Substance abuse Flashcards
What is the traditional theory on the pattern of addiction
- intense initial intoxiciation
- development of tolerance
- escalation in intake
- profound dysphoria, physical discomfort and somatic withdrawal
What is the ‘reward’ pathway
- when activated by rewarding stimulus, informationt ravels from the VTA to the nucelus accumbens and then up to the prefrontal cortex
- dopamine mediated transmission allows us to feel pleasure
How do drugs effect neurotransmitters
increased dopamina levels - euphoria
decreased levels of serotonin - decreased levels of contentment
What does prolonged exposure to drugs of abuse result in
addiction via reward pathway
chronic exposure reduces sensitivity of brain to reward system
What are features of drug dependance
- psychological - taking the drug knowing its harmful
- physical - symptoms if drug not taken
- withdrawal syndrome - symptoms following sudden withdrawal
- tolerance - repeated administration means they become less sensitive
What are the risks of illicit drug use
- STI
- BBV
- TB
- smoking/alcohol risks
What are injection related complications from drug use
- cellulitis
- abscess
- thrombophlebitis
- thrombosis
- embolism
- DVT
What are the effects of cannabis
- euphoria
- slowed thinking and reaction time
- confusion
- impaired balance and coordination
- cough
- frequent resp infections
- impared memory and learning
- increased HR
- anxiety
- panic
What are the effects of alcohol
- CNS depressant
- judgement, concentration and coordination
- effects are dose related
- eventually interfere with cerebellar function
- cause ataxia and motor coordination
- ultimately unconsciousness
What are signs of substance misuse
- loss of reliability
- mood and behaviour changes - defensive and angry
- subjective symptoms
- requesting specific drugs
- progressive deterioration in personal appearance and hygiene
- tremor
- constricted pupils or dilated
- puncture marks, scars or pigmentation over veins
What are barriers to accessing dental services for drug misusers
- fear of judgement
- low priority of OH
- fear of dentists
- self medication
- chaotic lifestyle
- poor attendance compliance
- cost
What can help facilitate access for drug misusers
- key workers may be assigned if enrolled in addiction programmes
- key workers can encourage attendance and accompany px to appointments
What are the medical implications of drug misuse
- increased rates of infection
- general health neglect
- oral health neglect
- chronic liver disease in alcohol abuse - impaired drug metabolism and bleeding risk
- BBV
- infective endocarditis
- venous thromboses
Why may consent be an issue for this group
- issue for dependent px
- fluctuating capacity
- capacity unlikely when under the influence
- postpone tx
What are examples of alcohol related brian damage
korsakoffs syndrome
similar to dementia
How can LA be impacted in cannabis misusers
LA with adrenaline can prolong acute tacychardia
What problems can LA pose for alcohol misusers
- liver problems
- lidocaine metabolzied in liver
- keep doses to minimum
- use articaine
- avoid IDB
Why can sedation pose a problem to this group
- px may have developed tolerance to sedative drugs so larger doses required - refer to anaesthetist
- alcohol and opiod have synergistic effect with sedative agents –> avoid if px actively using substance
- GA and IV can trigger relapse
- venous access –> collapsing veins
What are general dental implications of substance misuse
- rampant caries
- periodontal disease
- NCTSL
- masseteric hypertrophy
- hyposalivation
- poor OH
- opportunistic infections
- trauma
- oral cancer and mucosal lesions
Why are px at risk of necrotizing periodontal diseases
- impaired immune system
- stress, BBV, smokers
What appointment times should this group be given
morning as less likely to be under the influence
high chance of DNA however
What are the effect of sedatives in alcohol users
risk of tolerance
have an addictive effect
Why should GA be avoided in alcohol abusers
- risk of vomiting
- risk of inhalation of vomit
- can be resistant to GA
What drug to recoveirng alcoholics use and what problems does it pose
disulfiram
psychotic reaction seen with those who use this drug and metronidazole
