alcohol misuse

Question 1

what are risk factors for substance misuse

Answer 1

FH of substance misuse
neglect
abuse

Question 2

common features of substance misuse

Answer 2

history of substance misuse with 2 of:
impaired control 
social impairment 
risky use 
pharmacological criteria

Question 3

examples of impaired control

Answer 3

taking larger amounts for longer
unsuccessfully tried to cut down
spending a lot of time trying to obtain, use or recover from the drug
cravings/desires

Question 4

examples of social impairment

Answer 4

affecting performance at work or school
continued use despite social problems
giving up work or recreational activities

Question 5

examples of risky use

Answer 5

continued use of drug despite health risk

taking drug in a hazardous way

Question 6

examples of pharmacological criteria

Answer 6

tolerance has developed

experience withdrawal

Question 7

q

Answer 7

a

Question 8

what is the criteria for alcohol dependence

Answer 8

3 of: 
cravings/compulsions
difficulty controlling use 
primacy 
increased tolerance
persistence despite consequence 
(for >1month or repeatedly over 12)

Question 9

what is intoxication

Answer 9

use of a substance causing psychobehavioural and cognitive changes

Question 10

what is withdrawal

Answer 10

when stopping/decreasing a drug causes psychobehavioural and cognitive changes

Question 11

what are the effects of alcohol intoxication

Answer 11

slurred speech 
incoordination 
unsteady gait 
nystagmus 
impairment in attention and memory 
stupor 
coma 
inappropriate behaviour - sexual or aggressive 
overly emotional responses 
impaired judgement

Question 12

what are risks of alcohol levels 350-900mg/dl

Answer 12

respiratory depression 
stupor 
seizures 
shock syndrome 
coma 
death

Question 13

what are symptoms of alcohol withdrawal

Answer 13

autonomic hyperactivity - sweating, tachycardia 
hand tremor 
insomnia 
nausea/vomiting
psychomotor agitation 
anxiety 
tonic clonic seizures

Question 14

how can alcohol impact relationships

Answer 14

aggression 
morbid jealousy 
poor parenting 
neglect 
loss of friendship

Question 15

what medications can be used in alcohol withdrawal

Answer 15

long acting benzodiazepines - chlordiazepoxide/diazepam
carbamazepine
monitor at risk patients in hospital

Question 16

what medications can be used to treat alcohol dependency

Answer 16

disulfiram
anti-craving meds - acamprosate, naltrexone
thiamine
IV fluids with dextrose (alcoholics often have poor diet)

Question 17

what is delerium tremens

Answer 17

excess adrenergic activity in response to sudden cessation of alcohol consumption

Question 18

symptoms of delirium tremens

Answer 18

confusion 
agitation 
delusions/hallucinations 
tremor 
tachycardia 
hypertension 
ataxia 
hyperthermia 
sleeplessness

Question 19

management of delerium tremens

Answer 19

benzodiazepine (titrate from high to low dose over about 5 days)
IV B vitamins
thiamine - low oral dose

Question 20

what is wernickes encephalopathy

Answer 20

reversible condition caused by thiamine deficiency

triad of confusion, ataxia, oculomotor disturbance

Question 21

what is korsakoff syndrome

Answer 21

irreversible
medical emergency
memory impairment (antegrade), behavioural/personality changes, confabulation
very serious

Question 22

treatment for korsakoffs

Answer 22

emergency
IV fluids and thiamine
very serious patient will often need institutional care

Question 23

features of alcohol related brain damage

Answer 23

50-80% heavy drinkers have cognitive impairment when sober
short term memory, long term recall, new skill acquisition all impaired
visuospatial ability decline
language decline
cortical atrophy
ventricular enlargement