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Year 3 Exam 2 > Substance Abuse > Flashcards

Substance Abuse Flashcards

1
Q

What are the potential warning signs of substance abuse?

A
  • Taking higher doses than advised or prescribed
  • Running out of meds early (emergency supply etc)
  • Regularly losing medication
  • Requesting specific drugs
  • Stealing or forging scripts
  • Drug hoarding (fear of running out)
  • Risky behaviours
  • Reduced social function
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2
Q

How might someone who is using substances present?

A
  • Intoxicated, sedated or withdrawal symptoms
  • Unkempt appearance
  • Mood swings or hostility
  • Change in sleep patterns
  • Avoiding drug testing
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3
Q

Non-pharmacological help for patients taking substances

A
  • Harm reduction advice
  • Peer support
  • Drug diaries
  • Mindfulness
  • Counselling
  • Therapy
  • Physiotherapy
  • Physical exercise
  • Hobbies/activities
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4
Q

Why do people drink alcohol?

A
  • Disinhibiting effects (dizzy etc)
  • Taste
  • Peer pressure
  • Stress
  • Anxiety and other mental health conditions
  • To prevent withdrawal symptoms
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5
Q

What are the risks of long term high alcohol intake?

A
  • Death
  • Liver damage
  • Cancer
  • Accidents due to being drunk
  • Mental health issues
  • Gut problems e.g. bleeds
  • Social problems (divorce etc)
  • Brain damage
  • Nerve damage
  • Strokes
  • Insomnia
  • Heart disease
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6
Q

What is Wernicke- Korsakoff syndrome?

A

It is a neuropsychiatric disorder caused by thiamine deficiency. It presents as confusion, apathy, disorientation, vomiting and disturbed memory. It is found to occur in as many as 12.5% of chronic alcohol misusers.

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7
Q

How is Wernicke- korsakoff syndrome treated?

A

Acute treatment= Pabrinex (IM or IV daily for 3-5 days)

Maintenance= Oral thiamine (100mg-300mg daily spread out)

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8
Q

What is disulfiram (Antabuse)? -Clinical

A
  • Makes the taker feel ill when alcohol is consumed.
  • Used as an adversive therapy to alcohol.
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9
Q

What is disulfiram (Antabuse) and how does it work?
-Science

A
  • It’s a prodrug that is activated in the liver.
  • It prevents the conversion of acetaldehyde to acetic acid, and dopamine to adrenaline.
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10
Q

What is acamprosate (Campral)?
- Clinical

A
  • A drug used after someone has stopped drinking large amounts of alcohol .
  • It rebalances the chemicals in the brain which is thought to help prevent the urge to drink alcohol.
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11
Q

What is Naltrexone and how does it work?

A
  • It is an opioid antagonist.
  • It blocks the opioid receptors that modulate the release of dopamine in the brain, blocking the rewarding effects from alcohol and heroin
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12
Q

What is Nalmefene and how does it work?

A
  • It is an opioid antagonist.
  • It blocks the opioid receptors that modulate the release of dopamine in the brain, blocking the rewarding effects from alcohol and heroin
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13
Q

What is the recommended maximum units of alcohol in a week?

A

14 units

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14
Q

What are the physical advantages of reducing alcohol intake?

A
  • Feeling better in the mornings
  • More energy
  • Improved skin
  • Weight control
  • Overall better functioning
  • Better memory
  • Lower risk of health problems
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15
Q

What are the non- physical benefits to reducing alcohol intake?

A
  • Developing better relationships
  • Improved self esteem
  • More money
  • More time available
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16
Q

When to refer someone who abuses alcohol to their GP?

A
  • They express a desire to talk in depth with someone about alcohol
  • They display alcohol dependence
  • They show a high level of alcohol harm, physically or mentally
  • A brief intervention isn’t appropriate
17
Q

What are opiates?

A

Natural opioids e.g. heroin, morphine and codeine

18
Q

What is the treatment process for opioid dependence?

A
  1. Assessment- to confirm dependence
    2.Detoxification- titrate over several days to curb withdrawal symptoms
  2. Maintenance- opioid substitute
  3. Gradual discontinuation- with support
19
Q

Opioid withdrawal symptoms

A
  • Runny nose
  • Watering eyes
  • Dilated pupils
  • Yawning
  • Nausea
  • Vomiting
  • Diarrhoea
  • Muscle aches
  • Restlessness
  • Difficulty sleeping
20
Q

Why/how is methadone used in opioid dependence?

A
  • It is a full agonist
  • It is an opioid substitute
  • It has a longer half-life than diamorphine so suppresses withdrawal and craving
  • Can be and is used ‘on top’
  • Avoids opioid withdrawal
21
Q

Why/how is buprenorphine used in opioid dependence?

A
  • It is a partial agonist
  • Has a longer half-life than methaone so suppresses withdrawal and craving
  • Can’t be used ‘on top’
    —Not absorbed orally (s/l, injection or rods)
22
Q

Methadone advantages

A
  • Established and familiar
  • Good evidence base for methadone maintenance treatment
  • Sedating
  • Cheap
  • Full agonist
  • Variety of forms/routes
  • Easy to supervise
  • Orally absorbed
23
Q

Buprenorphine advantages

A
  • Can’t be used ‘on top’
  • Safer in overdose
  • Less stigmatised
  • Easier to detox from
  • Less sedating
  • Better outcomes for new-borns
  • Can’t be adulterated
24
Q

Methadone disadvantages

A
  • Easy to overdose
  • Can use ‘on top’
  • Leakage onto the streets occurs
  • Stigmatised
  • Syrup rots teeth
  • Can accumulate in fatty tissue
  • 3 days to steady state
  • Long detox
  • Avoids withdrawal but doesn’t stop craving
  • Sedating
  • Toxic for drug naïve adults or children
25
Q

Buprenorphine disadvantages

A
  • Not orally absorbed
  • Unpleasant taste (s/l)
  • More difficult to supervise
  • Poor evidence base/ less experience
  • Can be injected
  • Less sedating
  • Relatively expensive
26
Q

What is the usual methadone maintenance dose?

A

40-120mg a day

27
Q

What are the CNS effects of methadone?

A
  • Euphoria
  • Pleasant, warm feeling in stomach
  • Pain relief
  • Drowsiness
  • Nausea/ Vomiting (stimulation of the chemoreceptor trigger zone)
  • Respiratory depression
  • Cough reflex depression
  • Histaminergic effects e.g. itching, sweating, blushing, flushing, constriction of the airways)
28
Q

What are the non-CNS effects of methadone?

A
  • Reduced or absent menstrual cycle
  • Sexual dysfunction
  • Dry eyes, mouth and nose (decreased secretions)
  • Dental problems (methadone is acidic)
  • Constipation
  • Constricted pupils
29
Q

Naltrexone dosing

A

‘Test’ dose of 25mg at least 7 days after the last dose of an opioid followed by 50mg a day
Should be continued for at least 3 months

30
Q

What cardiovascular risk can methadone cause?

A

It can increase the QT interval

31
Q

What are the symptoms of an opioid overdose?

A
  • Constricted pupils
  • Nausea/vomiting
  • Pale skin
  • Bluish lips, tip of nose, finger tips
  • Low blood pressure
  • Slow pulse
  • Sedation ( no response to noise or touch, loss of consciousness, breathing problems)
32
Q

Drug reduction advice for known drug users.

A
  • Do not use drugs when alone
  • If things go wrong, get help fast
  • Beware of loss of tolerance
  • Avoid polypharmacy
  • Try a small amount first and wait to see the effects
  • Use smaller amounts less often
  • Avoid using combination products
  • Don’t share injecting equipment
  • Safe injecting advice
  • Needle exchange info
  • Check BBV testing/ vaccination stats
  • Contraception/ sexual health advice
33
Q

What advice does the needle syringe provision service provide?

A
  • Check injection sites for infection
  • Wound care advice
  • Correct needle size
  • Use of minimal acid (vitamin C preferable)
  • Safe source of water
  • Hygiene
  • Safe disposal of needles
34
Q

Which receptors do cannabis effect?

A

CB1 (brain) and CB2 (peripheral)

35
Q

What does CB1 control?

A

Appetite, movement, higher cognitive functions, stress, nausea, pain sensation

36
Q

What does CB2 control?

A

Immune function

Year 3 Exam 2 (19 decks)

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