Substance Abuse Flashcards
A man presents to ED with uncontrolled eye movements. He is on 6mg Risperidone and sodium valproate 1500mg daily - what do you give him?
this man has EPSEs Benztropine has been shown to reverse the symptoms.
What things should you ask if you think they are substance dependent?
Substance dependence:
ADDICTeD
- A - activities are given up or reduced
- D - dependence (physical) - tolerance
- D - dependence (physical) - withdrawal
- I - interpersonal (internal consequences)
- C - can’t cut down
- T - time consuming
- D - duration
Outline the signs and symptoms of alcohol withdrawal?
6-48 hours after prolonged heavy drinking and can be fatal
Stage 1
- 12-18h after last drink
- tremors, sweating,
- shakes, agitation
- anorexia
- cramps, diarrhoea
- sleep disturbance
Stage 2 7-38hrs
- seizure usually tonic clonic
Stage 3
- 48 hours
- hallucinations
Stage4
- 3-5 days
- Delirium tremens
- confusion
- delusions
Wernickes encephalopathy (insult causes thiamine to leave cells) - ocular, cerebellar dysfunction, confusion.
- N/V
- tremor
- Delirium Tremens (sudden onset - global confusion and sympathetic overdrive)
Treatment of Alcohol Withdrawal?
- scale diazepam 5-10mg to max 120
- treat symptoms
- treat cravings (see other card)
- treat social (AA, MH issues, CBT/psychoeducation)
- observe for complications (gait, cirrhosis, weakness)
How to treat cravings of alcohol?
- naltrexone (continue 6-12 months) - blocks opioid receptor and decreases cravings. - most helpful in binge habits - CI if opioids required
- Acamprosate - decreased neuronal excitability with alcohol intake - CI in renal failure - increased time to first drink
- Disulfiram (antabuse) - terrible drug, blocks alcohol metabolism - (increased blood acetaldehyde cause SE (flushing, sweating, N/V, SOB) - good results in motivated patients
What do you do to Assess someone who is smoking?
5 As of smoking cessation:
Ask about smoking
Assess motivation + dependence
- withdrawal Sxs? (appetite, insomnia, mouth ulcers, depressed mood, irritable)
- previous quit attempts
- DARN-C motivational interviewing:
- Desire (I wish - contemplative?)
- Ability (self-capacity)
- Reasons
- Need (obligations)
- C (commitment)
Advise to Quit
- CVD health, every year you quit extra 3 mths
- important during pregnancy
- $$$ saved
Assist with cessation
- counselling
- pharmacological
- Quitline
Arrange follow-up
- dose adjust
- regular review and first 2 weeks most likely to relapse
Pharmacological Management of Smoking?
- NRT - nicotine replacement therapy - risk during pregnancy - SEs (dizzy, indigestion, hiccups, myalgia, vivid dreams) - CI in CVD, PKU (aspartame containing products), pregnancy
- Varenicline (Champix) - still smoking start and set quit date 2 weeks (as it takes some time to reach desired []) - 12 week course - Side effects: Nausea (30%) Flatulence, abdo pain Insomnia/abnormal dreams increased appetite
- Bupropion - less effective than champix - non-nicotine antidepressant
Outline the Treatment for Opioid Withdrawal?
- Supportive
- antiemetics
- loperamide (immodium - decrease diarrhoea)
- paracetamol
- Ciboxone (combo buprinorphine and naltrexone)
- initially just buprinophine which can be abused as its a partial opiate agonist
- decreased sedation
- Methadone program (stablisation difficult)
What do you use and in Benzodiazepines OD and withdrawal?
Specific signs of withdrawal?
- metallic taste
- distorted hearing, vision, smell, disorientation
- muscle stiffness, pain, spams
- paranoid thoughts
- seizures
antidotal treatment:
- flumazenil (competitive antagonist)
- rarely used as re-sedation may occur in 45-60min and can precipitate seizures.
- elderly with resp disease where intubation is CI or iatrogenic OD or unintentional lone paediatric ingestion
What are Anticholinergic side effects? What drugs tend to give them?
think alice in wonderland
- ‘red as a beet’ - flushed
- ‘mad as a hatter’ delirium
- ‘dry as a bone’ anhydrosis
- ‘hot as a hare’ antihydrotic hyperthermia
- ‘full as a flask’ urinary retention
- others - tachycardia and reduced bowel sounds
drugs that give these?
- TCAs
- antihistamines
What are some cholinergic side effects?
SLUDGE BBB (think muk)
S - salivation
L - lacrimation
U - urination
D - defecation
GE - gastric emesis (vomiting)
B - bronchorrhoea (watery sputum)
B - bronchospasm
B - bradycardia
often found in insecticides and organophosphates
DSM criteria for Substance Dependence?
WILD
- Work - interefers with obligations
- Interpersonal or social consequences
- Legal problems
- Dangerous situations (physically hazardous)
remember ADDICTeD
