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Psychiatry > Substance Abuse > Flashcards

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
Q

What are some CNS consequences of alcohol abuse

A 
cognitive and memory impairment
decrease in brain weight and volume
wernicke-korskoff syndrome (thiamine deficiency causing a pseudodementia) 
central pontine myelinolysis 
cerebellar degeneration
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26
Q

What are some PNS consequences of alcohol abuse

A

alcoholic peripheral neuropathy

optic atrophy + visual changes

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27
Q

what are some cardiorespiratory consequences of alcohol abuse

A 
increased infection susceptibility
alcoholic cardiomyopathy
arrhythmia
HTN
cerebrovascular accident
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28
Q

what are some cardiorespiratory consequences of alcohol abuse

A 
increased infection susceptibility
alcoholic cardiomyopathy
arrhythmia
HTN
cerebrovascular accident
29
Q

what are some hepatic consequences of alcohol abuse

A 
alcoholic fatty liver disease 
alcohol hepatitis
cirrhosis end stage 
chronic alcohol misuse related HCC
co--morbid Hep B/C infection with crrhosis
30
Q

what are some renal/pancreas/splenic consequences to alcohol abuse

A

hepato-renal syndrome in cirrhosis
CKD secondary to hypertension
chronic pancreatitis
splenomegaly (secondary to cirrhosis and portal hypertension

31
Q

what are some GI consequences to alcohol abuse

A

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
Q

what are some reproductive consequences to alcohol abuse

A

ED
hypogonadism (M)
fertility issues (F)
teratogenesis (F)

33
Q

What are some psychiatric consequences to alcohol abuse

A

alcoholic hallucinations
alcohol-related brain damage
pathological jealousy

34
Q

what are some features of alcoholic hallucinations

A

auditory hallucinations, usually stopping (95%) after alcohol intake has stopped

rare complication of chronic use

35
Q

what are some features of alcohol-related brain damage

A

cognitive impairment - 60% heavy drinkers
mostly seen in the MOCA
exacerbated by thiamine deficiency

36
Q

what are some features of pathological jealousy

A

monosymptomatic delusional disorder secondary to alcohol abuse

characterised by the delusion that partner has been unfaithful, violence and homicide not uncommon

37
Q

when should alcohol withdrawal syndrome be anticipated and prophylactically treated

A

known alcohol dependence
history of alcohol withdrawal
>10 units for >10 days
current withdrawal

38
Q

what are some features of mild/uncomplicated withdrawal

A 
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
Q

what is delirium tremens

A

medical emergency occuring 1-7 days after last drink, can be characterised as a potentially fatal withdrawal

40
Q

what are the symptoms of delerium tremens

A

all of the mild/uncomplicated symptoms, +

clouding of consciousness 
amnesia 
hallucinations and delusions 
severe psychomotor agitation + tremor
fever
autonomic disturbances and electrolyte imbalances
41
Q

what is the mortality of delerium tremens if left untreated

A

40%

42
Q

what is wernicke-korsakoff syndrome

A

wernicke-encephalopathy, korsakoff psychosis

thiamine deficiency causing a classic triad of:
peripheral neuropathy
resting tachycardia
nutritional deficiency stigmata

43
Q

what are common causes for wernicke korsakoff syndrome

A

GI malabsorption
chronic liver disease
poor intake

44
Q

what is wernicke-korsakoff syndrome

A

wernicke-encephalopathy, korsakoff psychosis

thiamine deficiency causing a classic triad of:
peripheral neuropathy
resting tachycardia
nutritional deficiency stigmata

followed by psychosis/pseudodementia

45
Q

how many patients present with the classic triad for wernicke-korsakoff syndrome

A

10%

46
Q

how do you treat Wernicke-Korsakoff syndrome

A

paraenteral thiamine - 200-500mg TDS for 5-7 days followed by a 100mg oral regime TDS for 1-2 weeks after

47
Q

how many people with wernickes encepalopathy progress to kosakoffs psychosis

A

80%

48
Q

whats the mortality of wernicke-korsakoff syndrome

A

15%

49
Q

what are some other causes of korsakoff psychosis

A

carbon monoxide poisoning

50
Q

what are some features of korsakoffs psychosis

A

anterograde amnesia
less severe retrograde amnesi
confabulation (make up stories to fill in gaps in memory)
apathy

51
Q

what is the prognosus of wernicke-korsakoff syndrome

A

20% completely recover
25% have significant recovery

the rest do not recover

52
Q

what medications are used for substance abuse

A

disulfiram

acamprosate

53
Q

what is the mechanism of action of disufiram

A

irreversible inhibitor ofADH

causes nausea when alcohol ingested

54
Q

what is the mechanism of action of acamprosate

A

decreased cravings

enhances GABA transmission

55
Q

what drugs are used for symptomatic relief in opiate withdrawal

A

Lofexidine -

loperamide/metclopramde (constipative) - for D+V during detox

56
Q

what drugs are used for substitute prescribing in opiate abuse

A

methodone

buprenorphine

57
Q

whats the shortest an opiate withdrawal regime can go on for

A

14-21 days

58
Q

What is motivational interviewing

A

psychological intervention used for alcohol abuse

patient-centered counseling, exploring the ambivilence towards health-harming behaviours, therapist is in a supportive role

59
Q

what are some principles behind motivational interviewing

A

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
Q

what are principles of harm reduction approaches for substance abuse

A

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
Q

what are some examples of harm reduction strategies

A 
needle exchange 
take-home naloxone 
substitute prescribing 
assessment and treatment of comorbid physical illness
education about safe sex
62
Q

what are the stages of change in the prochaska-diclemente model

A

an upward spiral of:

pre-contemplation
contemplation 
preparation
action
maintenance
relapse 
and repeat
63
Q

whats an important point about the prochaska-diclemente model

A

relapses are ok as long as you learn from them

64
Q

what are positive prognostic factors for addresing a substance abuse problem

A 
motivation to change
supportive family/relationship 
employed
treatable comorbid mental illness
AA/NA service involvement
65
Q

what are some negative prognostic factors for addressing a substance abuse problem

A 
ambivolent about change 
unstable accomodation 
absence of prosocial relationships 
unempltment 
primacy 
repeated treatment fialure
66
Q

what are some negative prognostic factors for addressing a substance abuse problem

A 
ambivolent about change 
unstable accomodation 
absence of prosocial relationships 
unempltment 
primacy 
repeated treatment failure 
cognitive impairment
67
Q

what are key components of treating alcohol withdrawal syndrome

A

medicate for symptomatic relief
give nutritional supplimentation (e.g. thiamine)
closely monitor for severe physical/psychiatric issues during withdrawal

68
Q

when should you consider inpatient treatment for substance abuse

A

previous history of severe/complicated withdrawals
current psychiatric symptoms
comorbid physical illness
severe nausea/vomiting

Psychiatry (13 decks)

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