Addictions Flashcards
How does ICD-10 define an alcoholic?
- 3 of clinical features of dependence apply to person
- Occurring at least once in a 12-month period
What are the 7 clinical features of Alcohol Dependency?
- Compulsion to drink
- Priority of drinking over other activities
- Stereotypical drinking pattern (narrowed repertoire)
- Increased tolerance
- Withdrawal symptoms
- Relief drinking to avoid withdrawal symptoms - eye-opener
- Reinstatement after abstinence
What is GABA?
- Gamma-aminobutyric Acid
- Neuro-repressor
What is the effect of Alcohol on GABA?
- Increased GABAergic activity
- Compensatory up-regulation of glutamate to counterbalance depressant symptoms of alcohol
What blood components are raised in heavy alcohol drinkers?
- ALP
- GGT
- MCV
What is a specific indicator of alcohol in the body? and why
- MCV, long half-time due to life of rbc so can tell more efficiently if person has drank or not
What are symptoms of Delirium Tremens?
- Clouding of consciousness
- Disorientation
- Visual hallucinations
- Paranoid delusions
- Short-term memory impairment
- Vomiting/nausea
- Dehydration
- Imbalance
- Seizures
What are differential Diagnoses of Delirium Tremens?
- UTI
- Hypoglycaemia
- Drug overdose
- Wernicke’s encephalopathy
What are the 3 main symptoms of Wernicke’s Korsakov Syndrome?
- Ataxia
- Confusion
- Ocular palsy
What causes Wernicke’s Korsakov Syndrome?
Vit B12 deficiency
What other causes are there to thiamine deficiency?
- Hyperemesis
- Starvation/malabsorption
- CO poisoning
What are differential diagnoses for Wernicke’s encephalopathy?
- Hypoglycaemia
- Hepatic encephalopathy
- Subdural Haemorrhage
What causes Korsakov Syndrome?
- Neuronal loss
- Gliosis
- Haemorrhage in mammillary bodies
- Damage to dorso-medial nucleus of thalamus
What are the features of Korsakov Syndrome?
- Confabulation
- Impairment to recent memory
What is Othello Syndrome?
- Pathological jealousy
- Sexual problems/lack of interest in intoxicated partner
What does CAGE stand for?
- Cutting Down
- Anger/Annoyance at criticising of drinking
- Guilt
- Eye-opener - drinking first thing in morning
How is detoxification achieved?
- Prescribing Benzodiazepine over 5-7 days in reductive amounts with thiamine
- Complete abstinence
How can abstinence be encouraged medically?
- Naltrexone
- Acamprosate
- Disulfiram
What interacts with Alcohol? Give 5 examples
- NSAIDs
- Anti-epileptics
- Antidepressants
- Antibiotics
- Warfarin
What are the symptoms of amphetamine overdose?
- Cardiac arrhythmias
- Severe HT
- Stroke
- Circulatory collapse
- Seizures/coma
How do Amphetamines work?
- Block re-uptake of dopamine and noradrenaline
- CNS stimulant
How do you treat amphetamine withdrawal?
- CBT - to treat co-morbid mental disorder
How do you treat acute intoxication of Amphetamine and Cocaine?
- Benzodiazepines
- Antipsychotics
What are the signs of a cocaine overdose (name 6)?
- Tremor
- Confusions
- Seizure
- Cardiac arrhythmia
- MI
- Respiratory arrest
How do opioids work?
- Act at specific opioid receptors
- Morphine and heroin are relatively selective for the μ-opioid receptor subtype
What are the desired effects of opioid use?
- Euphoria
- Analgesia
- Respiratory distress
What are the negative effects of opioid use?
- Constipation
- Anorexia
- Loss of libido
- Pruritis
What is the major issue with people who have been abstinent from opioids?
- Return to dose they stopped at and body cannot tolerate it
- overdose
What are the withdrawal symptoms of opioid use? (11)
- Intense craving
- Restlessness
- Insomnia
- Muscle pains
- Tachycardia
- Mydriasis
- Running nose and eyes
- Piloerection
- Abdo cramps
- Vomiting
- Diarrhoea
How long does it take to go through the ‘rattles’
- Start 8-12hrs from last
- Peak at 36-72hrs
- Subside over 7-10 days
How do you manage opioid detoxification?
- 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
If someone is unable for complete abstinence, how do you reduce harm?
- Prescribe oral methodone/buprenorphine with aim of reducing injecting
- Needle exchange and drug education programmes
How do you manage an opioid overdose?
- Cardiorespiratory support
- IV naloxone
- IM if patient threatening to self-discharge
Which Benzodiazepines have a long-acting half life?
- Lorazepam
- Diazepam
- Chlordiazepoxide
Which Benzodiazepines have a short-acting half life?
Midazolam
What do you give in the case of a benzodiazepine overdose?
Flumazenil
