Drug and Alcohol Problems Flashcards
defined as ‘any unwanted
effect of treatment from the medical use of drugs that
occurs at a usual therapeutic dose
adverse drug effect
______ are the most common and involve
augmented pharmacology; that is, they are caused by
unwanted, albeit predictable, effects of the drug
Type A reactions
Examples of Type A reaction
• _____ due to verapamil
• blurred vision and urinary outflow problems due
to ________
• hyperuricaemia due to______
constipation
tricyclic antidepressants
thiazide diuretics
Type A reactions are ______dependent
dose-
_____reactions are by definition bizarre. The
reactions are unpredictable from known properties of the drug
Type B
Examples of Type B
Examples include hepatotoxicity and blood
dyscrasias.
1 drug that causes side effects:
Antidepressants (number 1 cause): tricyclics,
MAOIs, SSRIs
_____ is the largest single, preventable
cause of death and disease in Australia.
Tobacco smoking
Signs of
major dependence are smoking within______
30 minutes of
waking and ≥ 20 cigarettes a day
What symptoms after stopping smoking?
The initial symptoms are restlessness, cravings,
hunger, irritability, poor concentration, headache
and frustration
Withdrawal
After about _____ days most of these effects subside but it takes about ____ for a smoker to feel relatively comfortable
with not smoking any more
10
three months
DSM criteria for nicotine withdrawal
1 Irritability, frustration or anger 2 Anxiety 3 Difficulty concentrating 4 Increased appetite 5 Restlessness 6 Depressed mood 7 Insomnia
______ which should
be used in conjunction with an educational support
program, has been proved to be effective and
is available as chewing gum, inhaler, oral spray,
lozenges, sublingual tablets or transdermal patches
(the preferred method).
Nicotine replacement therapy (NRT),
Ideally the nicotine should
not be used longer than _____months.
3
NRT should be directed at smokers who are
_______ There is little evidence that drug
treatment will benefit individuals with low levels
of nicotine dependence who smoke fewer than
10 cigarettes a day
motivated to quit.
All forms of NRT are effective: a pooled analysis
of all NRT trials showed an absolute increase in
cessation at 1 year of ______compared to placebo
7%
How to use the Nicotine gum
Low dependence (less than 10 cigarettes per
day, not needing to smoke within 30 minutes
of waking):______
use non-pharmacological methods
rather than replacement
How to use the Nicotine gum
Moderate dependence (10–20 cigarettes per day, smoking within 30 minutes of waking): \_\_\_\_\_\_
2 mg,
chew 8–12 pieces daily
How to use the Nicotine gum
High dependence (>20 per day, waking at night to smoke or first thing after waking):\_\_\_\_\_\_\_
4 mg
initially, 6–10 pieces chewed daily changing to
2 mg after 4–8 weeks
Useful points in using Nicotine gum:
• Chew each piece slowly for about______
• Ensure all the nicotine is utilised.
• Chew at least 6 pieces per day, replacing at regular
intervals (not more than 1 piece per hour).
• Use for ______ weaning off before the end of
this period
30 minutes.
3 months,
This is available as 16-hour or 24-hour nicotine
patches in three different strengths. The patients
should stop smoking immediately on use
Transdermal nicotine
Useful points in using Transdermal nicotine
low to moderate dependence (10–20 cigarettes/
day): ______
14 mg/24 hour or 10 mg/16 hour patch,
daily; aim to cease within 12 weeks
Useful points in using Transdermal nicotine
high dependence (>20/day): ______
21 mg/24 hour or 15
mg/16 hour patch; change to 14 mg or 10 mg patch
after 4–6 weeks; aim to cease within 12 weeks
Useful points in using Transdermal nicotine
Rotate sites with a_____for reuse of a
specific site.
7-day gap
Nicotine inhaler
Uses cartridges in a mouthpiece resembling smoking.
_________
• 6–12/day for 12 weeks then taper
____________
These are available in 2 mg and 4 mg strengths, the
strength used according to the level of dependence
Nicotine lozenges and sublingual tablets
Controlled trials have shown enhanced outcomes
when nicotine patches are combined with ______. Consider it for highly addicted smokers
gum or
inhaler.
This oral agent has a similar effectiveness to NRT.
Adverse effects include insomnia and dry
mouth (both common), with serious effects, such
as allergic reactions and increased seizure risk
Bupropion (Zyban)
Commence with 0.5 mg (o) daily for 3 days
titrating slowing to 1 mg bd by day 7 until the
end of the 12-week course
It is an effective agent but there are several side
effects, especially nausea
Varenicline tartrate (Champix)
__________ is one of the most
common and socially destructive problems in the world.
Excessive drinking of alcohol
At least 20–40% of acute general and psychiatric
hospital admissions have ________
an alcohol-related
illness
Problem drinkers represent about
_______of the population
15–20%
_____________occurs at >6
standard drinks (SDs) a day (average) for men and
>4 SDs for women
High-risk and harmful drinking
The main causes of alcohol-related deaths are
1
2
3
road
trauma, cancer and alcoholic liver disease
What questionaire is used?
1 Have you ever felt you should CUT down on your
drinking?
2 Have people ANNOYED you by criticising your
drinking?
3 Have you ever felt bad or GUILTY about your
drinking?
4 Have you ever had a drink first thing in the
morning to steady your nerves or get rid of a
hangover? (an EYE-OPENER)
CAGE questionnaire
The following blood tests may be helpful in the
identification of excessive chronic alcohol intake:
1
2
3
• blood alcohol
• serum GGT: elevated in chronic drinkers (returns
to normal with cessation of intake)
• MCV: >96 fL
_________is a syndrome in which an
individual demonstrates clinically significant
impairment or distress as manifested by three or
more of the following, occurring at any time in the
same 12-month period:
Alcohol dependence
Minimum intervention technique plan
(5–10 minutes) for alcohol dependence:
1 2 3 4 5 6
1 Advise reduction to safe levels
2 Outline the benefits
3 Provide a self-help pamphlet
4 Organise a diary or other feedback system
5 Obtain consent for a telephone follow-up
6 Offer additional help (e.g. referral to an alcohol and
drug unit or to a support group
Withdrawal
from alcohol in a chronic problem drinker includes
- agitation
- prominent tremor
- sweating
- insomnia
- seizures
- delirium tremens (DTs)
Goal of tx of withdrawal syndromes
The aim of treatment for acute withdrawal
symptoms is to prevent development of DT
Tx of withdrawal
Add _______, including thiamine, because the
patient is invariably thiamine deficient.
vitamin B complex
How to give Diaz in withdrawal
diazepam 20 mg (o) every 2 hours (up to 100 mg
(o) daily) titrated against clinical response (taper
off after 2 days) in the hospitalised or wellsupervised
patient
How to give Thiamine in withdrawal
thiamine 100 mg IM or IV daily for three days,
then 300 mg (o) daily for several weeks
Tx of withdrawal
for psychotic features add ________`
(o) bd or 5 mg IM as single dose if necessary
haloperidol 1.5–5 mg
_______ is a serious life-threatening withdrawal state. It
has a high mortality rate if inadequately treated and
hospitalisation is always necessary
DTs
Clinical features of DT
- May be precipitated by ____ and ____
- ____days after withdrawal (usually 3–4 days)
- Disorientation, agitation
- Clouding of consciousness
intercurrent infection or trauma
1–5
How to give Thiamine in DT
Thiamine (vitamin B1 300 mg IM or IV daily for
3–5 days, then thiamine 300 mg (o) daily
In the tx of DT:
____ is not recommended
because of its potential to lower seizure threshold.
_____ and _______ may worsen the symptoms
of hepatic toxicity
Chlorpromazine
Diazepam and haloperidol
The average lethal blood
alcohol concentration is about _____
0.45–0.5%.
Alcohol withdrawal may begin at _____
0.1%
Overdose of alcohol may cause
______ and ____
hypoglycaemia and metabolic acidosis
A type of acute drug toxicity causing headache, nausea
and fatigue
Hangover
______is another ‘designer’ drug which is
an amphetamine derivative—methylenedioxymethamphetamine
(MDMA)
Ecstasy
It has high abuse
potential, some hallucinogenic properties and a
tendency to neurotoxicity, as proved on PET brain
scans.
Ecstasy
An increasingly popular drug is _______which has sedative and
anaesthetic effects similar to alcohol
fantasy
(gamma-hydroxybutyrate),
Another party drug
is______, which is a short-acting anaesthetic with
hallucinogenic properties. It can produce nausea and
vomiting if used with alcohol. Like fantasy, treatment
of overdosage is symptomatic
ketamine
What drug?
Drowsiness, stupor, dullness, slurred speech, drunk
appearance, vomiting
Death from overdose or as a result of withdrawal,
addictions, convulsions
Barbiturates
Initial euphoria, floating feeling, sleepiness, lethargy, wandering mind, enlarged pupils, lack of
coordination, craving for sweets, changes of appetite, memory
difficulty
Cannabis/marijuana
What does marijuana worsen
or exacerbates schizophrenia
Convulsions, risk of death from heart attack, cerebral
haemorrhage, hyperthermia, fluid imbalance with
hyponatraemia, acute kidney failure, DIC, liver toxicity,
hangover, depression
Ecstasy (methylenedioxymethamphetamine)
Relaxation and drowsiness, dizziness, relaxed inhibition/
euphoria, increased sexual arousal, impaired mobility and
speech
Fantasy (gammahydroxybutyrate)
Cx of Fantasy
Tremors and shaking,
amnesia, coma, convulsions,
death from high doses
Aggression and violence, drunk appearance, slurred speech, dreamy or blank expression
Glue sniffing
Cx of Glue sniffing
Lung/brain/liver damage, death through suffocation or
choking
Severe hallucinations, feelings of detachment, incoherent speech, cold hands and feet, vomiting,
laughing and crying
LSD (lysergic acid
diethylamide)
Cx of LSD
LSD causes
chromosomal breakdown
Stupor/drowsiness, marks on body, watery eyes, loss of
appetite, running nose, constricted pupils, loss of sex drive
Narcotics (a) opioids
e.g. heroin
A __________ is identified
at 2–3 months and includes irritability, depression
and insomnia
secondary abstinence syndrome
Complications of narcotic dependence
_______________respiratory depression—
may include fatal cardiopulmonary collapse.
Since the early 2000s opioid deaths have fallen
from peak levels of the 1990s, when there was a
glut of heroin
Acute heroin reaction:
Complications of narcotic dependence
Injection site: scarring, pigmentation,
thrombosis, abscesses, ulceration (especially with
______
barbiturates)
Complications of narcotic dependence
________ septicaemia, infective
endocarditis, lung abscess, osteomyelitis,
ophthalmitis
Distal septic complications:
______ withdrawal (short term) is used to
prevent the emergence of a withdrawal syndrome in
contradistinction from buprenorphine maintenance,
where there is an extended treatment period
Buprenorphine
Tx of Opioid withdrawal
______ can be used as first-line treatment because of relative safety
These drugs are preferred to methadone for the management of opioid withdrawal.
Clonidine
Tx of Opioid withdrawal
______ can be used to
treat problematic anxiety and agitation, but avoid
benzodiazepines unless supervision is available
Diazepam
Maintenance programs for long-term
opioid dependence
There are currently three alternative programs—
______________—which
are substitutes for heroin and other opioids.
methadone, buprenorphine and naltrexone
Tx of Opioid withdrawal
Seek specialist advice before starting treatment. The
dose needs to be determined individually according to
past use and initial response
Methadone
Tx of Opioid withdrawal
_________2–8 mg sublingual, once daily
initially, increase to 8–24 mg daily or alternative
days once stabilised. It is less dependent and
prone to overdose than methadone but can
precipitate withdrawal if used too soon
Buprenorphine
Tx of Opioid withdrawal
Care is required in giving ________ to a person
physically dependent on opioids. A naloxone challenge
test is used
naltrexone
How to give Naltrexone:
Naltrexone 25 mg (o) initially increasing to 50 mg
daily on day 2 if tolerated. Careful supervision
with appropriate counselling is required
What syndrome?
- Aggressive behaviour
- Paranoid behaviour
- Irritability
- Transient toxic psychosis
- Delirium
- Schizophrenic-like syndrome
Stimulant-induced syndrome
Stimulant substance abuse TX
1
2
3
Withdrawal of drugs
• Cognitive behaviour therapy
• No firm evidence on effectiveness of drugs
This syndrome should be suspected in people whose
occupation involves shift work, interstate transport
driving or multiple jobs presenting with the following
symptoms:
- drowsiness
- hypersomnia, then insomnia
- irritability
- aggressive behaviour
- dysphoria
- urge to resume drugs
Stimulant-withdrawal syndrome
Stimulant-withdrawal syndrome Tx
• Psychological support and encouragement
• Desipramine (or similar tricyclic antidepressant)
75 mg (o) nocte (increasing as necessary)
• Bromocriptine 1.25 mg (o) bd has also been used
for cocaine withdrawal
_________ in use include lysergic acid (LSD),
phencyclidine (angel dust), diethylamide and many
synthetics
Hallucinogens
Treatment of hallucinogen abuse, especially where there is fear or anxiety, is ________
diazepam 10–20 mg (o) statim.
Treatment (medication to counter
symptoms of hallucinogen abuse)
• haloperidol 2.5–10 mg (o) daily
or
• diazepam 10–20 mg (o) repeated every 2 hours
prn (to max 120 mg daily)
It contains the chemical tetrahydrocannabinol, which makes people get ‘high’. It is commonly called marijuana, grass, pot, dope, hash or hashish.
Cannabis
The effects of smoking marijuana take up
to _________to appear and usually last_________and then drowsiness follows
20 minutes
2 to 3 hours
The apparent positive effects of _________
include gains in muscular strength (in conjunction
with diet and exercise) and quicker healing of muscle
injuries. However, the adverse effects, which are
dependent on the dose and duration
anabolic steroids
Banned drug groups in sports include
stimulants,
narcotics, cannabinoids (e.g. marijuana), antioestrogen
agents (e.g. tamoxifen), glucocorticosteroids
(e.g. prednisolone), anabolic agents, diuretics and
various hormones.
Banned methods include
1
2
3
and pharmaceutical, chemical and physical
manipulation (substances or methods that alter the
integrity and validity of the urine testing).
blood doping (the administration of blood, red blood cells
and related blood products)
, enhancement of oxygen transfer (e.g. erythropoietin, efaproxiral),
gene doping
