Drug Use + Withdrawal

Question 1

What is harmful use?

Answer 1

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

Question 2

What is substance abuse or misuse?

Answer 2

The continued misuse of any psychoactive substance that severely affects physical + mental health, social situation + responsibilities

Question 3

What is a psychoactive substance?

Answer 3

Substance that has effect on CNS

Question 4

What is the diagnostic criteria for dependence syndrome? (6)

Answer 4

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

Question 5

What is the stages of change model?

Answer 5

Pre-contemplation

Contemplation

Preparation

Action

Maintenance

Relapse

Question 6

What is the management for alcohol addiction?

Answer 6

1. MOTIVATIONAL INTERVIEWING
2. Offer referral to specialist alcohol services
3. Form plan for elimination + improving health e.g. BP . Interventions to promote abstinence
4. Alcohol dependent required by law to notify DVLA
5. Prophylactic oral thiamine
6. Drink diary

Question 7

What therapy is offered for opiate addicts?

Answer 7

Opiate substitution therapy:

Pharmacological- Methadone or Buprenorphine

Psychosocial: harm reduction interventions e.g. overdose prevention training

Question 8

Describe Methadone use in OST

Answer 8

Long acting, half life 24h, administered OD

Can be reduced slowly over weeks, has less euphoria than heroin

Question 9

Describe Buprenorphine use in OST

Answer 9

Partial agonist, long half life, administered OD
Attenuates effects of opiates
Produces less sedation, less euphoria + positive reinforcement + less resp depression

Question 10

What scale is used to assess opiate withdrawal?

Answer 10

Clinical opiate withdrawal scale (COWS)

Question 11

Give 4 effects of cannabis use

Answer 11

Difficulty sleeping, vivid dreams or nightmares
Low mood
Difficulty concentrating
Irritability

Question 12

Give 5 features of cocaine use

Answer 12

Anxiety + paranoia
DILATED pupils
Euphoria + increased energy
Tachycardia + HTN (vasoconstriction causes flushed cheeks)
Hyperthermia

Question 13

Name 1 key feature of cocaine intoxication

Answer 13

Formication
Sensation of insects crawling on/ below skin

Question 14

Give 5 features of heroin use

Answer 14

PINPOINT pupils
Drowsiness
Bradypnoea
Dizziness/ confusion
N+V

Question 15

Give 4 features of cocaine withdrawal

Answer 15

Fatigue
Sleep disturbances
Agitation
Depression

Question 16

What are substance use disorders?

Answer 16

patterns of Sx resulting from use of a substance that is continued to take, despite experiencing problems as a result.

Question 17

What are substance induced disorders?

Answer 17

inc. intoxication, withdrawal, + other substance/ medication-induced mental disorders
Caused by the effects of substances

Question 18

What investigations can be used for drug disorders?

Answer 18

Drug screen

LFTs

HIV screen

Infection screen

Urine drug analysis

Question 19

What is alcohol dependence?

Answer 19

Craving, tolerance, preoccupation with alcohol + continued drinking in spite of harmful consequences

(e.g. liver disease or depression caused by drinking).

Question 20

What is harmful drinking?

Answer 20

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.

Question 21

What are the elements of the CAGE screening tool?

Answer 21

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?

Question 22

What formal screening tool can be used to assess alcohol use disorder?

Answer 22

AUDIT-C

Question 23

What assessment tool can be used to quantify severity of alcohol withdrawal?

Answer 23

CIWA-Ar

Question 24

What is the mechanism of Naltrexone?

Answer 24

Mu-opioid receptor antagonist- blocks euphoric effects of alcohol + feelings of intoxication

Question 25

What is the mechanism of Acamprosate?

Answer 25

Anti-craving
Increases GABA + decreases excitatory glutamate

Question 26

What is the mechanism of disulfiram?

Answer 26

Inhibits acetaldehyde dehydrogenase. Acetaldehyde accumulates, cause the effects of a hangover

Question 27

Which 3 features characterise Wernicke’s encephalopathy?

Answer 27

• Nystagmus
• Opthalmoplegia
• Ataxia

Question 28

Which 2 features characterise Korsakoff’s psychosis?

Answer 28

• Amnesia (anterograde + retrograde)
• Confabulation

Question 29

Describe the course of symptoms in alcohol withdrawal

Answer 29

6h: anxiety, irritability, tremor, palpitations + tachycardia, clammy skin, sweating, headaches, insomnia

36h: peak incidence of seizures

48-72: peak incidence delirium tremens

Question 30

Give 6 features of delirium tremens

Answer 30

Coarse tremor
Confusion
Fever
Agitation
Hallucinations (visual + tactile)
Delusions