Clinical Topic 7: Substance Misuse Flashcards
What is the triad of Wernicke’s syndrome? What is it caused by?
Confusion
Ataxia
Opthalmoplegia
Caused by thiamine (Vitamin B1) deficiency
What is the CAGE questionnaire used for? What do the questions comprise of? What score should be looked out for?
Used to assess alcohol misuse
- Have you ever thought to Cut down?
- Have you ever felt Annoyed at people’s ideas you should quit?
- Do you feel Guilty about your alcohol intake?
- Do you drink alcohol as an Eye-opener?
Score 2 of 4 -> possible alcohol misuse
What is the AUDIT questionnaire used for? What score should be looked out for?
Used to assess alcohol misuse
20/40 -> consider detox
For patients with acute alcohol withdrawal, what is first line and second line medication?
- First line: Chlordiazepoxide
- Second line: Carbamazepine
What is the mechanism of action for Disulfaram (Antabuse)?
Inhibits ALDH (Acetylaldehyde Dehydrogenase) resulting in accumulation of acetaldehyde, which leads to hangover like symptoms
What is the mechanism of action of Chlordiazepoxide?
Benzodiazepine, potentiates GABA
What is the treatment for Wernicke’s encephalopathy?
Mg and Thiamine supplements; oral or IV (Pabrinex)
In the management of patients with Alcohol Dependence, why is it not recommended to stop alcohol suddenly?
Risk of delirium tremens - fatal in 20% of cases
How is Delirium tremens treated? What if they have liver failure?
Benzodiazepines i.e. Chlordiazepoxide
If they have liver failure -> Lorazepam
What is CIWA-Ar used for?
Clinical Institute Withdrawal Assessment for Alcohol. Used to guide management of alcohol withdrawal treatment
If untreated, what can Wernicke’s lead to? What are the symptoms?
Korsakoff’s syndrome, with symptoms of memory loss and confabulation
What medications can be used to MAINTAIN alcohol abstinence? What are their MoAs?
Disulfiram - Aldehyde dehydrogenase inhibitor
Acamprosate - GABA modulator
Naltrexone - Opiod receptor antagonist
Seizures in alcohol withdrawal may be shown from what point after not drinking?
36 hours
Delirium tremens in alcohol withdrawal may be shown from what point after not drinking?
48-72 hours
What four tests could be performed to support / refute a diagnosis of Alcohol Dependence?
- GGT levels (elevated)
- MCV (elevated)
- Alcohol Blood Content (elevated)
- CT scan in patients with alcohol associated falls
What illicit substances cause Miosis (constriction) of the eyes?
Opiates i.e. herion
What illicit substances cause Mydriasis (dilatation) of the eyes?
Cocaine, Methamphetamines, Amphetamines, LSD
What illicit substance causes bladder dysfunction?
Ketamine
How do you treat Paracetamol overdose?
Activated charcoal (if < 1 hour) N-acetylcysteine
How do you treat Opiate overdose?
Naloxone
How do you treat Benzodiazepine overdose?
Flumazenil
How do you treat Tricyclic antidepressant overdose?
IV bicarbonate
A heroin user is referred to the local drugs unit for community based detoxification. Which heroin substitutes is he most likely to be offered?
Methadone
Buprenorphine
