liason psych day 5 Flashcards

Question

what is 'coke'

Answer 1

cocaine minus the hydrochloride = freebase, rocks.  Cocaine: snort, inject, rub on gums, Crack: smoked, inject

Answer 2

Feel confident, physically and mentally strong  Dry mouth, sweating, ↓ appetite, increased HR, restlessness, anxiety, paranoia, hallucinations and rarely death from respiratory or heart failure  After effects include fatigue, depression, difficulty sleeping, diarrhea, vomiting, the “shakes”, insomnia, anorexia, weight loss and sweating  Acute effects ischaemia, infarction  Long-term effects include inflammed nasal mucosa, perforated septum, respiratory problems and partial aphonia

Answer 3

 Euphoria, increased confidence and libido  Anesthetic- sedative  Easy to overdose – small window between recreational dose and overdose  Vomiting, convulsions, muscle spasm, coma and respiratory depression  Physical dependence- withdrawals include insomnia, anxiety, tremor and psychosis

Answer 4

MMCAT/Miaow/meow  Synthetic stimulant drug recently made illegal  Causes euphoria, alertness, talkativeness and feelings of empathy  Snort or swallow  Increases heart rate/BP/vasoconstriction  Some reports of paranoia, convulsions + death  Low mood after use

Answer 5

Effects: euphoria, sexual arousal, increased energy, decreased appetite, nausea, meth mouth, perceptual disturbances e.g. insects crawling under skin, sleeplessness, panic attacks, compulsive repetitive movements, paranoia, hallucinations.  Prolonged use  violent, aggressive behaviour  psychosis resembling paranoid schizophrenia  brain damage

Answer 6

Mild hallucinogenic/stimulant effect intensifying emotions  Tingly skin, dry mouth, cramps, pupils dilated, blurred vision, chills, sweats, nausea, jaw clenching  May experience depression, paranoia, anxiety, confusion  Increase BP, HR, Temp  >200 deaths in last 15yrs – heatstroke/ dilutional hyponatraemia /heart failure  After use- tired and low for 3-4 days.

Answer 7

Smack, gear, junk, brown £50 for 1g

Answer 8

Euphoria, relaxation, detachment, reduced anxiety – followed by drowsiness, nausea, stomach cramps, vomiting  Overdose – coma and respiratory failure  Long-term- constipation, amenorrhoea, decreased resistance to infections

Answer 9

 Glue, paint thinner, dry cleaning fluids, petrol, hair spray, aerosol deodorants, spray paint  sniffed- breathe directly from container  bagging- from plastic bag  huffing holding inhalant-soaked rag in mouth

Answer 10

 Immediate high, giddy and confused  Long-term users get headaches, nosebleeds, lose hearing and smell, neurological damage, liver damage  Abused substance most likely to cause severe toxic reaction and death

Answer 11

 Quick acting anaesthetic

Answer 12

 Intoxication and hallucinations like LSD  Lose sense of time/reality <2 hours – trip or K-hole  Also nausea, vomiting, delirium, memory disturbance, movement difficulties, body numbness and decreased RR – can cause coma, cardiovascular or respiratory arrest

Answer 13

Heroin – smoked (“chasing”), injecting | (“shooting up”), snorting. If injecting, where?

Answer 14

Crack – smoked (“on the pipe”), injected | (often with heroin known as “snowballing”

Answer 15

Cocaine – snorted through a straw or bank | note – “tooting”.

Answer 16

 Daily use – Heroin and alcohol – dependent users tend to use daily, if they don’t, they get sick.

Answer 17

 Binge pattern – crack/cocaine – binge pattern common, e.g. 3 days of use, 2 days without using, etc. Alcoholic binges or benders

Answer 18

 Cocaine/crack withdrawal is more psychological: irritability, craving, restlessness.

Answer 19

Alcohol: sweats, tremors, tachycardia, nausea, retching, anxiety, raised blood pressure – may lead to withdrawal fits (within a few hours) and even DTs (disorientation, visual hallucinations and withdrawal symptoms).

Answer 20

Alcohol: sweats, tremors, tachycardia, nausea, retching, anxiety, raised blood pressure – may lead to withdrawal fits (within a few hours) and even DTs (disorientation, visual hallucinations and withdrawal symptoms).

Answer 21

ICD10:A cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include: 1. a strong desire to take the drug. 2. difficulties in controlling its use. 3. persisting in its use despite harmful consequences. 4. a higher priority given to drug use than to other activities and obligations. 5. increased tolerance. 6. and sometimes a physical withdrawal state.

Answer 22

• Overdose – pinned pupils, shallow respiration, cyanosis, low O2 saturation, loud snoring, unrousable, respiratory depression and death

Answer 23

Overdose Treatment: • Naloxone – opiate antagonist • Will reverse opiate effects (some patients may have it at home, ambulances carry it) • But has short half-life, so patient may try to leave after being given naloxone, but risk of becoming unconscious again when naloxone wears off.

Answer 24

• Flumazenil will reverse benzodiazepine | effects

Answer 25

``` • GBL has a short half-life and intoxication can rapidly progress to withdrawal symptoms. In some cases this is a medical emergency requiring admission to ITU ```

Answer 26

``` Cocaine/crack • Stimulant drug with effects on dopamine • Binge pattern of use. • High doses can lead to intoxication, fits, hypertension, ischemia (MI, ischaemic stroke, intestinal infarction, rhabdomyolosis) ```

Answer 27

``` Physical complications - Infections: – Lack of venous access due to repeated episodes of thrombophlebitis – Mainly related to injecting – e.g. abscesses, cellulitis, septicaemia, acute endocarditis, – Rare complication such as botulism, tetanus and anthrax ``` ``` Other vascular complications: – Groin injecting – Deep Vein Thrombosis with secondary pulmonary embolus – Acute endocarditis – infection of the heart valves – Ischaemia from injecting into an artery and causing a blockage down-stream with secondary compartment syndrome ```

Answer 28

Opiate withdrawal • Sweaty, mild tremor, muscle aches, muscle jerks, abdominal cramps and diarrhoea, piloerection, dilated pupils, runny nose, yawning, nausea. Treatment • In A&E substitute drugs such as methadone not usually prescribed • Symptomatic medications, e.g. diazepam, loperamide, buscopan • On AMU may need to prescribe methadone to prevent further withdrawal symptoms, patient using drugs on the ward or patient discharging self • Follow local protocols for prescribing methadone • Seek advice from local drug service

Answer 29

GBL withdrawal • From mild anxiety to confusion, agitation, tremor, muscular cramps, insomnia, combativeness, delirium, delusions, paranoia with hallucinations (auditory, tactile and visual), tachycardia, hypotension Treatment – with benzodiazepines and Baclofen. May need admission to ITU

Answer 30

``` Benzodiazepine withdrawal: • Anxiety, depersonalisation and derealisation, sensitivity to light and sound, fits Treatment: • Diazepam detoxification ```

Answer 31

``` History: • Confirm history of opiate use (heroin, Methadone, Buprenorphine, other opioids) • Confirm history of dependence – withdrawal symptoms when stops using, e.g. COWS (clinical opiate withdrawal scale) • Confirm treatment history – is patient on a prescription for Methadone or Buprenorphine – if so confirm with treatment agency and community pharmacy ``` ``` Examination: • Examine for signs of drug use (e.g. injection sites) and for withdrawal symptoms • Do urine drug screen Treatment: • Follow protocol for prescribing Methadone or Buprenorphine ```

Answer 32

80mg of alcohol/100mL blood | 35microgrammes/100mL breath

Answer 33

``` Gastritis • Alcoholic hepatitis • Fatty liver • Fibrosis • Cirrhosis • De-compensated cirrhosis • Encephalopathy • Oesophageal varices • Alcoholic hallucinosis ```

Answer 34

``` Alcohol withdrawal symptoms: Sweating, tremor, tachycardia, anxious, nausea and vomiting • Withdrawal seizures • Delirium tremens – disorientation, visual hallucinations and signs of alcohol withdrawal ```

Answer 35

Wernicke’s encephalopathy – caused by thiamine deficiency – ophthalmoplegia, nystagmus, ataxia, confusion – petechial haemorrhages in brain stem – medical emergency – treated with intravenous thiamine (also glucose and saline but thiamine is priority – Correct magnesium deficiency and hypoglycaemia

Answer 36

Korsakoff’s syndrome – caused by thiamine deficiency – sequellae of Wernicke’s - loss of short term memory (ability to register and recall new information)

Answer 37

``` ≥3 during the past year: (a) Strong desire or compulsion to drink (b) Difficulty controlling drinking in terms of onset, termination or level of drinking (c) Physiological withdrawal symptoms or drinking to relieve or avoid withdrawal symptoms (d) Tolerance (e) Neglect of alternative interests because of drinking or time recovering (f) Persisting drinking despite clear evidence of harmful consequences ``` a better version is the SADQ questionnaire (severity of alcohol dependence quotient), gives you stages of dependence based on self reported score from phisical symptoms, behaviours and psych.

Answer 38

* Full history, alcohol history * Physical Examination • SADQ Score 30 Severe ``` • Bloods, inc. – Full Blood Count – Urea & Electrolytes – Liver Function Tests – GammaGT – Amylase – Clotting ``` ``` • Supportive Measures • Chlordiazepoxide – Reducing regimen, e.g. – As per SADQ (Severity of Alcohol Dependence Questionnaire) score – Physical observations – Monitor withdrawal symptoms • Thiamine po 100mgs tds; or Pabrinex I + II im/iv for 3-5 days • Discharge planning early ```

Answer 39

``` • Delirium tremens – disorientation, visual hallucinations and signs of alcohol withdrawal ``` – Medical emergency – Consider Haloperidol • 5-10mg orally or 5mg IM • (max 30mg daily orally, 18mg daily IM lower in elderly)

Answer 40

This easy to use patient questionnaire is a screening test for problem drinking and potential alcohol problems.[1] The CAGE questions should not be preceded by any questions about alcohol intake - ie its sensitivity is dramatically enhanced by an open-ended introduction Two "yes" responses indicate that the possibility of alcoholism should be investigated further. The questionnaire asks the following questions: Have you ever felt you needed to Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt Guilty about drinking? Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover? By far the most important question in the CAGE questionnaire is the use of a drink as an Eye Opener, so much so that some clinicians use a "yes" to this question alone as a positive to the questionnaire; this is due to the fact that the use of an alcoholic drink as an Eye Opener connotes dependence since the patient is going through possible withdrawal in the morning, hence the need for a drink as an Eye Opener