Assessment and management of people with substance use disorder Flashcards
What scoring system is used to assess opioid withdrawal?
1 - CIWA score
2 - Wells score
3 - COWS score
4 - all of the above
3 - COWS score
- Clinical Opiate Withdrawal Scale
What scoring system is used to assess problem alcohol drinking?
1 - CIWA score
2 - Wells score
3 - COWS score
4 - AUDIT-C score
4 - AUDIT-C score
- Alcohol Use Disorders Identification Test
What is the recommended alcohol use that patients are advised to stay below?
1 - <6 units
2 - <12 units
3 - <14 units
4 - <20 units
3 - <14 units
- calculation for alcohol units =
% of alcohol x volume of alcohol / 1000
Which 2 drugs are typically detectable in the blood for the shortest length of time?
1 - amphetamines
2 - benzodiazepines
3 - cocaine
4 - cannabis
1 - amphetamines
3 - cocaine
Which of the following medications is the drug of choice for uncomplicated alcohol detoxication and delirium tremens?
1 - chlordiazepoxide
2 - diazepam
3 - atropine
4 - naloxone
1 - chlordiazepoxide
Which of the following medications is the drug of choice for alcohol detoxication when there is a risk of seizures and in delirium tremens?
1 - chlordiazepoxide
2 - diazepam
3 - atropine
4 - naloxone
2 - diazepam
Thiamine (B1) is used in alcoholics. Is thiamine effective in both Wernicke’s encephalopathy and Korsakoff’s?
- no
- just Wernicke’s encephalopathy which is caused by a sudden stop in glucose from alcohol
- no thiamine means glycogen cannot be mobilised causing neurological damage
Typically, how quickly can alcohol withdrawal seizures occur?
1 - <12h
2 - 12-24h
3 - 12-48h
4 - >48h
3 - 12-48h
Typically do patients who have seizures due to alcohol withdrawal have EEG abnormalities?
- no
- they can be normal
Typically patients with alcohol withdrawal (12-48h) can have alcohol withdrawal seizures. What is a precipitating factor that can make the seizures worse?
1 - age
2 - gender
3 - hypoglycaemia
4 - liver cirrhosis
3 - hypoglycaemia
Are Delirium tremens dangerous?
- yes
- medical emergency
Delirium tremens is a medical emergency. Which of the following is NOT a stage of delirium tremens?
1 - prodrome
2 - acute on chronic
3 - later
4 - finally
2 - acute on chronic
- essentially the symptoms can develop and worsen over time
Delirium tremens is a medical emergency. How long from the last drink is it before delirium tremens begins?
1 - 1-2 days
2 - 2-4 days
3 - 3-7 days
4 - 5-10 days
2 - 2-4 days
- typically lasts 3-7 days
Which of the following is NOT a typical complication of delirium tremens?
1 - Wernicke’s encephalopathy
2 - amnesic (Korsakoff’s) syndrome
3 - dehydration
4 - hyperkalaemia
5 - cardiac failure
6 - intercurrent infection
4 - hyperkalaemia
- typically causes hypokalaemia
All of the following can cause delirium tremens, but which is the most likely?
1 - alcohol withdrawal
2 - vitamin deficiency
3 - liver disease
4 - hypomagnesaemia
1 - alcohol withdrawal
Which of the following drugs is used to treat alcohol dependence and as part of a relapse prevention strategy?
1 - adenosine
2 - haloperidol
3 - disulfiram
4 - lithium
3 - disulfiram
Disulfiram is used to treat alcohol dependence. What is the mechanism of action of this drug?
1 - agonist of NMDA receptors and increases glutamate
2 - inhibits GABA A receptors
3 - inhibits aldehyde dehydrogenase
4 - all of the above
3 - inhibits aldehyde dehydrogenase
Which are the 2 most commonly used drugs are used to treat patients who are opioid dependent?
1 - Methadone
2 - Buprenorphine
3 - Codeine
4 - Diclofenac
1 - Methadone
2 - Buprenorphine
- both long acting oral preparations
- essentially titrating the patient off drugs
Which are the 2 most commonly used drugs are used to treat patients who are completely off opioids?
1 - Naltrexone
2 - Buprenorphine
3 - Lofexidine
4 - Diclofenac
1 - Naltrexone
3 - Lofexidine
If a patient is addicted to opioids, the aim is for complete absence. However, this is generally not possible and a treatment pathway should be used. What should be the first aim of a treatment plan?
1 - stop the drug and monitor the patient
2 - motivate the patient towards change and involve them in treatment plan
3 - start on a lower dose of opioids and slowly withdraw the drug
2 - motivate the patient towards change and involve them in treatment plan
- important to consider the stages of change model
If a patient is addicted to opioids, the aim is for complete absence. However, this is generally not possible and a treatment pathway should be used. The first step is to try and motivate the patient towards change and involve them in treatment plan. What should be the next phase?
1 - stop the drug and monitor the patient
2 - motivate the patient towards change and involve them in treatment plan
3 - start on a lower dose of opioids and slowly withdraw the drug
4 - minimise harm related to taking substances, improve mental and physical health, reduce criminal activity and blood born infections
4 - minimise harm related to taking substances, improve mental and physical health, reduce criminal activity and blood born infections
If a patient is addicted to opioids, the aim is for complete absence. However, this is generally not possible and a treatment pathway should be used. What should be the final phase of any treatment plan?
1 - stop the drug and use naloxone (opiod antagonist) and monitor the patient
2 - motivate the patient towards change and involve them in treatment plan
3 - start on a lower dose of opioids and slowly withdraw the drug
4 - minimise harm related to taking substances, improve mental and physical health, reduce criminal activity and blood born infections
1 - stop the drug and use naloxone (opiod antagonist) and monitor the patient
- if the opiod cannot be stopped then it should be substited to a safer drug
Deaths surrounding heroine and morphine have increased since 2011, which of the following is not a common factor that has been highlighted as a contributing factor towards this?
1 - age
2 - hepatitis
3 - lung disease
4 - metabolic syndrome
4 - metabolic syndrome
- research suggests patients have a lesses respiratory reserve and this is what they die from
- naloxone is given to patients to reduce the risk of death as an antidote to opioids
