Alcohol + substance misuse Flashcards
Recommended weekly amount of alcohol
14 units women, 21 units men
Risk factors for alcohol abuse
Fam hx, unemployed, divorced, young males
Core features of alcohol dependance
Compulsion to drink Primacy of drinking over other activities Stereotyped pattern of drinking Increased tolerance Withdrawal symptoms Relief drinking to avoid withdrawal Reinstatement after abstinence
Delirium Tremens - S+S, onset
Occurs 1-3 days after stopping alcohol Clouding of consciousness, disorientation, visual hallucinations, paranoid delusions, autonomic disturbances, N+V, seizures
Management of withdrawal
Benzos (lorazepam or chlordiazepoxide) Thiamine
Wernicke’s encephalopathy - S+S, pathology, complications
Confusion, ataxia, ocular palsy Results from thiamine (B1) deficiency Can develop Korsakov’s syndrome
Korsakov’s syndrome - S+S
Irreversible impairment of recent memory May confabulate
Risk factors for substance misuse
Young, male, single/ divorced, renting, limiting disability, unemployment, earning more than £30,000
Use of disulfram - when to use, S+S
Alcohol sensitising deterrent drug - blocks oxidation of alcohol Symptoms of flushing, palpitations, headache, nausea
Opioid (effects, OD, withdrawal S+S + management)
Effects: euphoria, analgesia, pinpoint pupils, constipation OD: respiratory depression Withdrawal: restlessness, insomnia, muscle pain, tachycardia, sweating Substitute with methadone. OD management with IV naloxone
Cocaine (effects, OD, withdrawal, treatment for acute intoxication)
Effects: dilated pupils, tachycardia, HTN, hyperthermia, hallucinations, N+V OD: tremor, confusion, seizures, cardiac arrhythmias Withdrawal: anxiety, irritability To treat acute intoxication: benzos + APs
Amphetamines (effects, OD, withdrawal)
Effects: overactivity, pupil dilation, hyperthermia, HTN, tachycardia, hallucinations/ delusions OD: cardiac arrhythmias, HTN, stroke Withdrawal: decreased energy, depression
Benzos (effects, OD, withdrawal, treatment for OD)
Effect: muscle relaxant, sedation OD: oversedation, coma Withdrawal: anxiety, tremor, delirium tremens Treat OD with flumazenil
Methadone - effects, complications
Euphoric, then sedated Respiratory depression
What are legal highs + what are the effects?
New psychoactive substances
Can be stimulants/ sedatives/ hallucinogens
TCA OD ECG + ABG signs
Broad QRS complex (sine wave), positive R wave in aVR
ABG = acidotic
Describe anticholinergic OD in terms of:
Drugs causing it
HR + BP
Temp
Pupils
Bowel sounds
Diaphoresis
Drugs causing it = antipsychotics, oxybutinin, ipratropium, ACh receptor antagonists (atropine,
HR + BP = increased
Temp = increased
Pupils = dilated
Bowel sounds = decreased
Diaphoresis = decreased
Describe cholinergic OD in terms of:
Drugs causing it
Pupils
Bowel sounds
Diaphoresis
Drugs causing it = ACh receptor agonists (neostigmine), Donepezil
Pupils = pin point
Bowel sounds = increased
Diaphoresis = increased
Describe opioid OD in terms of:
Drugs causing it
HR + BP
RR
Temp
Pupils
Bowel sounds
Diaphoresis
Drugs causing it = morphine, heroin
HR + BP = decreased
RR = decreased
Temp = decreased
Pupils = pin point
Bowel sounds = decreased
Diaphoresis = decreased
Describe sympathomimetic OD in terms of:
Drugs causing it
HR + BP
RR
Temp
Pupils
Bowel sounds
Diaphoresis
Drugs causing it = cocaine, amphetamine, epinephrine
HR + BP = increased
RR = increased
Temp = increased
Pupils = dilated
Bowel sounds = increased
Diaphoresis = increased
Describe sedative/ hypnotic OD in terms of:
Drugs causing it
HR + BP
RR
Temp
Bowel sounds
Diaphoresis
Drugs causing it = benzos, Z drugs, barbiturates, antihistamines
HR + BP = decreased
RR = decreased
Temp = decreased
Bowel sounds = decreased
Diaphoresis = decreased
What are the S+S of TCA OD + what is it treated with?
divergent squint + upward plantar reflexes
treat with sodium bicarbonate
What is used to treat beta blocker OD?
Glucagon
What is definied as serious toxicity in paracetamol OD?
150mg/kg
What is Parvolex?
N acetylcholine
Pathology of paracetamol OD + amount needed for death
Oversaturation of normal metabolic pathway leading to accumulation of NAPQIDeath in >30g or >10g if with alcohol or other drugs
Psych + medical assessment of paracetamol OD
Psych - assess risk, current suicidal ideation
Medical - amount, staggered over time, other drugs or meds
Investigations for ?paracetamol OD
LFTs, U+E, clotting screen VBG (lactic acidosis) Plasma paracetamol level
Caution with N acetylcysteine
20% have allergic reaction - turn red
Give antihistamine + halve dose
Graph points for paracetamol OD
100mg/L at 4 hours 15mg/L at 15 hours
When to give liver transplant in paracetamol OD?
Late acidosis
PT >100
Creatinine >300
Grade 3 encephalopathy
S+S alcohol withdrawal
6-12 hrs: tremor, sweating, tachycardic
36 hrs: seizures
48-72 hrs: delirium tremensWernicke’s encephalopathy + Korsakoff’s
NICE guidelines for paracetamol OD
1.<1hrs= activated charcoal 2.1-4hrs= wait until it has been over 4 hrs, to get the maximum serum paracetamol 3.Use treatment graph guidelines to decide whether or not someone will receive the anti-dote- if above the line then…4.4-8hrs= N-ACETYL-CYSTEINE (comes in bags 1st over 1hr, 2nd over 4hrs, 3rd over 16hrs= 3 bags altogether)
