General health Flashcards
What is the screening tool used in primary care to test for problem drinking and potential alcohol problems?
CAGE questionnaire.
> 2 or equal to 2 should prompt further exploration
Which questionnaire assesses for high risk alcohol use?
AUDIT
Which questionnaire assesses for the severity of alcohol dependence?
SADQ
What interventions are recommended for individuals with moderate to severe alcohol dependence, particularly when they have limited social support, complex comorbidities, or haven’t responded to initial community-based treatments?
Offer intensive structured community-based interventions.
Consider pharmacological interventions (e.g., acamprosate, oral naltrexone) administered by specialists.
Ensure psychological interventions are based on evidence-based treatment manuals.
Staff should receive regular supervision, use outcome measurements, and monitor treatment adherence.
In the context of alcohol dependence, what considerations should be taken into account when assessing individuals who typically consume over 15 units per day, and what interventions may be offered based on the assessment outcome?
Consider offering an assessment for community-based assisted withdrawal.
If safety concerns arise, consider assessment and management in specialist alcohol services.
For successful withdrawal, consider offering acamprosate or oral naltrexone with individual psychological interventions.
What are the criteria for considering inpatient or residential assisted withdrawl in individuals with alcohol dependence?
Consider inpatient withdrawal for those drinking over 30 units per day, scoring over 30 on the SADQ, or having specific medical conditions.
What drug regimens are recommended for assisted withdrawal in community-based programs for mild to moderate alcohol dependence?
Offer outpatient programs with fixed-dose benzodiazepines, averaging 2-4 meetings per week for the first week.
What is the preferred medication for assisted withdrawal in individuals with alcohol dependence, and how should it be prescribed and monitored?
Prefer benzodiazepines (chlordiazepoxide or diazepam) in fixed-dose regimens, prescribing for instalment dispensing. Monitor users every other day during assisted withdrawal.
When managing withdrawal from co-existing benzodiazepine and alcohol dependence, what is the recommended approach and duration of withdrawal regimens?
Manage withdrawal with one benzodiazepine and inpatient regiments should last 2-3 weeks or longer, tailored to the severity and circumstances of the individual.
What are the treatment goal differences for individuals with alcohol misuse in specialist alcohol services?
Abstinence is recommended for dependence
Moderation may be considered for mild cases
Harm reduction is an option for those unwilling to aim for abstinence initially, with encouragement for eventual absitnence.
How should thiamine be managed for individuals at high risk of Wernicke’s encephalopathy, especially during assisted alcohol withdrawal in specialist settings, according to NICE guidelines?
For those at risk in specialist inpatient or prison settings with malnutrition or decompensated liver disease, offer parenteral thiamine followed by oral thiamine. People with Wernicke-Korsakoff syndrome should be placed in supported living or 24-hour care, adapted for cognitive impairment, emphasizing abstinence support.
Can Varenicline or Bupropion be prescribed to pregnant or breastfeeding women or people under 18?
No
What withdrawal symptoms is a person likely to experience when they stop smoking?
- Irritability
- Frustration
- Anger
- Anxiety
- Difficulty concentrating
- Increased appetite
- Restlessness
- Depressed mood
- Insomnia
What are the benefits of stopping smoking?
- Stopping smoking before the age of 40 avoids over 90% of the increased risk of dying caused by continuing to smoke.
- Circulation improves
- Risk of heart attack, lung cancer reduces
- Carbon monoxide is almost eliminated from the body.
- Ability to taste and smell improves.
If a person smokes, what is included in VBA? (very brief advice)
VBA is typically given in less than 30 seconds:
* Ask about current and past smoking behaviour.
* Provide verbal and written information on the risks of smoking and the benefits of stopping smoking.
* Advise on the options for quitting smoking including behavioural support, medication and e-cigarettes.
* Refer the person to their local stop smoking service (if they wish to stop smoking).
What is the first step in a patient who wants to quit smoking?
Referral to the local NHS stop smoking services
What is involved in NHS stop smoking services?
- Carbon monoxide measurement
- If they want to be involved in a group they can or they can have 1-1
- Patches, nicotine replacement given. Champix (tablets), can get from boots. Champix programme.
If a person does not want to stop smoking, what harm reduction methods might be used?
Stopping smoking, but continuing to use NRT.
Cutting down before stopping smoking, with or without NRT.
Smoking reduction, with or without NRT.
Temporary abstinence from smoking, with or without NRT.
NRT may be used as long as necessary to prevent relapse.
In pregnancy, what is the recommended option for smoking cessation, and how does it compare to using e-cigarettes?
For pregnant individuals, licensed nicotine replacement therapy (NRT) products such as patches and gum are recommended over e-cigarettes, as the safety of e-cigarette vapour for the baby is unknown.
