Alcohol

Question 1

Signs of DT x6

Answer 1

Agitation
Anxiety
Sweating
Shaking
Tremors
Tachycardia

Question 2

Define alcohol use disorder

Answer 2

A cluster of behavioral and physical symptoms that include alcohol cravings, withdrawal and tolerance

Question 3

TIME 2 CUT DOWN PAL

Answer 3

Time spent
2+ symptoms
Cravings
Unable to stop
Tolerance

Question 4

2 enzymes involved in alcohol use disorder

Answer 4

Alcohol dehydrogenase
Aldehyde dehydrogenase

Question 5

Risk factors of AUD x5

Answer 5

Male gender
Age 18-25
Mood disorder
Personality disorder
Other substance use disorders

Question 6

Dopamine pathways in the brain x4 and what they connect

Answer 6

Mesolimbic - ventral tegmental area to limbic sysytem
Mesocortical - ventral tegmental area to frontal cortex
Nigrostriatal - substantia nigra to dorsal striatum
Tuberoinfundibular- arcuate nucleus to pituitary gland

Question 7

Describe how ethanol acts as a neurotransmitter x2

Answer 7

Ethanol is a GABA agonist > inhibition of neuronal stimulation and signaling
It acts as a glutamate (ie excitatory) antagonist

Question 8

Effect of chronic alcohol use on neurotransmitters x2

Answer 8

Upregulation of glutamate as a compensation of the suppressing effect from ethanol
Downregulation of GABA

Question 9

How do neuroadaptive changes cause alcohol withdrawal syndrome x3

Answer 9

Alcohol withdrawal leaves an excess of glutamate > Hyperexcitable brain state > seizures

Question 10

Reward centers of the brain x2

Answer 10

Nucleus accumbens
Amygdala

Question 11

Psychological causes of AUD x2

Answer 11

Personality traits
Conditioned learning

Question 12

Biological causes of AUDx2

Answer 12

Genetics
Psychiatric comorbidities

Question 13

Investigations in AUD and justification x3

Answer 13

FBC- r/o macrocytic anemia
LFTs- to check GGT, AST, ALT
RBS -damage to pancreas

Question 14

Pharmacotherapy for AUD x5

Answer 14

Naltrexone- blocks euphoric effects
Acamprosate- decreases cravings
Disulfiram - unpleasant effects
Thiamine and vitamin B supplements

Question 15

Describe motivational interview and its 4 principles

Answer 15

Used to enhance the patients motivation to change
Resist the righting reflex
Understanding patients own motivation
Listen with empathy
Empower

Question 16

Psychological management of AUD x3

Answer 16

CBT
Motivational interview
Peer support groups

Question 17

Public health approach to management of AUD x5

Answer 17

Strict age limit
Heavy taxation
Advertising restrictions
Time for selling alcohol
Limit availability of alcohol

Question 18

Risk factors of AWS x5

Answer 18

Prior withdrawal
Family history of withdrawal
Concurrent medical conditions
Consumption of sedatives
Increased quantity and frequency

Question 19

Pathophysiology of AWS x5

Answer 19

• Desensitization of the sympathetic nervous system > autonomic disturbance > tachycardia, hypertension and orthostatic changes

Question 20

Pathophysiology of withdrawal seizures

Answer 20

Decreased GABA > decreased Cl influx > decreased hyperpolarization > more action potentials > seizures

Question 21

Triad of Wernicke encephalopathy

Answer 21

Ataxia
Ophthalmoplegia
Acute cognitive impairment

Question 22

DSM criteria for AWS x4

Answer 22

1. Cessation of prolonged heavy alcohol use
2. Two or more of; anxiety, autonomic hyperactivity, N&V, Insomnia, hallucinations
3. Those in B cause distress and functional impairment
4. Not due to any medical condition or mental disorder

Question 23

Differential for AWS x4

Answer 23

DKA
Hypoglycemia
Essential tremor
Sedative withdrawal

Question 24

Management of AWS x4

Answer 24

Rehydration
Benzodiazepines
Antipsychotics
Correct electrolyte imbalances

Question 25

Where are cannabis receptors present x4 and function of each

Answer 25

Hypothalamus- appetite
Amygdala- fear and anxiety
Brain stem- vomiting reflex
Spinal cord - pain sensation

Question 26

Effects of acute and chronic cannabis use x2 each

Answer 26

Acute- euphoria and relaxation
Chronic- paranoia and depression

Question 27

Syndrome caused by
heavy cannabis use

Answer 27

Amotivational syndrome - loss of energy and drive

Question 28

Cannabis withdrawal symptoms x3

Answer 28

Irritability
Insomnia
Hostility

Question 29

What specific substance is responsible for cannabis induced psychosis

Answer 29

THC tetrahydrocannabinol

Question 30

What do opioids do in the brain

Answer 30

Activation of brain reward system > reinforcement of behaviors

Question 31

Conditions and outcomes that opioid use is associated with x5

Answer 31

Hepatitis
High HIV prevalence
Preterm delivery
Fetal death
IUGR

Question 32

Screening tool of opioid use disorder

Answer 32

ASSIST- alcohol smoking and substance involvement screening tool

Question 33

Pharmacotherapy for opioid disorder X3

Answer 33

Naltrexone
Methadone
Buprenorphine - good neonatal outcomes

Question 34

Treatment goals for Opioid used disorder x3

Answer 34

Reduce HIV
Reduce criminality
Reduce drug associated mortality

Question 35

Management of opioid use disorder X6

Answer 35

Motivational interview
Harm reduction strategies
Mutual help groups

Question 36

Causes of death in DT x3

Answer 36

Hyperthermia
Cardiac arrhythmias
Complications of seizures

Question 37

Effects of chronic cannabis use x3

Answer 37

Paranoia
Low motivation
Depressive symptoms

Question 38

Features of cannabis dependence x2

Answer 38

Tolerance with heavy use
Abstinence leads to withdrawal symptoms

Question 39

5 stages of motivational enhancement therapy

Answer 39

Express empathy
Develop discrepancy
Avoid argumentation
Roll with resistance
Support self efficacy