Substance abuse

Question 1

Death, liver damage, accidents, cancer and gut bleeds are a risk associated with abusing what?

Answer 1

Alcohol

Question 2

How can chronic alcohol consumption affect the CNS?

Answer 2

-Cognitive impairment
-Wernicke-Korsakoff Syndrome

Question 3

What vitamin deficiency causes Wernicke-Korsakoff syndrome?

Answer 3

Thiamine

Question 4

What is the acute treatment for thiamine supplementation?

Answer 4

Pabrinex
-One pair of ampoules IM/IV daily for 3-5 days

Question 5

What is the maintenance treatment for oral thiamine?

Answer 5

100mg TDS

Question 6

How much thiamine can a human absorb?

Answer 6

Humans only absorb up to 4mg an hour so 100-300mg once a day is a pointless dose, needs to be spread out.

Question 7

Alcohol withdrawal - between 6-50 hours what symptoms could be present?

Answer 7

Generalised hyperactivity, tremor, sweating, nausea, retching, mood fluctuation, tachycardia, increased RR, HTN, pyrexia.

Question 8

The onset of alcohol withdrawal is between what hours?

Answer 8

6-8

Question 9

The peak from alcohol withdrawal is how many hours?

Answer 9

10-30

Question 10

Alcohol withdrawal affects subside in what hours?

Answer 10

40-50

Question 11

When can withdrawal from alcohol seizures occur?

Answer 11

0-48 hours

Question 12

Can alcohol withdrawal cause auditory and visual hallucinations?

Answer 12

YES - within 12 hours and can last 5-6 days

Question 13

Delirium tremens, coarse tremor, agitation, tachycardia, confusion, delusions and hallucinations often those involving seeing snakes or spiders can happen in what time frame from not having alcohol?

Answer 13

48-72 hours

Question 14

What is the long acting benzodiazepine, anticonvulsant, and is cross-tolerant with alcohol? You can give this without waiting for withdrawal symptoms?

Answer 14

Chlordiazepoxide

Question 15

What is the usual dose of Chlordiazepoxide?

Answer 15

20-40mg QDS then reduced over 9 days

Question 16

Should when required / on demand doses of Chlordiazepoxide be prescribed?

Answer 16

Yes

Question 17

Who needs reduced doses of Chlordiazepoxide?

Answer 17

Elderly and those with Hepatic impairment *Accumulation

Question 18

If a patient is in alcohol withdrawal and is in hepatic impairment what Benzodiazepine can be prescribed alternatively?

Answer 18

Lorazepam or Oxazepam

Question 19

Is vitamin supplementation usually combined with Benzodiazepines?

Answer 19

Yes

Question 20

What drug is a pro-drug, converted in the liver and prevents the conversion of acetaldehyde to acetic acid and dopamine to noradrenaline?

Answer 20

Disulfiram

Question 21

What happens when someone has alcohol on Disulfiram?

Answer 21

Vasodilation, palpitations and a headache = can be fatal

Question 22

What drug is given for alcohol withdrawal and is a glutamate antagonist, has a good safety profile and reduces the reward?
*Glutamate is released when you drink alcohol

Answer 22

Acamprosate

Question 23

What drug for alcohol misuse disorder is a opioid antagonist (blocks reward effect)?

Answer 23

Naltrexone and Nalmefene

Question 24

What drug blocks the opioid receptors that modulate the release of dopamine in the brain reward system thus blocking the rewarding effects from heroin and alcohol?

Answer 24

Naltrexone

Question 25

Name a Opioid antagonist when can be used on a 'when required' basis?

Answer 25

Nalmefene

Question 26

What is FAST?

Answer 26

Fast Alcohol Screening Test

Question 27

If someone scores a total score of 3 or more on the first or all 4 questions of the FAST positive, what should we do?

Answer 27

FAST + = complete AUDIT or AUDIT-C

Question 28

If a patient scores 5+ on the AUDIT-C what does this indicate?

Answer 28

Increasing or higher risk of drinking = AUDIT-C positive

Question 29

What are full opioid agonists?

Answer 29

-Codeine -Diamorphine -Morphine -Dihydrocodeine -Fentanyl -Methadone -Pethidine -Oxycodone

Question 30

What are partial agonist opioids?

Answer 30

-Buprenorphine Sub-lingual only (Subutex)

Question 31

What is the name for Buprenorphine + Naloxone?

Answer 31

Suboxone

Question 32

What are examples of opioid antagonists?

Answer 32

-Naloxone -Naltrexone

Question 33

Runny nose, watering eyes, dilated pupils, yawning, nausea, vomiting, diarrhoea, muscle aches, restlessness and difficulty sleeping are examples of what?

Answer 33

Opioid withdrawal

Question 34

What full agonist, reduces the peak from injecting and has a longer half-life than diamorphine therefore it suppresses withdrawal and craving from drugs?

Answer 34

Methoadone

Question 35

Does methadone give you a buzz?

Answer 35

No

Question 36

What partial agonist, reduces peak levels from injecting and has a longer half life than methadone so suppresses withdrawal and craving. But is not absorbed orally (Sub-lingual, injection or implants only), but you can't use drugs additional to this?

Answer 36

Buprenorphine

Question 37

Buprenorphine or Methadone, what has a better outcome for new-born babies?

Answer 37

Buprenorphine

Question 38

How many mg of Methadone can be fatal for a child?

Answer 38

10mg

Question 39

What is the usually optimal dose of methadone?

Answer 39

40-120mg/day

Question 40

What side effects can Methadone cause?

Answer 40

-CNS -Constipation -Dry eyes, nose and mouth -Dental issues -Menstrual cycle issues -Histaminergic effects

Question 41

What dose of Methadone can increase the QTc interval?

Answer 41

over 100mg/day *Offer ECG

Question 42

When should the first dose of Buprenorphine be given?

Answer 42

Objective symptoms of withdrawal to reduce the risk of precipitated withdrawal

Question 43

What is Sixmo?

Answer 43

6 weekly one-off implanted rod of Buprenorphine

Question 44

What is Buvidal?

Answer 44

Weekly and monthly injection

Question 45

What can be given to aid in the avoidance of having opioids?

Answer 45

Naltrexone

Question 46

Do you need a test dose for Naltrexone?

Answer 46

Yes 25mg at least 7 days prior to last dose of opioid then have 50mg OD and continue for 3 months

Question 47

Who can supply Naloxone without a prescription?

Answer 47

Drug services & anyone can use it in an emergency

Question 48

If a patient misses three consecutive doses of buprenorphine or methadone, what should we do?

Answer 48

DO NOT supply and CONTACT the prescriber *Document all*

Question 49

Can you die from opioid withdrawal?

Answer 49

No

Question 50

Can you die from methadone toxicity?

Answer 50

Yes

Question 51

What three chemicals does Cannabis contained?

Answer 51

-THC -CBD -Turpenes

Question 52

What is the legal classification of cannabis?

Answer 52

Class B

Question 53

What is the dose of Cannabidiol you can buy?

Answer 53

Very low! -Oral bioavalability of 4-6%

Question 54

Does CBD that you can buy have any effect on the cannabis receptors?

Answer 54

NO, may inhibit adenosine like caffeine!

Question 55

What happens if you start smoking cannabis before your the age of 15?

Answer 55

4 x more likely to have a psychotic illness

Question 56

Can cannabis cause psychosis?

Answer 56

The more you use the more likely to have psychosis.

Question 57

What can sudden cessation of long-term high dose benzodiazepine cause?

Answer 57

Seizures

Question 58

How many mg of caffeine is considered moderate use?

Answer 58

500mg

Question 59

What is considered the toxic range of caffeine intake?

Answer 59

1000mg+

Question 60

Pt X is passing urine more frequently, has a fine tremor or shake, increased physical stamina, mild anxiety, heart palpitations and nervousness, they drink a lot of caffeine, what is this?

Answer 60

Low-moderate doses of Caffeine

Question 61

Pt S, has been experiencing sleep issues, long-term anxiety, restless, paranoid, slightly disorientated, stomach pains and headaches, they drink a lot of caffeine, what could this be due to?

Answer 61

Effects of high doses of caffeine

Question 62

Citalopram, Escitalopram, Fluoxetine, Serta line are examples of what?

Answer 62

SSRI's

Question 63

What are examples of Tricyclic antidepressants (TCA's?)

Answer 63

Clomipramine, and Lofepramine

Question 64

When should you take SSRI/SNRI?

Answer 64

In the morning as they can disrupt sleep

Question 65

When should you take Mirtazapine?

Answer 65

At night as serotonin uptake may be counteracted by 5-HT - histamine blocker and histamine keeps us awake

Question 66

When switching between SSRI's what do we need to be aware of?

Answer 66

Serotonin syndrome

Question 67

What antidepressant has a very long half life?

Answer 67

Fluoxetine

Question 68

If your swapping medication from a non-reversible MAOI, what is required?

Answer 68

A 2 week washout period

Question 69

Can mirtazapine be used with citalopram?

Answer 69

Yes! - has little interactions with other drugs and helps sleep

Question 70

If a patient has 2 failed antidepressants what needs to be done? Depression

Answer 70

Review of diagnosis