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Psych Y5 > Drug And Alcohol > Flashcards

Drug And Alcohol Flashcards

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1
Q

What is harmful use of a substance?

A

Pattern of use causing physical or mental health damage, often with social consequences

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2
Q

4 criteria for ICD10 definition of harmful use?

A

Clear evidence of substance use leading to physical or psychological harm
Nature of harm should be clearly identifiable and specified
Pattern of use persisted for at least 1m month or repeatedly within 12m
Disorder meets no other criteria for mental or behavioural disorders apart from acute intoxication

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3
Q

What is dependence syndrome of a substance?

A

A cluster of behavioural, psychological and physical symptoms in which the use of a substance takes on a much higher priority for an individual than any other previously highly held beliefs

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4
Q

How many criteria and for how long must be present for diagnosis of dependence syndrome?

A

At least 3 for at least 1m or repeatedly over 12m

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5
Q

What are the 6 ICD10 criteria for dependence?

A

Strong desire or compulsion to take substance
Impaired capacity to control onset, amount or termination of use e.g. Increasing amount
Physiological withdrawal if stopped
Tolerance
Preoccupation with substance e.g. Giving up other pleasures
Persistent use despite clear evidence of harmful consequences

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6
Q

What is buprenorphine?

A

A partial competitive opioid agonist

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7
Q

2 opioid antagonists used in substance misuse management?

A

Naloxone

Naltrexone

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8
Q

What is methadone?

A

A full non-competitive opioid agonist

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9
Q

What is bupropion?

A

A substance used to help quit smoking

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10
Q

What is the half life of methadone?

A

Between 24-36 and 48-72 hours

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11
Q

Why is the pharmacological profile of methadone relevant and useful in substance use?

A

Longer half life than heroin so less euphoria and less risk of withdrawal

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12
Q

Side effects of high methadone use?

A

Similar to heroin - respiratory depression, constipation, reduced salivation (poor dental hygiene)

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13
Q

How is methadone taken?

A

Liquid form PO

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14
Q

What is subutex?

A

Buprenorphine

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15
Q

What is the trade name for buprenorphine?

A

Subutex

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16
Q

What does the pharmacological profile of buprenorphine mean in terms of its use? Cautions of use?

A

Partial agonist and highly competitive at opioid receptor
So competes with heroin/methadone causing acute withdrawal before takes time to kick in - can be dangerous so must be completely cold turkey before starting

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17
Q

How do naltrexone and naloxone work?

A

Opioid receptor antagonism - short term prevention of acute overdose or after abstinence to reduce reinforcing effects of taking more heroin

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18
Q

What is lofexidine used for? Major side effect?

A

Adjunct used to detox from opioids as it reduces withdrawal side effects
Major SE is hypotension

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19
Q

What medications are used in acute alcohol withdrawal to reduce symptoms and seizures risk?

A

Benzos - chlordiazepoxide, diazepam

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20
Q

What is disulfiram and what is it used for?

A

Aldehyde dehydrogenase inhibitor
Used once a patient is abstinent from alcohol to stop them from drinking again, as it causes acetaldehyde build up if they do and nasty hangover effects

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21
Q

Medication used to put abstinent people off drinking again by inhibiting aldehyde dehydrogenase?

A

Disulfiram

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22
Q

What is acamprosate useful for?

A

Reducing cravings for alcohol and urge to drink, use in abstinence

23
Q

What medication can be given for alcohol abstinence to reduce cravings and urge to drink?

A

Acamprosate

24
Q

What is varenicline?

A

Medication used to help quit smoking

25
Q

Questionnaires used to assess opioid withdrawal?

A

Objective Opioid Withdrawal Scale OOWS

Subjective Opiate Withdrawal Scale SOWS

26
Q

How do you calculate a unit of alcohol?

A

Percentage by volume X volume (mls)

All divided by 1000

27
Q

What is the AUDIT rating scale used for?

A

Assessment of alcohol dependence/harmful use

28
Q

What does AUDIT stand for?

A

Alcohol Use Disorders Identification Test

29
Q

What cut off score on the AUDIT Scale is recommended for hazardous/harmful alcohol use and possible dependence?

A

8 or more

30
Q

What is the SADQ-C?

A

Severity of Alcohol Dependence Questionnaire

31
Q

What is the SADQ-C used for?

A

To assess the severity of established alcohol dependence

32
Q

What questionare is used to assess severity of established alcohol dependence?

A

SADQ-C

33
Q

What questionare is used to assess for presence of harmful or hazardous use of alcohol or possible dependence?

A

AUDIT-C

34
Q

What liver marker is raised in acute intoxication or hangover from alcohol?

A

Gamma GT

35
Q

What liver and other markers change in chronic alcohol use?

A

ALT/AST
Raised mcv anaemia
Low magnesium
Clotting abnormalities

36
Q

In a patient with chronic heavy alcohol use and dependence, when will symptoms of withdrawal occur following stopping? What are the mild initial symptoms?

A

Around 12 hours

Tremor, sweating, tachycardia, nausea, insomnia, nightmares, anxiety, depression

37
Q

When do symptoms of alcohol withdrawal reach their worst? What are these?

A

48-72 hours

Severe agitation, confusion, delirium/hallucinations, fever, seizures

38
Q

How many of the 10 criteria are required for ICD10 diagnosis of acute alcohol withdrawal?

A

3

39
Q

What are the 10 ICD10 criteria for acute alcohol withdrawal?

A 
Tremor (tongue, eyelid, outstretched hand)
Sweating
Nausea and or vomiting
Tachycardia, hypertension
Psychomotor agitation
Headache
Insomnia
Malaise and weakness
Hallucinations/illusions - tactile, visual or auditory
Seizures (grand mal)
40
Q

4 core features of delirium tremens?

A

Autonomic instability
Fluctuating confusion
Severe tremor
Visual, auditory or tactile hallucinations

41
Q

Management of delirium tremens?

A

Chlordiazepoxide
Diazepam
IM/IV pabrinex 2 pairs TDS for 3-5 days
Haloperidol for disturbed behaviour/may require benzos

42
Q

What is pabrinex? What specific B vits?

A

B vitamins - thiamine, riboflavin, pyridoxine, nicotinamide (B1, 2, 3 and 6)
Vit C ascorbic acid
Glucose

43
Q

What additional management is required for alcohol withdrawal seizures?

A

Increase benzodiazepine dose and initiate/continue anticonvulsants

44
Q

What syndrome is due to acute thiamine B1 deficiency?

A

Wernicke’s encephalopathy

45
Q

Triad of Wernicke’s encephalopathy?

A

Ataxia
Confusion
Ophthalmoplegia

46
Q

Alcohol withdrawal questionnaire?

A

Clinical Institute Withdrawal Assessment for Alcohol

CIWA-Ar

47
Q

What syndrome occurs from chronic untreated Wernicke’s encephalopathy?

A

Korsakoff’s psychosis

48
Q

What 3 factors suggest need to uptitrate methadone?

A

Withdrawal Sx
Cravings
Using on top

49
Q

How is subutex/buprenorphine taken? What does this mean?

A

Sublingual - faster absorption and avoids first pass metabolism

50
Q

What are NPSs?

A

Novel psychoactive substances e.g. Synthetic cannabinoids

51
Q

What is SPICE/black mamba?

A

An NPS/synthetic cannabinoid

52
Q

Antidote for NPS use?

A

There is none as you don’t know what’s in it

53
Q

Acute Sx and risks of NPS use?

A

Psychosis
Respiratory depression
Nausea, vomiting

54
Q

What constitutes rapid tranquillisation for acute agitation?

A

Haloperidol and lorazepam

Psych Y5 (13 decks)

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