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Substance Abuse Flashcards

1
Q

What are examples of Class A drugs

A

Heroin
Ecstasy
Cocaine
LSD

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2
Q

Examples of Class B drugs

A

Amphetamines
Cannabis
Barbiturates

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3
Q

Examples of class C drugs

A

Anabolic steroids
Valium
Tranquilizers
Ketamine

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4
Q

Why can’t cocaine be ingested orally

A

it undergoes rapid first pass metabolism

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5
Q

What is the pharmacological mechanism of heroin

A

Mu-receptor agonist, inhibiting GABA receptors leading to a decrease in the inhibition of dopaminergic neurones, resulting in an increase in synaptic dopamine

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6
Q

What are the acute harmful effects of cocaine

A

CVS - tachycardia, HTN, vasoconstriction

increased risk of MI, arrythmia, CVA

increased risk of anxiety, panic attacks, impaired judgment, impulsivity

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7
Q

what are the chronic harmful effects of cocaine

A

necrosis of the nasal septum

CKD secondary to HTN

increased risk of miscarriage +placental abruption

psychatric complications (GAD, panic disorder, psychosis)

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8
Q

What may chronic marijuana use precipitate

A

anxiety and panic attacks

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9
Q

what are some long term effects of chronic marijuana use

A

dysthymia, decreased motivation, anxiety disorders

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10
Q

What are the acute harmful effects of MDMA

A 
jaw clenching  
nausea
blurred vision 
hyperthermia
comedown
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11
Q

what are some chronic harmful effects of MDMA

A

tolerance

depression and anxiety

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12
Q

what is the pharmacological mechanism of LSD

A

seratonin receptor agonist

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13
Q

what are some acute harmful effects of LSD

A

dilated pupils

HTN

Tachycardia

high-risk behavior - e.g. believing they can fly

‘bad trip’

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14
Q

.

A

.

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15
Q

what are some acute harmful effects of benzodiazepines

A 
intoxication 
drowsiness
dizziness
decreased concentration 
decreased co-ordination 
hypotension, respiratory depression
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16
Q

what are some chronic harmful effects of benzodiazepines

A 
decreased memory
decreased concentration 
depression tolerance
dependence 
withdrawal
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17
Q

what are common withdrawals for benzodiazepines

A 
agitation 
insomnia
seizures
psychosis 
delerium
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18
Q

what age groups drinks daily the most

A

> 65 (13%)
25-44 (4%)
6-25 (1%)

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19
Q

what percentage of men and women are dependent on alcohol

A

9% of men and 4% of women

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20
Q

what psychological demographics tend to become alcohol dependent more commonly

A

depression
anxiety
low self-esteem

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21
Q

what professions are higher risk for developing an alcohol dependency

A

bartending
farming
healthcare

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22
Q

what is the screening tool used for substance misuse

A

CAGE-FAST or CAGE-AID for drugs

Cut down (felt like you had to?)
Annoyed by criticism?
Guilty about current drinking?
Eye-opener (had a drink 1st thing in the morning?)

no = 0, yes = 1 >2=significant

FAST

1) >8 units (6 for women) on >1 occasion
2) blackouts whilst drinking
3) how often has drinking caused you to fail expectations
4) had anyone approached you about drinking (no = 0, yes >1yr ago = 1, yes this year = 2)

never = 0,

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23
Q

what is the screening tool used for substance misuse

A

CAGE-FAST or CAGE-AID for drugs

Cut down (felt like you had to?)
Annoyed by criticism?
Guilty about current drinking?
Eye-opener (had a drink 1st thing in the morning?)

no = 0, yes = 1 >2=significant

FAST

1) >8 units (6 for women) on >1 occasion
2) blackouts whilst drinking
3) how often has drinking caused you to fail expectations
4) had anyone approached you about drinking (no = 0, yes >1yr ago = 1, yes this year = 2)

never = 0,

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24
Q

How should you take an alcohol misuse history

A

1) LIFETIME PATTERN - when did you start, when did you start to feel there was an issue, any abstinence
2) CURRENT DRINKING - typical day, how often, what, how much, when ,what setting
3) DEPENDENCE - withdrawals, tolerance, memory loss
4) SOCIAL/OCCUPATION - missed work?, relationship issues, financial issues, criminal charges
5) PREVIOUS TREATMENT - sought treatment previously, nature of previous treatments, why return to drinking
6) PHYSICAL/MENTAL HEALTH - physical health issues, drinking related, psychiatric health - mood?

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25
What are some CNS consequences of alcohol abuse
``` cognitive and memory impairment decrease in brain weight and volume wernicke-korskoff syndrome (thiamine deficiency causing a pseudodementia) central pontine myelinolysis cerebellar degeneration ```
26
What are some PNS consequences of alcohol abuse
alcoholic peripheral neuropathy | optic atrophy + visual changes
27
what are some cardiorespiratory consequences of alcohol abuse
``` increased infection susceptibility alcoholic cardiomyopathy arrhythmia HTN cerebrovascular accident ```
28
what are some cardiorespiratory consequences of alcohol abuse
``` increased infection susceptibility alcoholic cardiomyopathy arrhythmia HTN cerebrovascular accident ```
29
what are some hepatic consequences of alcohol abuse
``` alcoholic fatty liver disease alcohol hepatitis cirrhosis end stage chronic alcohol misuse related HCC co--morbid Hep B/C infection with crrhosis ```
30
what are some renal/pancreas/splenic consequences to alcohol abuse
hepato-renal syndrome in cirrhosis CKD secondary to hypertension chronic pancreatitis splenomegaly (secondary to cirrhosis and portal hypertension
31
what are some GI consequences to alcohol abuse
OESOPHAGEAL mallory-weiss tearing oesophageal varicies Barrett's oesophagus/oesophageal carcinoma GASTRIC gastritis peptic ulcer gastric carcinoma SMALL AND LARGE BOWEL malabsorption and chronic diarrhoea lower GI tract carcinoma
32
what are some reproductive consequences to alcohol abuse
ED hypogonadism (M) fertility issues (F) teratogenesis (F)
33
What are some psychiatric consequences to alcohol abuse
alcoholic hallucinations alcohol-related brain damage pathological jealousy
34
what are some features of alcoholic hallucinations
auditory hallucinations, usually stopping (95%) after alcohol intake has stopped rare complication of chronic use
35
what are some features of alcohol-related brain damage
cognitive impairment - 60% heavy drinkers mostly seen in the MOCA exacerbated by thiamine deficiency
36
what are some features of pathological jealousy
monosymptomatic delusional disorder secondary to alcohol abuse characterised by the delusion that partner has been unfaithful, violence and homicide not uncommon
37
when should alcohol withdrawal syndrome be anticipated and prophylactically treated
known alcohol dependence history of alcohol withdrawal >10 units for >10 days current withdrawal
38
what are some features of mild/uncomplicated withdrawal
``` 4-12 hours from last drink 2-5 days length coarse tremor sweating insomnia tachycardia N+V Psychomotor agitation anxiety intense cravings transient hallucinations ```
39
what is delirium tremens
medical emergency occuring 1-7 days after last drink, can be characterised as a potentially fatal withdrawal
40
what are the symptoms of delerium tremens
all of the mild/uncomplicated symptoms, + ``` clouding of consciousness amnesia hallucinations and delusions severe psychomotor agitation + tremor fever autonomic disturbances and electrolyte imbalances ```
41
what is the mortality of delerium tremens if left untreated
40%
42
what is wernicke-korsakoff syndrome
wernicke-encephalopathy, korsakoff psychosis thiamine deficiency causing a classic triad of: peripheral neuropathy resting tachycardia nutritional deficiency stigmata
43
what are common causes for wernicke korsakoff syndrome
GI malabsorption chronic liver disease poor intake
44
what is wernicke-korsakoff syndrome
wernicke-encephalopathy, korsakoff psychosis thiamine deficiency causing a classic triad of: peripheral neuropathy resting tachycardia nutritional deficiency stigmata followed by psychosis/pseudodementia
45
how many patients present with the classic triad for wernicke-korsakoff syndrome
10%
46
how do you treat Wernicke-Korsakoff syndrome
paraenteral thiamine - 200-500mg TDS for 5-7 days followed by a 100mg oral regime TDS for 1-2 weeks after
47
how many people with wernickes encepalopathy progress to kosakoffs psychosis
80%
48
whats the mortality of wernicke-korsakoff syndrome
15%
49
what are some other causes of korsakoff psychosis
carbon monoxide poisoning
50
what are some features of korsakoffs psychosis
anterograde amnesia less severe retrograde amnesi confabulation (make up stories to fill in gaps in memory) apathy
51
what is the prognosus of wernicke-korsakoff syndrome
20% completely recover 25% have significant recovery the rest do not recover
52
what medications are used for substance abuse
disulfiram | acamprosate
53
what is the mechanism of action of disufiram
irreversible inhibitor ofADH | causes nausea when alcohol ingested
54
what is the mechanism of action of acamprosate
decreased cravings | enhances GABA transmission
55
what drugs are used for symptomatic relief in opiate withdrawal
Lofexidine - | loperamide/metclopramde (constipative) - for D+V during detox
56
what drugs are used for substitute prescribing in opiate abuse
methodone | buprenorphine
57
whats the shortest an opiate withdrawal regime can go on for
14-21 days
58
What is motivational interviewing
psychological intervention used for alcohol abuse patient-centered counseling, exploring the ambivilence towards health-harming behaviours, therapist is in a supportive role
59
what are some principles behind motivational interviewing
develop discrepancies to increase cognitive dissonance between patient and health harming behaviours rolll with resistance and address it express empathy support self efficacy (increase confidence to overcome barriers to change)
60
what are principles of harm reduction approaches for substance abuse
accept people will take drugs/abuse substances no matter how discouraged it is, so spreading info to help reduce harm is the most effective
61
what are some examples of harm reduction strategies
``` needle exchange take-home naloxone substitute prescribing assessment and treatment of comorbid physical illness education about safe sex ```
62
what are the stages of change in the prochaska-diclemente model
an upward spiral of: ``` pre-contemplation contemplation preparation action maintenance relapse and repeat ```
63
whats an important point about the prochaska-diclemente model
relapses are ok as long as you learn from them
64
what are positive prognostic factors for addresing a substance abuse problem
``` motivation to change supportive family/relationship employed treatable comorbid mental illness AA/NA service involvement ```
65
what are some negative prognostic factors for addressing a substance abuse problem
``` ambivolent about change unstable accomodation absence of prosocial relationships unempltment primacy repeated treatment fialure ```
66
what are some negative prognostic factors for addressing a substance abuse problem
``` ambivolent about change unstable accomodation absence of prosocial relationships unempltment primacy repeated treatment failure cognitive impairment ```
67
what are key components of treating alcohol withdrawal syndrome
medicate for symptomatic relief give nutritional supplimentation (e.g. thiamine) closely monitor for severe physical/psychiatric issues during withdrawal
68
when should you consider inpatient treatment for substance abuse
previous history of severe/complicated withdrawals current psychiatric symptoms comorbid physical illness severe nausea/vomiting

Psychiatry (13 decks)

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