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My MRCPsych Paper B > MRCPsych Paper B - Addiction > Flashcards

MRCPsych Paper B - Addiction Flashcards

1
Q

Average heroin use per in a day of a typical dependent user

A

0.25-2.0g/ day

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2
Q

Preferred maintenance treatment for opioid use disorder

A

Buprenorphine

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3
Q

3 main types of pharmacotherapy in opioid withdrawal symptom

A
  1. Methadone at tapered doses
  2. Buprenorphine
  3. a2 adrenergic agonists - lofexidine, clonidine
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4
Q

Tolerance to this symptom does not usually develop with long-term opiate use

A

constipation

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5
Q

Intervention with the most consistent evidence base among all psychosocial interventions for cocaine users

A

Contingency management

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6
Q

Most common side effects of benzodiazepines

A

drowsiness, ataxia, dizziness

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7
Q

ICD-11 term that denotes a state in which alcohol has caused damage to a person’s physical and mental health, without meeting the criteria for dependence

A

Harmful pattern of use

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8
Q

Most commonly used illicit opioid in Europe

A

heroin

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9
Q

Acute harmful effects of LSD (2 answers)

A

Behavioral toxicity, bad trips

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10
Q

NICE guidelines: first choice treatment for opioid dependence

A

Methadone → buprenorphine

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11
Q

Most common cause of death in benzodiazepine overdose

A

respiratory depression

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12
Q

LSD can be detected in the urine for up to how many days

A

4 days

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13
Q

Initial treatment period for nicotine replacement therapy

A

8-12 weeks

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14
Q

Kinaesthetic hallucinations are reported incases with

A

benzodiazepine withdrawal
*patients feel that their limbs are being twisted, pulled, or moved

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15
Q

NICE recommendation: atypical antidepressant for smoking cessation

A

Bupropion
*seizure risk 1:1000

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16
Q

Opioid injection practice that is associated with Candida enophthalmitis

A

using lemon juice to reconstitute

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17
Q

Main side effect of varenicline

A

nausea

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18
Q

Most effective smoking cessation pharmacotherapy in the general population

A

Varenicline

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19
Q

Percentage of UK men aged 55-64 that drinks over 14 SD per week

A

38%

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20
Q

Lifetime risk of suicide in those with alcohol dependence drinkers

A

10-15%

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21
Q

Lifetime risk of suicide in those with alcohol problems

A

4%

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22
Q

Cerebellar degeneration has been reported to occur in up to what percentage of alcoholics

A

33%

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23
Q

Most common CNS complication in alcoholics with and without micronutrient deficiencies

A

Cerebellar degeneration
*damage is irreversible

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24
Q

Reducing regime management for alcohol withdrawal: typical duration of chlordiazepoxide to be given

A

5-7 days
*Chlordiazepoxide 10-20mg QID, reducing gradually over 5-7 days

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25
Q

Classic triad of delirium tremens

A

clouding of consciousness/ confusion
vivid hallucinations
marked tremors

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26
Q

Onset of delirium tremens

A

72-96 hours after last drink

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27
Q

Discrete episodes of anterograde amnesia that occur in association with alcohol intoxication

A

Alcoholic blackouts/ alcohol induced amnesia/ palimpsest

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28
Q

Percentage of alcoholic patients that experience alcoholic hallucinosis with abstinence

A

5%

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29
Q

Medication avoided for outpatient assisted withdrawal from alcohol due to the risk of respiratory depression

A

Chlormethiazole

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30
Q

Edwards & Gross criteria for alcohol dependence

A
  1. Narrowing of the drinking repertoire
  2. Salience/ primacy of alcohol-seeking behaviour
  3. Increased tolerance
  4. Repeated withdrawal symptoms
  5. Relief or avoidance of withdrawal symptoms by further drinking
  6. Subjective awareness of compulsion to drink
  7. Reinstatement after abstinence
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31
Q

Mortality rate of delirium tremens

A

1-15%

32
Q

Alcohol detoxification protocol: patient with liver disease, COPD, and want to avoid over-sedation

A

Oxazepam
*shorter-acting benzodiazepine

33
Q

Opioid receptor antagonist that is effective in blocking the high of alcohol

A

Naltrexone

34
Q

Common side effect reported by patients for disulfram

A

halitosis & headache

35
Q

Wernicke encephalopathy: gliosis and small haemorrhages in which brain region

A

Mamillary bodies
*accounts for wakefulness, hypertonia, ocular palsies

36
Q

General finding in the MATCH trial

A

Matching patients to treatment options does not make a significant impact on outcome
*Motivational therapy vs social behaviour and network therapy

37
Q

Alcohol withdrawal symptoms usually subside within how many days after cessation

A

3-7 days

38
Q

NICE guidelines: inpatient opioid detoxification with buprenorphine lasts for how many days

A

7-14 days

39
Q

NICE guidelines: inpatient opioid detoxification with methadone lasts for how many days

A

14-21 days

40
Q

NICE recommendations: most suitable screening tool in primary care settings in detecting hazardous and dependent drinking

A

Alcohol use disorders identification test (AUDIT)

41
Q

Alcohol withdrawal symptom timeline

A

Time from last drink:
3-12 hours - mild symptoms
12-18 hours - generalized seizures
24-48 hours - peak symptoms
3-4 days - delirium tremens

can last up to 14 days

42
Q

Minimum interval from last drink when starting disulfram

A

24 hours

43
Q

Time to normalize on abstinence: blood alcohol levels/ breathalyzer

A

6 hours in blood, 12-24 hours in breath
*useful in assessing recent drinking

44
Q

Time to normalize on abstinence: GGT

A

4 weeks
*best used in follow-up

45
Q

Time to normalize on abstinence: MCV

A

3-6 mos
*best used inf follow-up

46
Q

Time to normalize on abstinence: ALT/ AST

A

4 weeks

47
Q

Time to normalize on abstinence: carbohydrdate-deficient transferrin (CDT)

A

4 weeks

48
Q

Case: treatment for pregnant woman who is opioid dependent

A

Methadone

49
Q

Investigations: CBC findings in alcohol use disorder

A

anaemia, thrombocytopenia, neutropenia, raised MCV (macrocytosis)

50
Q

Opioid overdose triad

A

unconsciousness, low RR, pin-point pupils (miosis)

51
Q

Case: management of opioid-dependent women

A

stabilization on substitute methadone

52
Q

Case: which medication to give - pregnant woman + heavy user of heroin + plan on breastfeeding

A

methadone or buprenorphine

53
Q

Case: highly motivated opioid user who wants to remain abstinent and follow-up appointments + supportive partner

A

Naltrexone

54
Q

Case: heroin user + unsuccessful trial of methadone and buprenorphine (opioid substitution treatment). Next best treatment option?

A

injectable diamorphine

55
Q

Case: man being treated for heroin addiction + “running out of methadone” + demanding treatment. What is the best course of action?

A

Optimise the dose of methadone

56
Q

Case: physically dependent on dihydrocodeine for low back pain + wants to stop and go back to work. What is the best course of action?

A

Withdraw codeine gradually.
*opioids are harmful in the treatment of low back pain. Dont prescribe opioids for long term treatments.

57
Q

Case: Patient keen on stopping heroin + anxious about withdrawal symptoms. Which is best suited to support detoxification?

A

Methadone
*Buprenorphine is a partial agonist therefore a precipitated withdrawal may occur

58
Q

Percentage of schizophrenia that use nicotine

A

70-80%

59
Q

Case: adult man + unable to cut down due to withdrawal symptoms + low mood, anhedonia, fatigueability. What would be the most appropriate treatment option?

A

Alcohol detoxification

60
Q

Indications for alcohol detoxification

A

regular consumption of 15+ units/day
AUDIT >20
history of significant withdrawal symptoms

61
Q

Case: 55yo man with opioid dependence + considering pharma maintenance treatment along with psychosocial interventions. What is the most appropriate medication would be?

A

NICE guidelines: maintenance therapy - methadone & buprenorphine

62
Q

Type of memory that is most affected in Korsakoff syndrome

A

Episodic memory

63
Q

Case: polysubstance user complaining of frequent urination and hematuria. What is the most likely offending drug?

A

Ketamine
*UTI

64
Q

Signs of advanced opioid withdrawal state

A

Muscle spasms and twitching

65
Q

Investigation: sensitive marker of alcohol abuse

A

GGT

66
Q

Investigation: alcohol abuse test that accurately predicts RECENT alcohol use and can be useful in detecting relapse

A

Carbohydrate deficient transferrin (CDT)

67
Q

Investigation: alcohol abuse test that is more specific but less useful in detecting relapse

A

MCV
*RBC’s life span is 120 days. range is too big to assess for relapse

68
Q

Investigation: best alcohol use disorder screening tool in primary care

A

AUDIT

69
Q

Investigation: part of the routine assessment of patients in follow-up under a supervised detoxification programme

A

Breathalyser

70
Q

Investigation: most widely used screening tool for alcoholism but does not ask for frequency of alcohol use

A

CAGE

71
Q

Investigation: brief structured interview for alcohol use disorder for general practice use

A

AUDIT

72
Q

Investigation: tool for detecting dependent drinkers + focus on lifetime alcohol related problems

A

Michigan Alcohol Screening Test (MAST)

73
Q

Investigation: shorter version of AUDIT

A

Fast alcohol screening test (FAST)

74
Q

Case: adult alcoholic + abstinent + motivated

A

disulfram

75
Q
A

My MRCPsych Paper B (8 decks)

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