Substance abuse Flashcards
Death, liver damage, accidents, cancer and gut bleeds are a risk associated with abusing what?
Alcohol
How can chronic alcohol consumption affect the CNS?
-Cognitive impairment
-Wernicke-Korsakoff Syndrome
What vitamin deficiency causes Wernicke-Korsakoff syndrome?
Thiamine
What is the acute treatment for thiamine supplementation?
Pabrinex
-One pair of ampoules IM/IV daily for 3-5 days
What is the maintenance treatment for oral thiamine?
100mg TDS
How much thiamine can a human absorb?
Humans only absorb up to 4mg an hour so 100-300mg once a day is a pointless dose, needs to be spread out.
Alcohol withdrawal - between 6-50 hours what symptoms could be present?
Generalised hyperactivity, tremor, sweating, nausea, retching, mood fluctuation, tachycardia, increased RR, HTN, pyrexia.
The onset of alcohol withdrawal is between what hours?
6-8
The peak from alcohol withdrawal is how many hours?
10-30
Alcohol withdrawal affects subside in what hours?
40-50
When can withdrawal from alcohol seizures occur?
0-48 hours
Can alcohol withdrawal cause auditory and visual hallucinations?
YES - within 12 hours and can last 5-6 days
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?
48-72 hours
What is the long acting benzodiazepine, anticonvulsant, and is cross-tolerant with alcohol? You can give this without waiting for withdrawal symptoms?
Chlordiazepoxide
What is the usual dose of Chlordiazepoxide?
20-40mg QDS then reduced over 9 days
Should when required / on demand doses of Chlordiazepoxide be prescribed?
Yes
Who needs reduced doses of Chlordiazepoxide?
Elderly and those with Hepatic impairment *Accumulation
If a patient is in alcohol withdrawal and is in hepatic impairment what Benzodiazepine can be prescribed alternatively?
Lorazepam or Oxazepam
Is vitamin supplementation usually combined with Benzodiazepines?
Yes
What drug is a pro-drug, converted in the liver and prevents the conversion of acetaldehyde to acetic acid and dopamine to noradrenaline?
Disulfiram
What happens when someone has alcohol on Disulfiram?
Vasodilation, palpitations and a headache = can be fatal
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
Acamprosate
What drug for alcohol misuse disorder is a opioid antagonist (blocks reward effect)?
Naltrexone and Nalmefene
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?
Naltrexone
Name a Opioid antagonist when can be used on a ‘when required’ basis?
Nalmefene
What is FAST?
Fast Alcohol Screening Test
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?
FAST + = complete AUDIT or AUDIT-C
If a patient scores 5+ on the AUDIT-C what does this indicate?
Increasing or higher risk of drinking = AUDIT-C positive
What are full opioid agonists?
-Codeine
-Diamorphine
-Morphine
-Dihydrocodeine
-Fentanyl
-Methadone
-Pethidine
-Oxycodone
What are partial agonist opioids?
-Buprenorphine
Sub-lingual only (Subutex)
What is the name for Buprenorphine + Naloxone?
Suboxone
What are examples of opioid antagonists?
-Naloxone
-Naltrexone
Runny nose, watering eyes, dilated pupils, yawning, nausea, vomiting, diarrhoea, muscle aches, restlessness and difficulty sleeping are examples of what?
Opioid withdrawal
What full agonist, reduces the peak from injecting and has a longer half-life than diamorphine therefore it suppresses withdrawal and craving from drugs?
Methoadone
Does methadone give you a buzz?
No
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?
Buprenorphine
Buprenorphine or Methadone, what has a better outcome for new-born babies?
Buprenorphine
How many mg of Methadone can be fatal for a child?
10mg
What is the usually optimal dose of methadone?
40-120mg/day
What side effects can Methadone cause?
-CNS
-Constipation
-Dry eyes, nose and mouth
-Dental issues
-Menstrual cycle issues
-Histaminergic effects
What dose of Methadone can increase the QTc interval?
over 100mg/day
*Offer ECG
When should the first dose of Buprenorphine be given?
Objective symptoms of withdrawal to reduce the risk of precipitated withdrawal
What is Sixmo?
6 weekly one-off implanted rod of Buprenorphine
What is Buvidal?
Weekly and monthly injection
What can be given to aid in the avoidance of having opioids?
Naltrexone
Do you need a test dose for Naltrexone?
Yes 25mg at least 7 days prior to last dose of opioid then have 50mg OD and continue for 3 months
Who can supply Naloxone without a prescription?
Drug services & anyone can use it in an emergency
If a patient misses three consecutive doses of buprenorphine or methadone, what should we do?
DO NOT supply and CONTACT the prescriber
Document all
Can you die from opioid withdrawal?
No
Can you die from methadone toxicity?
Yes
What three chemicals does Cannabis contained?
-THC
-CBD
-Turpenes
What is the legal classification of cannabis?
Class B
What is the dose of Cannabidiol you can buy?
Very low!
-Oral bioavalability of 4-6%
Does CBD that you can buy have any effect on the cannabis receptors?
NO, may inhibit adenosine like caffeine!
What happens if you start smoking cannabis before your the age of 15?
4 x more likely to have a psychotic illness
Can cannabis cause psychosis?
The more you use the more likely to have psychosis.
What can sudden cessation of long-term high dose benzodiazepine cause?
Seizures
How many mg of caffeine is considered moderate use?
500mg
What is considered the toxic range of caffeine intake?
1000mg+
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?
Low-moderate doses of Caffeine
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?
Effects of high doses of caffeine
Citalopram, Escitalopram, Fluoxetine, Serta line are examples of what?
SSRI’s
What are examples of Tricyclic antidepressants (TCA’s?)
Clomipramine, and Lofepramine
When should you take SSRI/SNRI?
In the morning as they can disrupt sleep
When should you take Mirtazapine?
At night as serotonin uptake may be counteracted by 5-HT - histamine blocker and histamine keeps us awake
When switching between SSRI’s what do we need to be aware of?
Serotonin syndrome
What antidepressant has a very long half life?
Fluoxetine
If your swapping medication from a non-reversible MAOI, what is required?
A 2 week washout period
Can mirtazapine be used with citalopram?
Yes! - has little interactions with other drugs and helps sleep
If a patient has 2 failed antidepressants what needs to be done? Depression
Review of diagnosis
