Alcohol + substance misuse

Question 1

Recommended weekly amount of alcohol

Answer 1

14 units women, 21 units men

Question 2

Risk factors for alcohol abuse

Answer 2

Fam hx, unemployed, divorced, young males

Question 3

Core features of alcohol dependance

Answer 3

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

Question 4

Delirium Tremens - S+S, onset

Answer 4

Occurs 1-3 days after stopping alcohol Clouding of consciousness, disorientation, visual hallucinations, paranoid delusions, autonomic disturbances, N+V, seizures

Question 5

Management of withdrawal

Answer 5

Benzos (lorazepam or chlordiazepoxide) Thiamine

Question 6

Wernicke’s encephalopathy - S+S, pathology, complications

Answer 6

Confusion, ataxia, ocular palsy Results from thiamine (B1) deficiency Can develop Korsakov’s syndrome

Question 7

Korsakov’s syndrome - S+S

Answer 7

Irreversible impairment of recent memory May confabulate

Question 8

Risk factors for substance misuse

Answer 8

Young, male, single/ divorced, renting, limiting disability, unemployment, earning more than £30,000

Question 9

Use of disulfram - when to use, S+S

Answer 9

Alcohol sensitising deterrent drug - blocks oxidation of alcohol Symptoms of flushing, palpitations, headache, nausea

Question 10

Opioid (effects, OD, withdrawal S+S + management)

Answer 10

Effects: euphoria, analgesia, pinpoint pupils, constipation OD: respiratory depression Withdrawal: restlessness, insomnia, muscle pain, tachycardia, sweating Substitute with methadone. OD management with IV naloxone

Question 11

Cocaine (effects, OD, withdrawal, treatment for acute intoxication)

Answer 11

Effects: dilated pupils, tachycardia, HTN, hyperthermia, hallucinations, N+V OD: tremor, confusion, seizures, cardiac arrhythmias Withdrawal: anxiety, irritability To treat acute intoxication: benzos + APs

Question 12

Amphetamines (effects, OD, withdrawal)

Answer 12

Effects: overactivity, pupil dilation, hyperthermia, HTN, tachycardia, hallucinations/ delusions OD: cardiac arrhythmias, HTN, stroke Withdrawal: decreased energy, depression

Question 13

Benzos (effects, OD, withdrawal, treatment for OD)

Answer 13

Effect: muscle relaxant, sedation OD: oversedation, coma Withdrawal: anxiety, tremor, delirium tremens Treat OD with flumazenil

Question 14

Methadone - effects, complications

Answer 14

Euphoric, then sedated Respiratory depression

Question 15

What are legal highs + what are the effects?

Answer 15

New psychoactive substances

Can be stimulants/ sedatives/ hallucinogens

Question 16

TCA OD ECG + ABG signs

Answer 16

Broad QRS complex (sine wave), positive R wave in aVR

ABG = acidotic

Question 17

Describe anticholinergic OD in terms of:
Drugs causing it
HR + BP
Temp
Pupils
Bowel sounds
Diaphoresis

Answer 17

Drugs causing it = antipsychotics, oxybutinin, ipratropium, ACh receptor antagonists (atropine,
HR + BP = increased
Temp = increased
Pupils = dilated
Bowel sounds = decreased
Diaphoresis = decreased

Question 18

Describe cholinergic OD in terms of:
Drugs causing it
Pupils
Bowel sounds
Diaphoresis

Answer 18

Drugs causing it = ACh receptor agonists (neostigmine), Donepezil
Pupils = pin point
Bowel sounds = increased
Diaphoresis = increased

Question 19

Describe opioid OD in terms of:
Drugs causing it
HR + BP
RR
Temp
Pupils
Bowel sounds
Diaphoresis

Answer 19

Drugs causing it = morphine, heroin
HR + BP = decreased
RR = decreased
Temp = decreased
Pupils = pin point
Bowel sounds = decreased
Diaphoresis = decreased

Question 20

Describe sympathomimetic OD in terms of:
Drugs causing it
HR + BP
RR
Temp
Pupils
Bowel sounds
Diaphoresis

Answer 20

Drugs causing it = cocaine, amphetamine, epinephrine
HR + BP = increased
RR = increased
Temp = increased
Pupils = dilated
Bowel sounds = increased
Diaphoresis = increased

Question 21

Describe sedative/ hypnotic OD in terms of:
Drugs causing it
HR + BP
RR
Temp
Bowel sounds
Diaphoresis

Answer 21

Drugs causing it = benzos, Z drugs, barbiturates, antihistamines
HR + BP = decreased
RR = decreased
Temp = decreased
Bowel sounds = decreased
Diaphoresis = decreased

Question 22

What are the S+S of TCA OD + what is it treated with?

Answer 22

divergent squint + upward plantar reflexes
treat with sodium bicarbonate

Question 23

What is used to treat beta blocker OD?

Answer 23

Glucagon

Question 24

What is definied as serious toxicity in paracetamol OD?

Answer 24

150mg/kg

Question 25

What is Parvolex?

Answer 25

N acetylcholine

Question 26

Pathology of paracetamol OD + amount needed for death

Answer 26

Oversaturation of normal metabolic pathway leading to accumulation of NAPQIDeath in >30g or >10g if with alcohol or other drugs

Question 27

Psych + medical assessment of paracetamol OD

Answer 27

Psych - assess risk, current suicidal ideation

Medical - amount, staggered over time, other drugs or meds

Question 28

Investigations for ?paracetamol OD

Answer 28

LFTs, U+E, clotting screen VBG (lactic acidosis) Plasma paracetamol level

Question 29

Caution with N acetylcysteine

Answer 29

20% have allergic reaction - turn red

Give antihistamine + halve dose

Question 30

Graph points for paracetamol OD

Answer 30

100mg/L at 4 hours 15mg/L at 15 hours

Question 31

When to give liver transplant in paracetamol OD?

Answer 31

Late acidosis

PT >100

Creatinine >300

Grade 3 encephalopathy

Question 32

S+S alcohol withdrawal

Answer 32

6-12 hrs: tremor, sweating, tachycardic

36 hrs: seizures

48-72 hrs: delirium tremensWernicke’s encephalopathy + Korsakoff’s

Question 33

NICE guidelines for paracetamol OD

Answer 33

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)