Psychiatry Flashcards
What are the 2 screening tools for alcohol use disorder? What are they?
CAGE
AUDIT
Pharmacological mx options for alcohol use disorder - name of drug, MoA (brief), effect (brief)
Naltrexone (opioid-R antagonist) = reduced craving, reduced pleasure of alcohol when consumed
Disulfiram = abstinence. Induces severe vomiting, tachycardia and death
Acamprosate (NMDA-R antagonist) = reduce cravings.
Pharmacological mx options for nicotine addiction -
Nicotine replacement therapy
Buproprion - NDRI. SEs: dry mouth, insomnia (norad)
Varenicline
Ix results in acute alcohol consumption
Indirect biomarkers
= LFT: AST:ALT >2:1 and ↑↑↑ GGT (no associated rise in ALP)
= FBC: macrocytic anemia? Iron def anemia? mild pancytopenia?
= UEC: high osmolar gap then HAGMA
= Carbohydrate deficient transferrin (CDT) elevated
Direct biomarkers
= Urine ethyl glucuronide (EtG)
= Blood alcohol level of >100mg/Dl during routine exam
Opioid intoxication CLINICAL SIGNS
Reduced HR, hypotension, shallow breaths, reduced temperature, reduced GCS, miosis
Opioid intoxication DSM5 criteria
Recent opioid use + pupillary constriction + one or more of SAD: slurred speech, attention/memory impaired, drowsy/coma.
Acute opioid intoxication management?
(1) Airway/breathing/circulation
Clear and secure airway, may need LMA
Ventilate / give supplemental O2 as needed
IVC and manage hypotension with fluid bolus
Assess and support cardiac function
(2) Take bloods for baselines and toxicology
(3) IV glucose
(4) IV naloxone hydrochloride (0.4mg – 2mg)
a. Can induce opioid withdrawal
b. As naloxone has short half-life compared to some opiates, there may be re-sedation
Opiate withdrawal
How to remember the following:
Symptoms of opiate withdrawal
Signs of opiate withdrawal
Opiate withdrawal is characterised by noradrenergic (SNS) hyperactivity
Symptoms: anxiety/restlessness, intense opioid cravings, insomnia, anorexia, nausea, myalgia/arthralgia, hot/cold flushes, diarrhoea
Signs: YAWNING, tachycardia, diaphoresis + (piloerection, lacrimation, rhinorrhea), tremor + muscle twitching, vomiting
Opiate withdrawal management
- Long-acting opioid agonist: buprenorphine or methadone
- Buprenorphine is preferred as it allows for long-term maintenance therapy - Alpha-adrenergic antagonist: clonidine (reduce BP + HR)
- Symptomatic mx:
Metoclopramide - nausea
Paracetamol - myalgia/arthralgia, abdo cramps
Diazepam - anxiety/restlessness. - Prevent dehydration from lacrimation/diarrhoea = IV fluids or ORS, electrolyte replacement
- Discuss long-term relapse prevention strategies and refer to services in week following
What are the complications of withdrawing from stimulants/amphetamines?
Withdrawal from stimulant drugs is not medically dangerous and no specific treatment has been shown to be effective.
Just two complications to note = relapse, suicide (risk increased in withdrawal period)
Amphetamine intoxication complications
Complications
= CVS - MI, CVA 2’HTN, palpitations, ruptured aneurysm, aortic dissection
= NEURO - seizures
= PSYCH - psychosis, paranoia, delirium
= OTHER - nasal cleft degeneration from cocaine inhalation, coke lung from smoking, retinal emboli and vision loss from IVDU etc.
Acute amphetamine intoxication management
Managing acute amphetamine intoxication:
IV diazepam - agitation/anxiety and reduce seizure risk
HTN and increased HR - give calcium channel blockers, not beta blockers (unopposed alpha adrenergic blockade can produce paradoxical effect)
FGA (haloperidol, zuclopenthixol) for psychosis
Mainstay management of long-term amphetamine withdrawal
Mainstay of managing amphetamine withdrawal in the long-term= symptomatic treatment and supportive counselling to help the patient interrupt the pattern of stimulant use
What are the complications of personality disorders (ie why do we care)?
Suicide Increased risk of violence to others Substance abuse high rates Treatment refractory Brief psychotic events are common
