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3a > Psychiatry: Substance Abuse > Flashcards

Psychiatry: Substance Abuse Flashcards

1
Q

drugs which stimulate which area of the brain (be specific - where is this located) are most addictive ? why is this ?

A

stimulants that stimulate the nucleus acumbens in the ventral tegmental area (rich in opioid + dopamine receptors) are most addictive

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2
Q

Name some recreational stimulants ?(5)

A
  • caffeine
  • nicotine
  • cocaine
  • meth-amphetamine
  • MDMA
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3
Q

how does caffeine work ? on what NT does it have an effect ? what are the effects of it ?

A

(recreational stimulant)
inhibits adenosine => increase dopamine + serotonin + NAd => increase focus + alertness (+ autonomic (SNS): hypertension, tachycardia, increase uriantion frequency)

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4
Q

why is nicotine so addictive ?

A

reaches the brain v quickly (7 secs)
- build up tolerance

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5
Q

what are some of the effects of nicotine ?

A

(recreational stimulant)
- sympathetic innervation
- suppress appetit

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6
Q

what drugs are used to help with smoking cessation ?

A
  • varencline
  • bupropion
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7
Q

overall: what are the effects of stimulants and depressant ? and describe th withdrawal associated with each ?

A
  • stimulant: SNS effects, withdrawal (PSNS, uncomfortable)
  • Depressant: PSNS effects (relaxation + sedation), withdrawal (SNS, deadly)
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8
Q

what are some of the effects of cocaine ?

A

SNS (recreational stimulant)
- euphoria
- agitation
- myoriasis (wide dilated pupil)
- increase heart rate
- increase BP

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9
Q

describe cocaine withdrawal ?

A

PSNS (opposite of the high)
- Sedation
- Lethargy
- Craving
(unpleasant bu not dangerous)

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10
Q

what are the effects of meth-ampheatmine ? what is it similar to ?

A

(recreational stimulant)
amped up cocaine,, greater potency, more addiactive
- similar effects as cocaine (SNS) but also increased libido

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11
Q

what is meth withdrawal like ?

A

(PSNS)
- depression
- lethargy
- increased appetite and hunger

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12
Q

what are the effects of MDMA ?

A

recreational stimulant
- derealization
- mania
- hulluciantions
- increase HR
- increase BP

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13
Q

MDMA withdrawal ?

A

(recreational stimulant withdrawal => PSNS)
- depression
- irritailty
- fatigue
- bruxism (high yield - grind/crush teeth)

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14
Q

name some recreational depressants ? (3)

A
  • Alcohol
  • benzodiazepiens
  • opiates
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15
Q

on what NT does alcohol work ? (2)

A

(recreational depressant)
GABA agonist
(and inhibits glutamate)

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16
Q

What are the overall effects of alcohol withdrawal ? (6)

A
  • anxiety
  • insomnia
  • tremor
  • siezures
  • hyptertension
  • delirium tremens
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17
Q

What are the effects of benzodiazepines ? (4)

A

recreational depressant
- Sedation
- Euphoria
- Ataxia
- Amnesia

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18
Q

what are the withdrawal syndomps associated with benzos ?

A
  • panic
  • anxiety
  • insomnia
  • tachycardia
  • siezures
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19
Q

what is the managment of benzodiazepine withdrawal ?

A

controlled with benzo taper

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20
Q

what would you give to treat a benzodiazepine overdose ? what type fo drug is this ?

A

flumazenil (GABA antagonist)

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21
Q

What are the effects of opiates ? (6)

A
  • euphoria
  • CNS depression
  • Miosis (pin point pupil)
  • reduces gag reflex
  • drowsiness
  • constipation
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22
Q

what is with drawl from opiates like ?

A

recreation depressant
- sweating
- diarrhoea
- piloerection
- mydriasis

23
Q

what is given to help with opiote withdrawal ? what type of drug ?

A

methadone (opiod analgesic)

24
Q

what is given as treatment for opiates overdose ? what type of drug is this ?

A

naloxone
(opiod receptor antagonist)

25
Q

what is a quick screening tool used to assess for alcohol dependance ?

A

CAGE
- Cut down ?
- Annoyed ? (when ppl ask about usage)
- Guilty
- Eye opener (ever need to drink immediately in morning)

26
Q

what causes alcohol related liver disease ?

A

from long term excessive consumption of alcohol

27
Q

what are the 3 stages in alcohol related liver disease ?

A
  • Acoholic fatty liver (hepatic steatosis)
  • Alcoholic hepatitis
  • Cirrhosis
28
Q

what is alcoholic fattly liver ? reversible ?

A

alcohol => build up of fat in liver
(reversible with abstinence)

29
Q

what is alcoholic hepatitis ? reversible ?

A

chronic alcohol use => inflam in liver cells
- usually reversible with permanent abstinence

30
Q

what is liver cirrhosis ? reversible ?

A

functional liver tissue replaced with scar tissue (irreversible)

31
Q

what is recommended alcohol consumption in a week ? for men ? women ?

A

don’t regularly diner >14 units/week
- spread over 3 days
- no more than 5 in one day
- sam for men and women

32
Q

what counts as bigne drinking ? men ? women ?

A

> 6 units (F)
8 units (M)

33
Q

Name some of the complications of alcohol ? (7)

A
  • alcohol related liver disease
  • cirrhosis (=> HCC)
  • alcohol dependance + withdrawal
  • wernike korsikoff syndrome
  • pancreatitis
  • cardiomyopathy
  • increase CVD risk
34
Q

what would be seen OE of someone drunk ?

A
  • smelling of alcohol
  • slurred speech
  • blood shot eyes
  • dilated capillaries on face
  • tremor
35
Q

what investigations might you to for alcohol liver disease ? what would be seen on blood tests ?

A
  • blood tests: raised MCV, high ALT, High AST:ALT ratio (wASTed), increased PTT
  • liver US: may show changes related to cirrhosis
  • Fibroscan: assess degree of fibrosis
  • Liver biopsy: confirm Dx of ARH of cirrhosis
36
Q

what is the Mx of ARLD ?

A
  • stop drinking permanently
  • psychotherapy (CBT)
  • detox regime
  • nutritional support (thiamine)
  • corticosteoird (reduce inflam in hepatitis)
37
Q

what is alcohol dependance ? symptoms (5)

A
  • daily consumption
  • stonr urges + cravings
  • difficulty controlling consumption
  • tolorance
  • withdrawal when stopping
38
Q

what are the symptoms of alcohol withdrawal ? time frame basis ?

A
  • 6-12 hours: tremor, sweating, headache, craving, anxiety
  • 36 hrs: siezures (peak incidence)
  • 48-72 hrs: delirium tremens (coarse tremor,confusion, delusions, auditory and visual hallucinations, fever, tachycardia)
39
Q

what is delirium tremens ? associated with what ?

A

medical emergency associated with alcohol withdrawal (35% mortality)

40
Q

how does chronic alcohol use affect NT ?

A

alcohol stimulates GABA and inhibits glutamate
- chronic use => GABA system down regulated + glutamate system unregulated

41
Q

what happens do brain NT when alcohol stops drinking ?

A

when alcohol removed
- (due to up/down regulation) GABA under functions + glutamate overfucntions => extreme excitability of brain + excessive adrenergic activity

42
Q

Mx of alcohol withdrawal ? (3) drug type ?

A

chlordiazepoxide (long acting benzo) PO reducing regime
- high dose B its (pabroninex) + long term oral thiamine (prevent WKS)

43
Q

what is wernike Korsakoff syndrome ? what causes it ?

A

alcohol excess => thiamine deficiency (poorly absorbed in presence of alcohol + poor diet associated)
(not related to withdrawal I think)

44
Q

what is wernikes encephalopathy ? presentation ?

A
  • confusion
  • oculomotor disturbances
  • ataxia
    (medical emergency with high mortality)
45
Q

what is Korsakoff syndrome ? presentation

A
  • memory impairment (retrograde + anterograde)
  • behavioural changes
    (often irreversible)
46
Q

wernike korsikoff syndorme Mx ?

A

thiamine supplementation + abstains from alcohol

47
Q

Name some hallucinogenics ?

A
  • serotinergic psychedelics (LSD)
  • dissociate psychedelics (PCP)

(cannabis isn’t but doesn’t have any other group either)

48
Q

how does cannabis work ? Px ? (6)

A

cannabis (cannabinoid receptor partial agonist)
- paranoia
- euphoria/relaxation
- eating
- red eyes
- impaired memory formation
- lack of motivation

49
Q

what is spice ?

A

synthetic canncis: canabidno receptor agonist (not partial like cannabis)
- associated with withdrawal + psychosis

50
Q

serotinergic psychedelics effects ?

A

(LSD, Shrooms)
- psychedelic: distortion of perception of objects that are there
- sensory distorion
- depersonalisation
- anxiety/paranoia
- openness
(no sig withdrawal)

51
Q

what type of drug is PCP ? Sx ?

A

dissociative psychedelic
- halluciantions
- beligencere
- impulsiveness

52
Q

patient present with mydriasis - what drug types could be causes this ?

A
  • stimulant
  • depressant withdrawal
53
Q

patient present with miosis - what drug types could be causing this ?

A
  • depressant
  • stimulant withdrawal
54
Q

reversible causes of cognitive impairment ? (6)

A
  • normal pressure hydrocephalus
  • thyroid problems
  • vitamin B12 deficiency
  • sleep depreviation
  • depressions
  • wernikes encephalopathy

3a (43 decks)

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