Smoking, alcohol, drugs Flashcards
Markers of alcohol dependence
AUDIT> 20, male> 50 units a week, or female> 35 units a week
Compulsion to drink
Loss of control
Tolerance
Alcohol takes priority over other activities
Persistent drinking despite presence of harm
Presence of withdrawal symptoms when not drinking
AUDIT_C Qs
How often do you have a drink containing
alcohol?
How many units of alcohol do you drink on a typical day when you are drinking?
How often have you had 6 or more units if
female, or 8 or more if male, on a single
occasion in the last year?
If>5 do whole AUDIT Qs
Signs of Wernike’s encephalopathy
nystagmus, ophthalmoplegia with third and sixth nerve palsy, impaired coordination, peripheral neuropathy
When would you admit an alcoholic?
Alcohol withdrawal
Gastrointestinal bleeding or decompensated liver disease
Seizures
How do you treat alcoholics?
Offer CAVDAS
Thiamine 100mg TDS until 1 month after stopping drinking
Folic acid
Reduce alcohol slowly
Risks of benzodiazepine use
Addiction
Tolerance
Accidental overdose and death (esp w/alcohol + opiates)
Breakdown of relationships, financial problems, parenting
Memory impairment, insomnia
Anxiety, depression, psychosis
Driving impairment, motor vehicle accident, Diminished capacity to operate machinery
Long term:
dependency, cognitive decline, and falls
Management of benzodiazepine dependence
Highlight risks
CAVDAS or GP led reduction
Change all benzos to equivalent dose diazepam then reduce this slowly, by 1/10th a week
Can consider melatonin for sleep and propranolol for withdrawal tremors
Counselling/support groups
Features of cannabis dependence
3 of:
Tolerance
Withdrawal- irritability, trouble sleeping, and depressive symptoms
Using more cannabis than intended
Persistent desire to stop using cannabis or to cut down, and being unsuccessful at this
Spending a lot of time obtaining, using, or recovering from the use of cannabis
Giving up important activities in favour of using cannabis
Using cannabis even when it is known that it causes problems
Risks of cannabis use
impaired driving, risk of motor vehicle accident
risk of oropharyngeal and lung cancer, and IHD
precipitation of acute psychosis in vulnerable person
chronic bronchitis.
decreased fertility in both sexes, menstrual abnormalities.
growth retardation in pregnancy and subsequent behavioural problems in children.
legal ramifications.
Symptomatic management of withdrawal symptoms
Sleep/anger: promethazine
Diarrhoea: loperamide
GI cramps: buscopan
Headache: paracetamol
Management opiate dependence
CAVDAS
or if prescribed opiates, wean by 1/4 dose per week if morphine, 1/6 if oxycodone
