dose of substitute such as methadone/buprenorphine
• Clonidine and lofexidine can also be used
• Naltraxone can help to prevent relapses
• Refer to psychological/social support

Question 32

If someone is unable for complete abstinence, how do you reduce harm?

Answer 32

• Prescribe oral methodone/buprenorphine with aim of reducing injecting
• Needle exchange and drug education programmes

Question 33

How do you manage an opioid overdose?

Answer 33

• Cardiorespiratory support
• IV naloxone
• IM if patient threatening to self-discharge

Question 34

Which Benzodiazepines have a long-acting half life?

Answer 34

• Lorazepam
• Diazepam
• Chlordiazepoxide

Question 35

Which Benzodiazepines have a short-acting half life?

Answer 35

Midazolam

Question 36

What do you give in the case of a benzodiazepine overdose?

Answer 36

Flumazenil