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4C - Psychiatry > Alcohol and Substance Misuse > Flashcards

Alcohol and Substance Misuse Flashcards

1
Q

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

A

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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2
Q

What are the features of opioid intoxication

A

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

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3
Q

how quickly can opioid withdrawal occur

A

6 hours later
peak at 36-72hr

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4
Q

is alcohol withdrawal potentially life threatening

A

yes

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5
Q

is opioid withdrawal potentially life threatening

A

no

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6
Q

what are some features of opioid withdrawal
(14 features)

A

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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7
Q

what medication can be given during opioid withdrawal

A

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

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8
Q

what 2 drugs do detox programmes use

A

methadone and buprenorphine

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9
Q

what drug can be given to prevent relapse of opioids

A

neltrexone

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10
Q

what drug can be given to treat an opioid overdose

A

naloxone

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11
Q

how long are opioids detectable in the blood

A

2 days

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12
Q

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

A

Ataxic gait
Nausea and vomiting
Reduced GCS
Dysarthria
Impaired judgement

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13
Q

how quickly does alcohol withdrawal occur

A

12hrs after last drink

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14
Q

what are the features of alcohol withdrawal
(7 features)

A

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

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15
Q

what is the potentially life threatening feature

A

Delirium tremens

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16
Q

what is delirium tremens

A

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

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17
Q

when does delirium tremens occur

A

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

18
Q

how is delirium tremens treated

A

1st oral lorazepam
2nd parenteral lorazepam or haloperidol.

19
Q

what drugs are given for treatment of alcohol withdrawal

A

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

20
Q

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

A

Disulfiram (anabuse) - blocks acetaldehyde dehydrogenase

Acamprosate (calcium acetyl homotaurinate) - suppresses cravings

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

Antidepressants - BUT NOT TCAs

21
Q

what is Wernicke-Korsakoffs syndrome

A

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

22
Q

what is the tetrad of symptoms of Wernicke’s encephalopathy

A

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

23
Q

what is a key differential of Wernicke’s encephalopathy

A

normal pressure hydrocephalus

24
Q

is Wernicke’s encephalopathy reversible and if so with what

A

Yes
Pabrinex

25
Q

What are the triad of features of Korsakoff’s psychosis

A

Retrograde amnesia
Anterograde amnesia
Confabulation

26
Q

is Korsakoff’s psychosis reversible and if so what with

A

No
permanent damage

27
Q

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

A

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

28
Q

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

A

GGT - raised in 70% of people
MCV - raised in 60%
CDT - more specific than GGT

breath alcohol concentration (detectable for 24h after heavy drinking)

29
Q

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

A

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

30
Q

what does LSD act on

A

acts at the dopamine receptors in the brain

31
Q

what are the features of LSD intoxication
*8 features)

A

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

32
Q

how does MDMA work

A

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

33
Q

how does cocaine work

A

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

34
Q

how does methamphetamine work

A

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

35
Q

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

A

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

36
Q

how is stimulant intoxication managed

A

Deaths occur due to hyperpyrexia and hypertension

cooling
antihypertensives - nitroprusside or GTN,
benzodiazepines

37
Q

what are the features of stimulant withdrawal

A

stimulants don’t tend to cause withdrawal symptoms

38
Q

who long are amphetamines detectable for

A

2 days

39
Q

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

A

2 days

40
Q

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

A

20 days

41
Q

how long is methadone detectable in the blood

A

7-9 days

42
Q

what is the standard nicotine treatment of nicotine addiction

A

nicotine replacement therapy

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

4C - Psychiatry (25 decks)

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