Substance abuse

Question 1

Duration of withdrawal effects in smoking

Answer 1

10 days

Question 2

What can you give for tobacco withdrawal pts

Answer 2

1. Nicotine replacement therapy - can give in pregnant
2. Bupropion - Causes seizures, dry mouth, insomnia
3. Varenicline - avoid in end stage kidney disease, careful in diabetes

For 3 months

Question 3

High risk alcohol drinking criteria

Answer 3

Men - >6 SD/day (standard drink)
Women - >4 SD/day

Question 4

Problem drinker questionnaire

Answer 4

CAGE questionnaire
1. Have you ever felt you should CUT down on your drinking?
2. Have people ANNOYED you by criticising your drinking?
3. Have you ever felt bad or GUILTY about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? (an EYE-OPENER)

Question 5

Investigations in problem drinkers

Answer 5

1. Blood alcohol
2. *Serum GGT: elevated in chronic drinkers (returns to normal with cessation of intake)
3. MCV: >96 fL
   Other changes:
   * abnormal liver functien tests (other than GGT)
   **carbohydrate-deficient transferrin (quite SPECIFIC–dependent on an enzyme induced by alcohol)
   * HDLs elevated
   * LDLs lowered
   *Serum uric acid

Question 6

1 SD contains how much alcohol?

Answer 6

10gms
1SD of
beer - 284ml
wine - 100ml
sherry/port - 60ml
spirit - 30ml

Question 7

Advise for problem drinking

Answer 7

1. Start having in safe limits (Cold turkey in smoking)
   Men - <12SD/wk
   Women - <8SD/wk
2. Anti craving drugs
   Naltrexone
   Acamprosate
   Disulfiram - under specialist

Question 8

Delirium tremens

Answer 8

Severe alcohol withdrawal(within 4-7 days of cessation)
Confusion
hallucination
tremors
sweating

Acute emergency - high mortality rate
IV fluids
*Diazepam
Thiamine (B1)
Haloperidol

Question 9

Short term mx for opioid withdrawal

Answer 9

1. Buprenorphine sublingual - Controlled withdrawal
   buprenorphine 4-8 mg as a single daily dose, increasing to 12 mg (max) on day 3,
   then reduce gradually over the next 3-5days
2. Clonidine - autonomic symptoms
3. Diazepam - agitation

Opioid poisoning anidote - naltrexone