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AI Exam 2 > Substance abuse > Flashcards

Substance abuse Flashcards

1
Q

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

A

Alcohol

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2
Q

How can chronic alcohol consumption affect the CNS?

A

-Cognitive impairment
-Wernicke-Korsakoff Syndrome

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3
Q

What vitamin deficiency causes Wernicke-Korsakoff syndrome?

A

Thiamine

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4
Q

What is the acute treatment for thiamine supplementation?

A

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

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5
Q

What is the maintenance treatment for oral thiamine?

A

100mg TDS

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6
Q

How much thiamine can a human absorb?

A

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

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7
Q

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

A

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

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8
Q

The onset of alcohol withdrawal is between what hours?

A

6-8

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9
Q

The peak from alcohol withdrawal is how many hours?

A

10-30

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10
Q

Alcohol withdrawal affects subside in what hours?

A

40-50

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11
Q

When can withdrawal from alcohol seizures occur?

A

0-48 hours

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12
Q

Can alcohol withdrawal cause auditory and visual hallucinations?

A

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

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13
Q

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?

A

48-72 hours

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14
Q

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

A

Chlordiazepoxide

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15
Q

What is the usual dose of Chlordiazepoxide?

A

20-40mg QDS then reduced over 9 days

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16
Q

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

A

Yes

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17
Q

Who needs reduced doses of Chlordiazepoxide?

A

Elderly and those with Hepatic impairment *Accumulation

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18
Q

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

A

Lorazepam or Oxazepam

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19
Q

Is vitamin supplementation usually combined with Benzodiazepines?

A

Yes

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20
Q

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

A

Disulfiram

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21
Q

What happens when someone has alcohol on Disulfiram?

A

Vasodilation, palpitations and a headache = can be fatal

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22
Q

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

A

Acamprosate

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23
Q

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

A

Naltrexone and Nalmefene

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24
Q

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?

A

Naltrexone

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25
Q

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

A

Nalmefene

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26
Q

What is FAST?

A

Fast Alcohol Screening Test

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27
Q

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?

A

FAST + = complete AUDIT or AUDIT-C

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28
Q

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

A

Increasing or higher risk of drinking = AUDIT-C positive

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29
Q

What are full opioid agonists?

A

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

30
Q

What are partial agonist opioids?

A

-Buprenorphine
Sub-lingual only (Subutex)

31
Q

What is the name for Buprenorphine + Naloxone?

A

Suboxone

32
Q

What are examples of opioid antagonists?

A

-Naloxone
-Naltrexone

33
Q

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

A

Opioid withdrawal

34
Q

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

A

Methoadone

35
Q

Does methadone give you a buzz?

A

No

36
Q

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?

A

Buprenorphine

37
Q

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

A

Buprenorphine

38
Q

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

A

10mg

39
Q

What is the usually optimal dose of methadone?

A

40-120mg/day

40
Q

What side effects can Methadone cause?

A

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

41
Q

What dose of Methadone can increase the QTc interval?

A

over 100mg/day
*Offer ECG

42
Q

When should the first dose of Buprenorphine be given?

A

Objective symptoms of withdrawal to reduce the risk of precipitated withdrawal

43
Q

What is Sixmo?

A

6 weekly one-off implanted rod of Buprenorphine

44
Q

What is Buvidal?

A

Weekly and monthly injection

45
Q

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

A

Naltrexone

46
Q

Do you need a test dose for Naltrexone?

A

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

47
Q

Who can supply Naloxone without a prescription?

A

Drug services & anyone can use it in an emergency

48
Q

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

A

DO NOT supply and CONTACT the prescriber

Document all

49
Q

Can you die from opioid withdrawal?

A

No

50
Q

Can you die from methadone toxicity?

A

Yes

51
Q

What three chemicals does Cannabis contained?

A

-THC
-CBD
-Turpenes

52
Q

What is the legal classification of cannabis?

A

Class B

53
Q

What is the dose of Cannabidiol you can buy?

A

Very low!
-Oral bioavalability of 4-6%

54
Q

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

A

NO, may inhibit adenosine like caffeine!

55
Q

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

A

4 x more likely to have a psychotic illness

56
Q

Can cannabis cause psychosis?

A

The more you use the more likely to have psychosis.

57
Q

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

A

Seizures

58
Q

How many mg of caffeine is considered moderate use?

A

500mg

59
Q

What is considered the toxic range of caffeine intake?

A

1000mg+

60
Q

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?

A

Low-moderate doses of Caffeine

61
Q

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?

A

Effects of high doses of caffeine

62
Q

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

A

SSRI’s

63
Q

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

A

Clomipramine, and Lofepramine

64
Q

When should you take SSRI/SNRI?

A

In the morning as they can disrupt sleep

65
Q

When should you take Mirtazapine?

A

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

66
Q

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

A

Serotonin syndrome

67
Q

What antidepressant has a very long half life?

A

Fluoxetine

68
Q

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

A

A 2 week washout period

69
Q

Can mirtazapine be used with citalopram?

A

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

70
Q

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

A

Review of diagnosis

AI Exam 2 (16 decks)

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