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Psychiatry Y3 > Alcohol + Drug Misuse > Flashcards

Alcohol + Drug Misuse Flashcards

1
Q

Features of opioid intoxication?

A

Drowsiness

Confusion

Decreased respiratory rate

Decreased heart rate

Constricted pupils

“Track marks”

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2
Q

What are “track marks” in opioid intoxication?

A

Aka needle marks

If the intravenous route has been used; abscesses at injection sites; veins thrombosed and damaged causing difficulties with intravenous access

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3
Q

What are the features of opioid withdrawal?

A

Agitation
Anxiety and irritability
Muscle aches or cramps
Chills
Runny eyes
Runny nose
Sweating
Hypersalivation
Yawning
Insomnia
Gastrointestinal disturbance such as abdominal cramps, nausea, diarrhoea and vomiting
Dilated pupils
Piloerection
Increased heart rate and blood pressure

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4
Q

Dilated pupils
Piloerection
Increased heart rate and blood pressure

Are all features of opioid intoxication. True/false?

A

False

These are features of opioid withdrawal

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5
Q

What drugs can be used to help with opioid withdrawal?

A

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

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6
Q

What drug is administered immediately for opiate overdose?

A

Naloxone

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7
Q

What receptors do heroin act upon in the brain?

A

Opioid receptors

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8
Q

What are some features of alcohol intoxication?

A

Ataxic gait
Nausea and vomiting
Reduced GCS
Dysarthria (broken speech)
Impaired judgement

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9
Q

What is ataxic gait?

A

A failure of muscle coordination and is characterised by an irregular foot placement, wide base, and instability.

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10
Q

When do the effects of alcohol withdrawal typically become prominent?

A

Usually 12 hours after the last drink

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11
Q

Features of alcohol withdrawal?

A

Nausea and vomiting
Tremor
Sweating
Anxiety
Agitation
Headache
Clouding of consciousness

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12
Q

Prevention and treatment of alcohol withdrawal?

A

Short acting benzodiazepines such as chlordiazepoxide (Librium).

Oxazepam may be used if there is evidence of liver injury.

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13
Q

Supportive treatment for alcohol withdrawal?

A

Fluids, anti-emetics, and Pabrinex (to prevent Wernicke-Korsakoff’s syndrome.)

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14
Q

What is delirium tremens?

A

A life threatening medical emergency, and usually occurs at day 3 of alcohol withdrawal, and lasts 3 days

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15
Q

Features of delirium tremens?

A

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

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16
Q

Management for delirium tremens?

A

Oral lorazepam as first line, and if the oral route cannot be used for whatever reason, parenteral lorazepam or haloperidol.

17
Q

What is wernicke-korsakoff syndrome?

A

A syndrome associated with chronic alcohol abuse that occurs due to B1 (thiamine) deficiency, resulting in mammillary body atrophy.

It is not exclusive to alcohol abuse, however, with any individual with severe nutritional deficiency at risk.

18
Q

What is wernicke’s encephalopathy?

A

A reversible presentation (treated with high dose intravenous thiamine, e.g. Pabrinex)

Characterised by triad of ophthalmoparesis with nystagmus, ataxia and confusion

19
Q

What vitamin is thiamine?

A

Vitamin B1

20
Q

What is the classic tetrad (group of 4) symptoms for wernicke’s encephalopathy?

A

Confusion

Ataxia

Ophthalmoplegia: classically of the lacteral rectus, but can also be an internuclear ophthalmoplegia or upward-gaze defects

Nystagmus

21
Q

What are some less classical features of Wernicke’s encephalopathy?

A

Urinary incontinence and hypothermia due to autonomic neuropathy therefore making normal pressure hydrocephalus a key differential/

22
Q

What is korsakoff’s psychosis?

A

An irreversible manifestation of untreated Wernicke’s encephalopathy.

23
Q

Triad of features for korsakoff’s psychosis?

A

Retrograde amnesia

Anterograde amnesia

Confabulation (create imaginary memories

24
Q

Features of cannabis intoxication?

A

Drowsiness
Impaired memory
Slowed reflexes
Slowed motor skills
Conjunctival injection
Increased appetite
Paranoia and psychotic symptoms (contrast with cannabinoid associated schizophrenia, which has a more insidious onset, over many years)
Tachycardia
Dry mouth

25
Q

Features of LSD intoxication?

A

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

Psychiatry Y3 (22 decks)

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