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Psychiatry > Alcohol & SA > Flashcards

Alcohol & SA Flashcards

1
Q

Alcohol withdrawal: onset, sx, mx

A

Onset: within 4-12 hrs of cessation
Sx: tremulousness, sweating, N/V, mood, hyperacusis, ANS hyperactivity, sleep, psychomotor agitation
Mx: IM lorazepam or chlordiazepoxide

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2
Q

Alcoholic hallucinosis: onset, sx, mx

A

Onset: within 12 hrs of cessation
Sx: hallucination (visual > auditory & tactile), secondary delusions
Mx: antipsychotics e.g. haloperidol x6m

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3
Q

Alcohol withdrawal seizures: onset, RF

A

GTC
Onset: within 24 hrs of cessation
RF: previous hx, concurrent epilepsy, low K or Mg

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4
Q

Delirium tremens: sx, mx

A

Sx: vivid hallucinations, altered LOC & cognitive impairment, tremor, ANS arousal (sweating, tachycardia, HT, fever), paranoid delusions
Mx: large dose BZD (chlordiazepoxide or lorazepam), antipsychotic (haloperidol), large dose parenteral thiamine

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5
Q

Wernicke encephalopathy: cause, sx, mx

A 
Thiamine deficiency (malabsorption -> acute brain damage)
Clinical triad: delirium, ophthalmoplegia, ataxia
Mx: parenteral thiamine BEFORE glucose
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6
Q

Korsakoff’s syndrome: sx, mx

A

Chronic state after Wernicke (irreversible)
Sx: amnesia, confabulation, poverty of speech, frontal lobe dysfunction, psychotic symptoms
Mx: lifelong oral thiamine

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7
Q

Alcoholic dementia / amnesic syndrome: epidemiology, sx

A

10% of all dementia

Sx: disoriented to time, confabulation, impaired short term memory

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8
Q

How to diagnose alcohol use disorder?

A

3 in past 12m

1) Craving
2) x control
3) Primacy
4) Tolerance
5) Withdrawal
6) Knowledge of harmful consequences (health, physical hazards)

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9
Q

How to manage alcohol use disorder?

A

Controlled drinking VS abstinence
Detox: chlordiazepoxide (taper down in 1st week)
Thiamine BEFORE glucose
Optional: disulfaram, naltrexone
Psychotherapy: CBT, motivational interviewing, AA

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10
Q

Cannabis intoxication

A

Physical: tachycardia, dry mouth, conjunctival injection, increased appetite
Psychological: euphoria, sedation, impaired judgment / memory / motor performance, distorted sensory perception, sensation of slowed time, asocial
Functional: amotivational syndrome

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11
Q

Cannabis withdrawal

A

Mood: irritable, anxious, depressed, restless
Poor sleep & appetite
Physical: abdominal pain, tremor, sweating/chills, headache

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12
Q

Examples of psychostimulants

A

Cocaine, meth, ecstasy

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13
Q

Examples of CNS depressants

A

Alcohol, BZD, Z drugs, heroin

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14
Q

What are the sx of psychostimulant intoxication?

A 
Increased excitement, talkativeness, confidence
Hand tremor
Tachycardia, HT, palpitation
Dilated pupils
Sweating
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15
Q

What are the sx of psychostimulant withdrawal?

A

Depression

Psychomotor retardation

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16
Q

What are the sx of CNS depressant intoxication?

A

Constricted pupil
Euphoria, relaxation, disinhibition
Dulling of pain

17
Q

What are the sx of CNS depressant withdrawal?

A

Withdrawal seizure
Restless, agitated, irritated
Insomnia

18
Q

What are the specific sx of heroin?

A

Thrombophlebitis

Pinpoint pupil

19
Q

What are the specific sx of ice?

A

Fornication -> festering, painful-looking sores

Meth mouth

20
Q

What are the specific sx of ketamine?

A

LUTS
Cholangiopathy
Perforation of nasal septum
Long pinky nail

21
Q

What are the sx of cough mixture?

A

Dental caries

22
Q

What are the sx of cannabis?

A

Conjunctival injection (hyperemia & vasodilation)

23
Q

What are the physical cx of SA?

A

Malnutrition, anemia, jaundice, hepatitis, DVT, IE, OD, accident
Alcohol: HI, liver disease, pancreatitis, cerebellar pathology
Ketamine: LUTS, nasal symptoms, cholangiopathy

24
Q

What are the components and effects of cough mixture?

A

Codeine / dextromethorpan: relax
Ephedrine: euphoria
Promethazine: sedate

25
Q

How to manage SA patient?

A

Admit for high risk
Inpatient detox
Psychotherapy: motivational abstinence, psychoeducation
Harm reduction advice

26
Q

How to quit BZD?

A

Switch to single prescription (lorazepam)
Taper off gradually (1/8th fortnightly)
Manage sleep problem

27
Q

What are the Cx of alcoholic cirrhosis?

A

Portal HT: esophageal varices, ascites, hypersplenism (splenomegaly, anemia, thrombocytopenia)
Renal dysfunction
Liver dysfunction: hypogly, low alb, coagulopathy, encephalopathy, jaundice
Respi: intrapulmonary vasodilation -> hypoxemia -> dyspnea
HCC

28
Q

What are the stigmata of CLD?

A 
Asterixis, ascites, ankle edema, x axillary hair
Bruise, spider nevi, caput medusa
Clubbing, color of nails (leukonychia)
Dupuytren’s contracture
Encephalopathy, palmar erythema
Fetor hepaticus
Gynecomastia, hypogonadism
Hepatosplenomegaly
Increased size of paotid
Jaundice
29
Q

How to investigate delirium tremens?

A

r/o other cx of alcohol e.g. GIB
r/o organic cause of delirium
LRFT, electrolyte, CBC, Ca, B12/folate, TFT, septic workup

Psychiatry (10 decks)

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