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- FINALS > Substance Abuse > Flashcards

Substance Abuse Flashcards

1
Q

Scoring system in PCM overdose?

A

Kings Criteria

Determines liver failure requiring immediate liver transplant

Creatinine, INR, acidaemia, encephalopathy, high lactate/phosphate

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2
Q

Causes of opiate overdose?

A

Iatrogenic

  • Medication overdosing
  • Lack of opiate clearing (poor renal function)

Recreational

  • Heroin, prescription opiates
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3
Q

Symptoms of opiate overdose/toxicity?

A

Toxicity = hallucinations, drowsiness

OD = reduced RR, pinpoint pupils, low GCS

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4
Q

Management of opiate overodse?

A

IV Naloxone 400mg (100mg if frail/lower level toxicity)

  • Very short half life - may require infusion
  • Monitor patient to ensure naloxone does not wear off and slip back into unconsciousness
  • Patient may wake agitated as naloxone acts very quickly, removing the effects of opioids and resulting in quick withdrawal
  • If RR <8 VENTILATE
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5
Q

Other things to think about in IVDUs with apparent opiate overdose?

A
  • Groin abscess
  • Psoas abscess
  • Infective endocarditis
  • Bacteraemia
  • Blood-borne virus
  • Malingering
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6
Q

Recommended alcohol consumption for males and females?

A

14 units a week

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7
Q

What constitutes 1, 2 and 3 units?

A

Pint of beer = 2/3

175ml wine = 2

250 ml wine = 3

25 ml spirit = 1

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8
Q

CAGE questionnaire?

A

C – Have you thought about cutting down?

A – Do you ever become annoyed if someone asks you to cut down?

G – Have you ever felt guilty about your drinking?

E – Ever had an eye opener?

2 or more = indicative.

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9
Q

Features of alcohol dependence?

A
  1. Compulsion to drink
  2. Increased tolerance to alcohol
  3. Stereotyped pattern of drinking/Less variability
  4. Repeated withdrawal symptoms
  5. Relief drinking to avoid withdrawal symptoms
  6. Primacy of drinking over other activities
  7. Reinstatement after abstinence

Obsessesion, Expansion, Constriction, Afflication, Alleviation, Prioritisation, Continuation

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10
Q

Bloods in alcohol dependence?

A
  • Gamma-glutamyl-transferase (GGT) – raised in 80% - BINGES
  • Alkaline phosphatase (ALP) – 60% - raised in CHRONIC ABUSE
  • ↑Mean corpuscular volume (MCV) – 50% (highest specificity for alcohol misuse) – Macrocytic anaemia (parietal cell destruction)
  • INR
    • Chronic = inducer - reduced INR
    • Acute = inhibitor = increased INR
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11
Q

Management of alcohol dependence?

A

Early

  • Advice and support, appraisal of current medical, psychological and social problems.

Post-Dependence - Detoxification

  • Reducing course of benzodiazepine in lieu of alcohol, supplemented by thiamine

Abstention

  • Naltrexone (opiate antagonist)
  • Acamprosate (anti-craving - enhances GABA)
  • Disulfiram (deterrent - aldehyde dehydrogenase inhibitor
  • Psychological Therapies
    • Support groups, psychotherapy, CBT, social skills training
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12
Q

Aspects of alcohol hx?

A
  1. Drinking pattern
  2. CAGE
  3. Features of dependence
  4. Mental problems - RISK
  5. Physical symptoms
  6. Forensic/social hx
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13
Q

Features of alcohol intoxiciation?

A

Ataxiate, dysarthria, nystagmus and drowsiness

Dizziness, loss of inhibition, N+V, elation, depression

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14
Q

Investigations and management in alcohol intoxication?

A

Investigations

  • Bloods = U+E, BM, LFTs
  • Toxicology screen - if patient not able to give full hx
  • CT scan if possibility of head injusry
  • ABG if patient in coma

Management

  • Maintain clear airway and prevent aspiration
  • Measure BM and give glucose if hypo
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15
Q

Features of delirium tremens?

A

Delirious Disorder

  • Clouding of consciousness
  • Disorientation (time and place)
  • Impairment of recent memory
  • Fear, agitation and restlessness
  • Vivid hallucinations and delusions
  • Insomnia
  • Autonomic disturbances
  • Coarse tremor
  • N+V, dehydration, electrolyte disturnaces
  • Seizures
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16
Q

Features of Wernicke-Korsakov syndrome?

A

Classical triad = confusion, ataxia and ocular palsy

  • Acute onset
  • Impaired consciousness and confusion
  • Episodic memory impairment
  • Ataxia
  • Nystagmus, abducens and conjugate gaze palsies, pupillary abnormalities
  • Peripheral neuropathy

Results from vitamin B1 deficiency

17
Q

What happens in Korsakov’s syndrome?

A
  • Irreversible syndrome of prominent impairment of recent memory.
  • Confabulation (falsification of memory in clear consciousness) is marked feature
  • Immediate recall, perception and other cognitive functions usually intact.
18
Q

Stages of addiction and recovery?

A
19
Q

Management of acute alcohol withdrawal?

A

Alleviating Withdrawal

  • Reducing dose of chlordiazepoxide (benzo - PO) – over days (dose depending on CIWA-Ar score)
  • If cannot tolerate oral - 10mg slow IV diazepam or 500 micrograms/kg rectal diazepam solution
  • Correct electrolyte abnormalities – IV phosphates if low

Prevention of *Wernicke’s*

  • Thiamine 25mg/24h PO and vitamin B
  • High-risk = IV Pabrinex 2 pairs/8h IV for 5 days – a high-potency combination of B and C vitamins – may sometimes cause anaphylaxis).
  • Prophylactic/Treatment dose
20
Q

Management of alcohol cessation?

A

Want To Stop

  • Refer to AA, involve family and friends

Detoxification in Community

  • Reducing regimen of chlorodiazopoxide with thiamine replacement (200mg OD for 7 days)

Unwilling to Change

  • Provide info, reassess and re-inform subsequently, support family
21
Q

Things to screen for in smoking cessation?

A

Cancer

Cardiovascular

Chronic lung disease

Pregnancy Risk

Others

  • Diabetes, osteoporosis, thrombosis, dyspepsia, gastric ulcer
  • Passive smoking - increased risk in kids, cot death etc.
22
Q

Management of smoking cessation?

A

Support Servies

  • Group education, conselling and support +/- individual support.

Smoking Cessation Aids

  • NRT (gum, patch) – continue for 3 months, tail off dose over 2 weeks.
    • Contraindicated immediately post MI, stroke or TIA or in patients with arrhythmia
  • Bupropion – tablets 2x quit rate.
    • Contraindications: increased risk of seizures, eating disorder, bipolar disorder
  • Varenicline (Champix). Lower dose in renal impairment.
    • Contraindications: psychiatric illness
23
Q

Heroin?

A
  • Effect
    • Drowsiness, sense of warmth and well being
  • Harm
    • Physical dependence and tolerance, overdose, HIV or HEP infection
24
Q

Cocaine?

A
  • Effect
    • Sense of wellbeing, alertness, confidence
  • Harm
    • Dependence, restlessness, paranoia, damage to nasal septum
25
Q

Amphetamine?

A
  • Effect
    • Wakefulness, energy and confidence
  • Harm
    • Insomnia, mood swings, irritability, panic. Comedown severe
26
Q

Ectsasy?

A
  • Effect
    • Alert and energetic, heightened senses and feeling of well being
  • Harm
    • Nausea and panic, overheating and dehydration (can be fatal), liver and kidney problems, risk of mental illness and depression
27
Q

Cannabis?

A
  • Effect
    • Relaxed, talkative state, heightened senses
  • Harm
    • Impaired coordination and increased injury, poor concentration, anxiety and depression, increased risk of resp. disease including lung cancer
28
Q

Management of recreational drug abuse?

A

Investigations

  • Urine toxicology to confirm drug misuse
  • FBC, UEs, LFTs, hep B, C and HIV serology (with counselling)

General focus on…

  • Education inc. safe injecting/sex advice, specific risk of drugs
  • Medical care: treat/advice re. complications of drugs use/blood borne viruses
  • Hep B immunisation
  • Treatment of dependence: refer to specialist team, give support, review regularly, set achievable goals.
29
Q

Desired effects and harmful effects of solvent abuse?

A

Desired

  • Like being drunk
  • Thick headed, dizziness, possible hallucinations
    • Slurred speech, dizziness and impaired judgement, reduced RR and HR

Harmful

  • Fatal arrhythmias can cause instant death
  • Suffocation inhaling from plastic bag
  • Nausea, blackouts, increased risk of accidents
  • May develop tolerance
30
Q

Management of solvent abuse?

A

Warn of risks. Encourage abstinence.

  • Psychologically rather than physically addictive
  • May have mild withdrawal symptoms such as tremors, dizziness, nausea, anxiety or depression.
31
Q

Presentation of beta blocker overodse?

A
  • Usually bradycardia
    • Sotalol = ventricular tachyarrhythmias including torsades de pointes
    • Propanonlol = coma and convulsions
32
Q

Management of beta blocker overdose?

A

Maintain clear air way and ventilate

  • IV Atropine sulfate
  • Or Glucagon 5-10mg IM if this fails
33
Q

Presentation of digoxin toxicity?

A
  • GI: Nausea, vomiting, anorexia, diarrhoea
  • Visual: Blurred vision, yellow/green discolouration, haloes
  • CVS: Palpitations, syncope, dyspnoea
  • CNS: Confusion, dizziness, delirium, fatigue
34
Q

Investigations in Digoxin toxicity?

A

ECG =” reverse tick”

  • Down-sloping ST depression with a characteristic “Salvador Dali sagging” appearance
  • Flattened, inverted, or biphasic T waves.
  • Shortened QT interval.
35
Q
A

- FINALS (24 decks)

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