alcohol and addiction Flashcards
1
Q
what drugs have the worst physical withdrawal problems
A
opiates barbiturates alchohol benzopdiazepines cocaine
2
Q
what drugs have the worst psychological withdrawal problems
A
opiates
crack/ cocaine
cigarettes
amphetamines, barbiturates, benbodiaspeines, alcohol, gambling
3
Q
what are the 2 different mechanisms of substance abuse
A
Tolerance (the basis of physical dependence) Reward centre (the basis of psychological craving)
4
Q
what is tolerance defined as
A
Reduced responsiveness to a drug caused by previous administration
5
Q
what drugs does tolerance develop to
A
opioids, ethanol, barbiturates, benzodiazepines
6
Q
how does less drug reach the active site in tolerance
A
¥ decreased rate of absorption
¥ increased rate of metabolism to inactive metabolites (broken down before reaching receptor)
¥ decreased rate of metabolism to active metabolites
¥ increased rate of excretion (liver and kidney)
7
Q
how is the site of action less affected by the drug in tolerance
A
¥ down-regulation or internalisation of drug receptors – smaller response
¥ reduced signalling down stream of drug receptors (2nd messengers)
¥ some other compensatory mechanism
8
Q
why do withdrawal symptoms occur in tolerance
A
The body becomes dependent to keep in normal state so when these substances are removed, adverse effects are seen
9
Q
what is the withdrawal phenomena
A
the withdrawal effect of a drug is usually the reverse of the acute effect
10
Q
give examples of 3 withdrawal phenomena
A
opiod - contipation > diarrhoea
barbiturate - anticonvulsant > convulsion
cocaine - elevated mood > depressed mood
11
Q
what neurones fire dopamine
A
ventral tegmental area
12
Q
what feeling does dopamine release cause
A
a sensation of pleasure/reward
13
Q
where do neurones from the ventral segmental area project (dopamine)
A
nucleus accumbens & prefrontal cortex.
14
Q
what normally activates the reward pathway and why
A
eating, drinking and sex to encourages those “healthy” behaviours that lead to propagation of your genes
15
Q
what drugs of abuse tap into reward pathway to increase dopamine levels
A
heroin
amphetamine
cocaine - inhibits uptake
alcohol - inhibits
16
Q
why do some people crave things more than others
A
genetic component to addictive personalities
17
Q
what is the prison sentence for possession of class A, B and C drugs
A
A - 10 years
B - 5 years
C - 3 years
18
Q
name some class A drugs
A
heroin cocaine strret methadone 4-MTA LSD ecstasy
19
Q
name some class B drugs
A
barbiturates
amphetamine
methylphenidate
20
Q
name some class C drugs
A
ketamine benzodiazepines buprenorphine cannabis anabloic steeds GHB
21
Q
what is cocaine extracted from
A
leaves of coca plant
22
Q
what is the difference between the associates of crack and cocaine
A
crack - violence
powder - wealth, sex
23
Q
what is the difference in effect of cocaine between smoking, injecting and snorting
A
smoking - immediates
injecting - 15-30s
sporting - 3-5 mins
24
Q
what are complications of snorting cocoaine
A
nose bleeds
lose nasal septum
25
what is the mechanism of cocaine in the body
powerful vasoconstrictor
26
what are some positive effects of cocaine
Ð stimulant and euphoriant
Ð increased alertness and energy
Ð increased confidence and impaired judgement
Ð lessens appetite and desire for sleep
Ð No cessation – can keep going as long as they can afford
27
what are some negative effects of cocaine
```
Ð damage to nose and airways
Ð convulsions with respiratory failure
Ð cardiac arrhythmia's and MI
Ð hypertension and stroke
Ð toxic confusion – acute if taken a lot
paranoid psychosis
```
28
what are some withdrawal effects seen with cocaine
```
• Depression, Irritability, Agitation
• Craving
• Hyperphagia – eat too much
• Hypersomnia – sleep too much
More psychological than physical dependence (due to dopamine)
```
29
what are the complications with amphetamine
Toxic confusion occasionally with convulsions and death
| Amphetamine psychosis in heavy chronic use
30
what drug are the effects of amphetamine similar to
cocaine
31
list some examples of opiates
meorphine
heroin
methadone
codeine + dihydrocodeine
32
what does opium come from
the dried milky juice of unripe seedpods of the opium poppy (Papavera somniferum).
33
how is heroin taken
snorting, smoking(chasing the dragon) and injection
| Smoking is safest, injecting the most dangerous method of use
34
what are some drawbacks of opiates
Respiratory depression (<8 breaths/ min)
Cough reflex depression
Sensitisation of the labyrinth with nausea and vomiting
Decreased sympathetic outflow (bradycardia and hypotension)
Lowering of body temperature
Pupillary constriction – pinpoint pupils unreactive to light
Constipation
Respiratory arrest with a pulse (overdose)
Varying degree of reduced consciousness/ coma
35
what are the benefits of opiates
Analgesia
Drowsiness and sleep
Mood change (euporia, intense pleasure)
A rush
36
what can be side effects of opiates with short term use
nausea/vomiting and headache
| dose wrong - die
37
what can be side effects of opiates with medium term use
phlebitis from injecting
Anorexia – loss of weight
Constipation
38
what can be side effects of opiates with long term use
tolerance
Withdrawal – craving, insomnia, yawning, muscle pain and cramps, increased salivary, nasal and lacrimal secretions, dilated pupils, piloerection (hence ‘cold turkey’)
Social and health problems – money
39
why was methadone introduced
to decriminalise drug use and allow normalisation of lifestyle
Methadone reduces iv misuse and harm – 7x less likely to die
40
how is ecstasy (MDMA) taken
orally
41
what are the effects of ecstasy
likened to mixture of LSD and amphetamine
euphoria followed by feeling of calm
increased sociability
inability to distinguish between what is and isn’t desirable
42
what are the side effects fo ecstasy
```
Nausea and dry mouth
increased blood pressure and temperature
in clubs users risk dehydration
large doses can cause anxiety and panic
drug induced psychosis
liver and brain cell damage
Loss of serotonin in brain – causes long term depression, anxiety and insomnia
```
43
how long do the effects of ecstasy last
2-4 hours
| after 20 minutes
44
what is the most commonly used illicit drug
cannabis
45
what are the 2 components of cannabis
tetrahydrocannabinol (THC) is the psychoactive agent and CBD is the antipsychotic, low risk
46
how is cannabis taken
eaten or smoked
47
what are the psychological effects of cannabis
relaxing or stimulating, euphoriant, increases sociability and hilarity, increases appetite, changes in time perception, synaesthesia (changes in perception)
in higher dose - anxiety, panic, persecutory ideation, hallucinatory activity
48
what are some of the ill effects of cannabis
* respiratory problems as with tobacco
* toxic confusion
* exacerbation of major mental illness
* cannabis psychosis
49
why are legal highs becoming more popular
internet
50
what are legal highs
illegal chemical compound slightly changed that may mimic effects of the drug but is still legal
51
what is the change in the law to make legal highs illegal
every psychoactive drug is illegal apart from a list etc prescribed, caffeine nicotine etc.
52
what population use anabolic steroid
athletes and sports requiring muscle mass
53
what are some side effects of anabolic steroids
Skin – acne, stretch marks, baldness
Feminisation in males with hypogonadism and gynaecomastia
Virilisation in women including hirsutism, deep voice, clitoral enlargement, menstrual irregularities, hair thinning
Cardiovascular – increased cholesterol and hypertension
Growth deficits due to premature closure of epiphyses
Liver Disease – cholestatic jaundice, liver tumours
Irritability and anger – ‘roid rage’
hypomania and mania
Depression and suicidality on withdrawal
54
what are the effects of alcohol at low dose
euphoria, reduced anxiety, relaxation, sociability in society
55
what are effects of alcohol at higher doses
intoxication
impaired attention and judgement, unsteadiness, flushing, nystagmus, mood instability, disinhibition, slurring, stupor, unconsciousness
56
what is intoxication
the pathological state produced by a drug, serum, alcohol or any toxic substance
57
what is the diagnosis of acute intoxication based on
disturbances of level of consciousness, cognition, perception, affect or behaviour
58
what is the diagnosis of harfmful use of alcohol based on
pattern of use causing damage to physical or mental health. Use >1 month or repeatedly over 12 months
59
what is the diagnosis of alcohol dependence based on
¥ 3 or more of the following for >1month or repeatedly over 12 months:
- Cravings/compulsions to take
- Difficulty controlling use
- Primacy
- Increased tolerance
- Physiological withdrawal on reduction/cessation
- Persistence despite harmful consequences
- Narrowed drinking repertoire & rapid reinstatement after abstinence (Edwards & Grosss)
60
what is the withdrawal state
Group of symptoms of variable clustering and severity on complete/relative withdrawal of a psychoactive substance, after persistent use of that substance
61
what symptoms are seen in the withdrawal state form alcohol
Tremor, weakness, nausea, vomiting, anxiety, seizures, confusion, agitation, death
62
what is delirium tremens
Acute Profound confusion, tremor, agitation, visual hallucinations, delusions, sleeplessness, autonomic over-activity (high HR, low BP)
mortality 5%
63
what is the risk period for delirium tremens
48-72 hours after alcohol stopped
64
what do people in delirium tremens die of
cardiovascular collapse, infection, hyperthermia, seizures or self injury
65
what impact does alcohol have on relationships
o Aggression - Verbal , Physical
o Marital difficulties
o Morbid jealousy
o Poor parenting/neglect +/- loss of parenting rights
o Loss of friendships and social supports
66
what are the 4 Ls of alcohol to consider
Liver - physical
Livelihood - mental health
Lover - relatiosnhsips
legal
67
what mental health effects can alcohol have
Anxiety, Depression (70-80%), Sleep disruption, Morbid Jealousy (Othello syndrome), Alcoholic hallucinosis, Deliberate self-injury, Suicidal thoughts/acts
68
describe the CAGE screening tool
CAGE (2 or more = likely alcohol problem)
¥ Have you tried to Cut down?
¥ Have you felt Annoyed by people criticising your drinking?
¥ Have you felt Guilty about drinking?
¥ Have you felt the need to have an Eye-opener?
69
what are some screening tools used for alcohol
CAGE
AUDIT (Alcohol Use Disorders Identification Test)
FAST (4 questions)
PAT (Paddington Alcohol Test; used in A&Es)
70
what non -pharmacological ways is alcohol dependence managed
Ð Support for patient and family
Ð Psychological help (e.g. CBT, group therapy)
Ð Social work input (benefits, housing, child protection)
Ð Skills training
Ð Community Support (eg AA, ADA)
Ð Inpatient or residential treatment
71
what dug is given to prevent wernicke-larsakoff syndrome
thiamine
72
what drugs are given to manage alcohol withdrawal
Benzodiazepines , commonly Chlordiazepoxide
73
name some anti-craving mediations
Acamprosate (Campral) (not rapid, 3 months,)
Naltrexone,
Nalmefene,
(Baclofen) – not licesnsed in UK, used for spasticity
74
which organ processes alcohol
liver
75
what are the main functions of the liver
```
carb metabolism - glycogen
fat metabolism - cholesterol
protein metabolism - AA, ammonia, albumin synthesis
storage - glucose, iron, copper, vits
synthesis - fibrinogen, thrombopoietin
kupffer cellls - macrophages
bile production
```
76
What should I do if my patient is drinking more than the low risk guidance?
¥ Opportunity to reduce their risk of health harm
¥ If alcohol dependence is likely – refer to treatment services
¥ Offer feedback, assess how willing they are to change and offer support strategies
77
what neurochemical changes occur when alcohol is consumed
opiate release
| Alcohol ENHANCES inhibitory GABA A, Glycine and Adenosine; alcohol REDUCES excitatory NMDA glutamate and Aspartate.
78
What is the most appropriate treatment to commence in an inpatient who is at risk of alcohol withdrawal
chlordiazepoxide
79
what is alcohol converted to in the liver
Alcohol >Acetylaldehyde (toxic) >Acetate >fatty acids, C20, H20
80
what enzymes help the processing of alcohol in the liver
alcohol dehydrogenase (ADH) acetyldehydrogenase (ALDH
81
what is the rate of 1 unit of alcohol processed by a healthy liver
1 unit per hour
82
what part of the alcohol metabolism is a carcinogen in excess
Acetaldehyde
83
which gender are more susceptible to liver damage
females
84
what are the main causes of cirrhosis
alcohol related liver disease
fatty liver sidease
hep C virus
autoimmune disease
85
what is the progression of disease from a normal liver to liver cirrhosis
```
normal liver
fatty liver (steatosis)
steatophepatitis
Fibrosis
Liver Cirrhosis
```
86
what stage of liver pathology is reversible with abstinence
normal liver to fatty liver (steatosis)
87
why does steatosis occur
alcohol is broken down into fatty acids and is also calorie rich. Fat is deposited around the central veins then parenchyma
88
give some indications of chronic alcohol abuse
* HISTORY
* Elevated gamma GT (liver enzyme)
* Macrocytosis (large red blood cells- fat pads out)
* Low platelets – hypersplenism, bone marrow suppression
* Elevated ferritin
* Enlarged smooth edged liver on AUSS
89
what is alcoholic hepatitis
Fatty change within the liver AND Infiltration with leucocytes/ Hepatic necrosis
90
how may alcoholic hepatitis present
Hepatomegaly, Jaundice, Abdominal Pain, Fever, +/- Hepatic decompensation
May or may not be cirrhotic (can be on top of cirrhosis or fatty liver)
91
what is your 28 day survival rate is GAHS > 9 and < 9
Day 1 GAHS <9 87%
| Day 1 GAHS >9 46%
92
what things are considered in the Glasgow Alcoholic Hepatitis Score
Age, markers of inflammation and liver function
93
how do you treat alcoholic hepatitis
ABSTINENCE, Steroids, management of infection and nutrition
94
what are complications of alcoholic hepatitis
Renal impairment and coagulopathy , ascites
95
what are symptoms of wernickes encephalopathy
Confusion, ataxia, opthalmoplegia, nystagmus
96
what is Korsakoff’s Psychosis
Prominent impairment of recent and remote memory, preservation of immediate recall, no general cognitive impairment, retrograde and anterograde memory, impaired learning and disorientation, may exhibit nystagmus and ataxia
97
what does wernickes encephalopathy progress to if left untreated
Korsakoff’s Psychosis
98
what causes a wernickes encephalopathy
```
thiamine deficiency
(Poor intake and absorption, poor hepatic function, increased requirement for alcohol metabolism
Problem because they don’t eat well
Directly toxic to gut lining)
```
99
what affects can alcohol have on the CNS
poor memory/ cognition, cortical/ cerebellar atrophy, retrobulbar neuropathy, fits, falls, accidents, neuropathy, Korsakoff’s/ Wernickes encephalopathy
100
what affects can alcohol have on the heart
arrhythmias, hypertension, cardiomyopathy
101
what affects can alcohol have on the gut
D&V, peptic ulcer, erosions, varices, pancreatitis
102
what affects can alcohol have on sperm
decreased fertility, decreased sperm motility
103
what is the recommended drinking limits
< 14 units per week
| Regular consumption – spread over >3 days
104
how many units a week will lead to serious liver disease
>100
105
how do you calculate a unit of alcohol
ABV (%) x volume/ 1000
106
what age group have the highest alcohol associated deaths
49-59
107
what are the most common alcohol related deaths
alcoholic liver disease, liver cirrhosis and mental and behavioural disorders due to alcohol.
108
describe the pathogenesis of fibrosis
Chronic inflammation
Activation of stellate cells
Collagen production bridging between veins/ tracts– stiffer, scarring
Loss of lobule structure
109
describe the pathogenesis of cirrhosis
pan lobular – pseudo lobules (nodules) formed – thick bands of fibrous tissue between lobule
110
what are complications of liver cirrhosis
Variceal haemorrhage
Encephalopathy (build up of ammonia)
Ascites (Na/ H20 balance)
Hepatocellular carcinoma
111
what are the difference in outcomes of you stop drinking
5 year survival if abstinent 65%,
| 5 year survival if ongoing alcohol consumption 35%
