alcohol misuse Flashcards
what are risk factors for substance misuse
FH of substance misuse
neglect
abuse
common features of substance misuse
history of substance misuse with 2 of: impaired control social impairment risky use pharmacological criteria
examples of impaired control
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
examples of social impairment
affecting performance at work or school
continued use despite social problems
giving up work or recreational activities
examples of risky use
continued use of drug despite health risk
taking drug in a hazardous way
examples of pharmacological criteria
tolerance has developed
experience withdrawal
q
a
what is the criteria for alcohol dependence
3 of: cravings/compulsions difficulty controlling use primacy increased tolerance persistence despite consequence (for >1month or repeatedly over 12)
what is intoxication
use of a substance causing psychobehavioural and cognitive changes
what is withdrawal
when stopping/decreasing a drug causes psychobehavioural and cognitive changes
what are the effects of alcohol intoxication
slurred speech incoordination unsteady gait nystagmus impairment in attention and memory stupor coma inappropriate behaviour - sexual or aggressive overly emotional responses impaired judgement
what are risks of alcohol levels 350-900mg/dl
respiratory depression stupor seizures shock syndrome coma death
what are symptoms of alcohol withdrawal
autonomic hyperactivity - sweating, tachycardia hand tremor insomnia nausea/vomiting psychomotor agitation anxiety tonic clonic seizures
how can alcohol impact relationships
aggression morbid jealousy poor parenting neglect loss of friendship
what medications can be used in alcohol withdrawal
long acting benzodiazepines - chlordiazepoxide/diazepam
carbamazepine
monitor at risk patients in hospital
what medications can be used to treat alcohol dependency
disulfiram
anti-craving meds - acamprosate, naltrexone
thiamine
IV fluids with dextrose (alcoholics often have poor diet)
what is delerium tremens
excess adrenergic activity in response to sudden cessation of alcohol consumption
symptoms of delirium tremens
confusion agitation delusions/hallucinations tremor tachycardia hypertension ataxia hyperthermia sleeplessness
management of delerium tremens
benzodiazepine (titrate from high to low dose over about 5 days)
IV B vitamins
thiamine - low oral dose
what is wernickes encephalopathy
reversible condition caused by thiamine deficiency
triad of confusion, ataxia, oculomotor disturbance
what is korsakoff syndrome
irreversible
medical emergency
memory impairment (antegrade), behavioural/personality changes, confabulation
very serious
treatment for korsakoffs
emergency
IV fluids and thiamine
very serious patient will often need institutional care
features of alcohol related brain damage
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
