Alcohol and Substance Misuse Flashcards by Elen Price

According to ICD-10, mental and behavioural disorders secondary to substance misuse may be categorised as what?

Acute intoxication
Harmful use (damage to health, either physical or mental)
Dependence syndrome
Withdrawal state
Withdrawal state with delirium
Psychotic disorder
Amnesic syndrome
Residual and late-onset psychotic disorder

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What are the features of opioid intoxication

Drowsiness
Confusion
Decreased respiratory rate
Decreased heart rate
Constricted pupils
Track marks

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how quickly can opioid withdrawal occur

6 hours later
peak at 36-72hr

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is alcohol withdrawal potentially life threatening

yes

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is opioid withdrawal potentially life threatening

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what are some features of opioid withdrawal
(14 features)

Agitation
Anxiety and irritability
Muscle aches or cramps
Chills
Runny eyes
Runny nose
Sweating
Hypersalivation
Yawning
Insomnia
abdo cramps, nausea, diarrhoea
Dilated pupils
Piloerection
Increased heart rate and blood pressure

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what medication can be given during opioid withdrawal

Methadone: beware, QTc
Lofexidine (alpha 2 receptor agonist)
Loperamide (for diarrhoea)
Anti-emetics (for nausea)
Benzodiazepines (for agitation)

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what 2 drugs do detox programmes use

methadone and buprenorphine

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what drug can be given to prevent relapse of opioids

neltrexone

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what drug can be given to treat an opioid overdose

naloxone

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how long are opioids detectable in the blood

2 days

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what are the common features of alcohol intoxication
(5 features)

Ataxic gait
Nausea and vomiting
Reduced GCS
Dysarthria
Impaired judgement

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how quickly does alcohol withdrawal occur

12hrs after last drink

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what are the features of alcohol withdrawal
(7 features)

Nausea and vomiting
Tremor
Sweating
Anxiety
Agitation
Headache
Clouding of consciousness
Delirium tremens

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what is the potentially life threatening feature

Delirium tremens

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what is delirium tremens

paranoid delusions, visual/auditory and classically haptic (tactile) hallucinations (sensation of crawling e.g. formication), and seizures.

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when does delirium tremens occur

occurs at day 3 of withdrawal, and lasts 3 days,

how is delirium tremens treated

1st oral lorazepam
2nd parenteral lorazepam or haloperidol.

what drugs are given for treatment of alcohol withdrawal

short acting benzodiazepines
- chlordiazepoxide (Librium)
- oxazepam - if liver damage
IV fluids
anti-emetics
Pabrinex - Wernicke-Korsakoff’s

what medication can be given to stop alcohol relapse and management long term

Disulfiram (anabuse) - blocks acetaldehyde dehydrogenase

Acamprosate (calcium acetyl homotaurinate) - suppresses cravings

Naltrexone: opioid antagonist - block alcohol-reinforcing effects & reduce relapse

Antidepressants - BUT NOT TCAs

what is Wernicke-Korsakoffs syndrome

Occurs due to B1 (thiamine) deficiency
resulting in mammillary body atrophy

what is the tetrad of symptoms of Wernicke’s encephalopathy

Confusion
Ataxia
Ophthalmoplegia and Nystagmus
urinary incontinence and hypothermia - due to autonomic neuropathy

what is a key differential of Wernicke’s encephalopathy

normal pressure hydrocephalus

is Wernicke’s encephalopathy reversible and if so with what

Yes
Pabrinex

What are the triad of features of Korsakoff's psychosis

Retrograde amnesia Anterograde amnesia Confabulation

is Korsakoff's psychosis reversible and if so what with

No permanent damage

what specific drink questions do you need to ask in an alcohol history

Describe a typical day’s drinking. What time is the first drink of the day? When did daily drinking start? Presence of withdrawal symptoms in the morning or after abstinence Previous attempts at treatment Physical health problems Patient’s attitude towards drinking

what key labs need testing and what would you expect to see

GGT - raised in 70% of people MCV - raised in 60% CDT - more specific than GGT breath alcohol concentration (detectable for 24h after heavy drinking)

what are the key features of cannabis intoxication (9 features)

Drowsiness Impaired memory Slowed reflexes Slowed motor skills Conjunctival injection Increased appetite Paranoia and psychotic symptoms Tachycardia Dry mouth

what does LSD act on

acts at the dopamine receptors in the brain

what are the features of LSD intoxication *8 features)

Labile mood Hallucinations Increased blood pressure Increased heart rate Increased temperature Sweating Insomnia Dry mouth

how does MDMA work

induces rapid serotonin and dopamine release, and directly binds to the 5HT2 receptor

how does cocaine work

prevents reuptake of dopamine, noradrenaline, and serotonin, resulting in increased levels of free serotonin and dopamine

how does methamphetamine work

acts at the sigma receptors, which induces dopamine release TAAR1 (Trace Amine-Associated Receptor 1) receptors

what are the features of stimulant intoxication (cocaine, MDMA and methamphetamines) (12 features)

Euphoria Hypertensive crises Increased heart rate Dilated pupils Increased temperature Rhabdomyolysis Seizures Agitation Arrythmias Psychosis Excessive thirst and SIADH - water overload and hyponatraemia Ischaemic events

how is stimulant intoxication managed

Deaths occur due to hyperpyrexia and hypertension cooling antihypertensives - nitroprusside or GTN, benzodiazepines

what are the features of stimulant withdrawal

stimulants don't tend to cause withdrawal symptoms

who long are amphetamines detectable for

2 days

how long is a single use of cannabis detectable in the blood

2 days

how long is daily (chronic use) of cannabis detectable in the blood

20 days

how long is methadone detectable in the blood

7-9 days

what is the standard nicotine treatment of nicotine addiction

nicotine replacement therapy 1. transdermal nicotine patches 2. gum 3. lozenges 4. meds - varenicline 5. nicotine vaping