Drug Use + Withdrawal Flashcards
What is harmful use?
Pattern of psychoactive substance use that is causing damage to health
Physical e.g. hepatitis from needles
OR
Mental e.g. depressive disorder secondary to alcohol
What is substance abuse or misuse?
The continued misuse of any psychoactive substance that severely affects physical + mental health, social situation + responsibilities
What is a psychoactive substance?
Substance that has effect on CNS
What is the diagnostic criteria for dependence syndrome? (6)
Strong desire or sense of COMPULSION to take the substance
Difficulties in CONTROLLING substance taking behaviour: onset, termination, levels of use
Physiological WITHDRAWAL STATE: when use has ceased/ reduced
Evidence of TOLERANCE: increased doses required to achieve effects
Progressive NEGLECT of alternative pleasures/ interests
PERSISTING with substance despite clear evidence of overtly harmful consequences
What is the stages of change model?
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Relapse
What is the management for alcohol addiction?
- MOTIVATIONAL INTERVIEWING
- Offer referral to specialist alcohol services
- Form plan for elimination + improving health e.g. BP . Interventions to promote abstinence
- Alcohol dependent required by law to notify DVLA
- Prophylactic oral thiamine
- Drink diary
What therapy is offered for opiate addicts?
Opiate substitution therapy:
Pharmacological- Methadone or Buprenorphine
Psychosocial: harm reduction interventions e.g. overdose prevention training
Describe Methadone use in OST
Long acting, half life 24h, administered OD
Can be reduced slowly over weeks, has less euphoria than heroin
Describe Buprenorphine use in OST
Partial agonist, long half life, administered OD
Attenuates effects of opiates
Produces less sedation, less euphoria + positive reinforcement + less resp depression
What scale is used to assess opiate withdrawal?
Clinical opiate withdrawal scale (COWS)
Give 4 effects of cannabis use
Difficulty sleeping, vivid dreams or nightmares
Low mood
Difficulty concentrating
Irritability
Give 5 features of cocaine use
Anxiety + paranoia
DILATED pupils
Euphoria + increased energy
Tachycardia + HTN (vasoconstriction causes flushed cheeks)
Hyperthermia
Name 1 key feature of cocaine intoxication
Formication
Sensation of insects crawling on/ below skin
Give 5 features of heroin use
PINPOINT pupils
Drowsiness
Bradypnoea
Dizziness/ confusion
N+V
Give 4 features of cocaine withdrawal
Fatigue
Sleep disturbances
Agitation
Depression
What are substance use disorders?
patterns of Sx resulting from use of a substance that is continued to take, despite experiencing problems as a result.
What are substance induced disorders?
inc. intoxication, withdrawal, + other substance/ medication-induced mental disorders
Caused by the effects of substances
What investigations can be used for drug disorders?
Drug screen
LFTs
HIV screen
Infection screen
Urine drug analysis
What is alcohol dependence?
Craving, tolerance, preoccupation with alcohol + continued drinking in spite of harmful consequences
(e.g. liver disease or depression caused by drinking).
What is harmful drinking?
pattern of alcohol consumption causing health problems directly related to alcohol.
Inc. psychological problems e.g. depression, alcohol-related accidents or physical illness e.g. acute pancreatitis.
What are the elements of the CAGE screening tool?
Cut down: ever felt you should cut down on drinking
Annoyed: ppl annoyed you by criticising your drinking?
Guilty: ever felt bad/ guilt about drinking?
Eye-opener: every had a drink first thing in the morning to steady your nerves or get rid of a hangover?
What formal screening tool can be used to assess alcohol use disorder?
AUDIT-C
What assessment tool can be used to quantify severity of alcohol withdrawal?
CIWA-Ar
What is the mechanism of Naltrexone?
Mu-opioid receptor antagonist- blocks euphoric effects of alcohol + feelings of intoxication
What is the mechanism of Acamprosate?
Anti-craving
Increases GABA + decreases excitatory glutamate
What is the mechanism of disulfiram?
Inhibits acetaldehyde dehydrogenase. Acetaldehyde accumulates, cause the effects of a hangover
Which 3 features characterise Wernicke’s encephalopathy?
- Nystagmus
- Opthalmoplegia
- Ataxia
Which 2 features characterise Korsakoff’s psychosis?
- Amnesia (anterograde + retrograde)
- Confabulation
Describe the course of symptoms in alcohol withdrawal
6h: anxiety, irritability, tremor, palpitations + tachycardia, clammy skin, sweating, headaches, insomnia
36h: peak incidence of seizures
48-72: peak incidence delirium tremens
Give 6 features of delirium tremens
Coarse tremor
Confusion
Fever
Agitation
Hallucinations (visual + tactile)
Delusions
