Drug use:

Question 1

List some behaviours seen in addiction:

Answer 1

• Craving
• Tolerance
• Compulsive drug-seeking behaviour
• Physiological withdrawal state

Question 2

List 3 areas which in which drug dependence can impact:

Answer 2

Physical - acute/chronic

Social

Psychological

Question 3

List 3 effects of heroin and 3 adverse effects:

Answer 3

Effects:
- Euphoria
- Intense relaxation
- Miosis (pupillary constriction)
- Drowsiness
Adverse effects:
- Dependence
- Nausea
- Constipation

Question 4

How would you manage someone with heroin addiction?

Answer 4

1) Harm reduction - education
2) Detoxification:
- 1st line: Buprenorphine
3) Maintenance:
- Methadone OR
- Buprenorphine
4) Psychological interventions

Question 5

What is the difference between methadone and buprenorphine?

Answer 5

Methadone = full agonist

Buprenorphine = partial agonist/antagonist

Question 6

What is maintenance treatment in heroin addiction useful?

Answer 6

(use if long time addicted)

• Reduces mortality
• Reduced drug-related morbidity
• Reduces crime

Question 7

What is used in heroin addiction to prevent relapses?

Answer 7

Naltrexone

Question 8

What should be offered to a newly presenting drug user?

Answer 8

(think HIV/ HepB/C)

• Health check
• Screening
• Contraception
• Sexual health advice
• Immunisation status
• Sign post for help
• Information on local drug services

Question 9

What is the mode of action of cocaine?

Answer 9

Block reuptake of serotonin and dopamine at synapse = intense pleasurable sensation

Question 10

What are the acute effects of cocaine?

Answer 10

• Confidence
• Well being
• Euphoria
• Impulsivity
• Increased energy

Question 11

What are the chronic effects of cocaine?

Answer 11

• Depression
• Panic
• Paranoia
• Psychosis
• Damaged nasal septum

Question 12

What are the principles of treatment in drug dependence?

Answer 12

• harm reduction
• Brief intervention - advice on use, effects, risks
• Team working - sexual health/infectious diseases, specialist advice

Question 13

List the 3 main classes or recreation drugs:

Answer 13

• Stimulants
• Sedatives
• Hallucinogens

Question 14

Give 3 examples of stimulants:

Answer 14

• Nicotine
• Cocaine
• Crystal meth

Question 15

Give 3 examples of sedatives:

Answer 15

• Alcohol
• BZD (Valium)
• Barbiturates

Question 16

Give an example of a hallucinogen:

Answer 16

LSD

Question 17

Give 3 acute and 3 chronic symptoms of stimulants:

Answer 17

Acute:
- Energy
- Excitement
- Euphoria
Chronic:
- Anxious
- restlessness
- Irritable

Question 18

Give 3 acute and 3 chronic symptoms of sedatives:

Answer 18

Acute:
- Euphoria
- Relaxation
- Reduced anxiety
Chronic:
- Depression
- Impaired coordination
- Lethargy

Question 19

Give 3 acute and 3 chronic symptoms of hallucinogens:

Answer 19

Acute:
- Euphoria
- Changed perceptions
- Hallucinations
Chronic:
- Nausea
- Paranoia
- Panic

Question 20

List 5 features of opiate withdrawal:

Answer 20

(picture of guy on sofa)

• Sweating
• Vomiting
• Mydriasis (dilated pupils)
• Tachycardia
• Abdo cramps
• Muscle cramps

Question 21

Why is buprenorophine safer than methadone?

Answer 21

It is a partial agonist. If someone is to OD on it then a point is reached with buprenorphine where excess has no further effect (ceiling effect).

Question 22

What services are there for drug users?

Answer 22

(SEX-C SHIT)

S - Sexual health screening
EX - needle EXchange
- C - Contraception

S - Signposting (councelling/stop-services)
H - Health Check
I - Immunisations (Hep B, C, A etc.)
T - Treatment (detoxification etc.)

Question 23

What is the classification for dependence syndrome?

Answer 23

3 + of the following features:

• Strong desire
• Difficult controlling
• Tolerance
• Physiological withdrawal
• Neglect
• Persistent taking