Substance Abuse Flashcards
S+S:
Dependency characteristics - mneumonic WANTIN
Withdrawal symptoms - physical
Adverse effects
Neglect of other things - family, job
Tolerance - need more to get the same effect
Intense desire (craving)
No control overuse in terms of starting, stopping, or amount
You would see 3 or more of these.
S+S:
What is meant by harmful use?
What is meant by acute intoxication?
Physical or mental health damage resulting from substance use.
Acutely altered consciousness, behaviour, perception, affect, and/or cognition, due to substance abuse.
Substance-specific signs and symptoms:
Injection drug use:
- What type of marks do you see?
- Vascular - 2
- Infection - 4
Opioid withdrawal:
- Breathing
- Skin
- Face - 4
- Abdo
- Later signs
Track marks - injection scars along the route of a vein.
Thrombophlebitis
VTE
Abscesses Endocarditis Hepatitis HIV ///////////////////// Tachypnoea Sweating
Rhinorrhoea - a condition where the nasal cavity is filled with a significant amount of mucus fluid.
Lacrimation
Yawning
Mydriasis - dilation of the pupil of the eye.
Substance-specific signs and symptoms:
Cannabis:
- main sign
- What is cannabinoid hyperemesis syndrome?
Cocaine and crack cocaine:
- main sign
- They get formication which is a type of tactile delusion. What is it?
- what might happen nasally?
Paranoid ideation
A condition that leads to repeated and severe bouts of vomiting. It is rare and only occurs in daily long-term users of marijuana. Marijuana has several active substances.
Paranoid psychosis
The sensation of insects crawling on the skin
Nasal discharge
Investigations:
Why is a urine drug test done?
What other tests should be done for IVDU?
For an initial assessment of detox
Also used for monitoring
Tests for blood-borne viruses
Management of opioid dependency:
What can be used to guide a user to positive change?
What patient are admitted or given residential Rx?
Motivational interviewing
Those with significant physical, psychiatric, or social problems (e.g. homelessness)
Management of opioid dependency:
How long does it take as an inpatient and as an outpatient?
4 wks - inpatient
12 wks - outpatient
Management of opioid dependency - Biological:
Opioid replacement:
What drugs are used for maintenance or detoxification? - M, B
What is a 2nd line drug for detoxification? - L
What opioid receptor blocker is used to prevent relapse after detoxification? - N
What is used in overdose? - N
Methadone
Buprenorphine
Lofexidine
Naltrexone
Naloxone
Management of opioid dependency - Psychological:
What advice can be given?
What can be used to encourage change?
What is narcotics anonymous?
Hard-reduction - self-injection behaviour
Motivational interviewing
A self-help group using 12 steps
Management of opioid dependency - Psychological:
Contingency management:
What is the aim?
What is available for couples?
When should CBT be used?
Aims to encourage change by rewarding positive behaviour instead of punishing negative behaviour.
Behavioural couples therapy for 12 wks
If there are co-morbid conditions - e.g. depression
Management of opioid dependency - Social:
Who needs to be contacted?
When is social support needed?
DVLA
Support with any difficulties regarding income, work, or housing
Smoking cessation - Psychological interventions:
1st line
2nd line
Contact with any services for advice.
Provide self-help materials
Individual behavioural counselling or group behavioural therapy, which include psychoeducation and education of CBT.
Smoking cessation - Pharmacotherapy:
Should treatment be started before or after cessation?
Nicotine replacement therapy (NRT):
- 4 ways it comes in?
- Who should it be avoided in?
Alternative 1st line Rx to NRT:
- An antidepressant used - B
- Varenicline - MOA?
Before to reduce withdrawal symptoms
Patches
Nasal spray
Gum
Lozenges
Those with cardiac disease
Bupropion
Nicotine receptor partial agonist
Assessment:
Why might they present?
In crisis
Impending court case/in prison/ referred from courts
Referred from/recommended by other medical
practitioner/SW etc
Wanting information on effects of drug use
Recent health risk or anxieties re drug misuse
Behaviour causing concern to others
Suffering mental illness
Pregnant
“had enough”/ usual source not available
Wanting help with drug misuse and motivated to change
Q’s to ask in drug history?
Age of initiation
Past & current drug use
Types and quantities
Frequency & routes of administration
Symptoms of withdrawal/ other signs of dependence
Periods of abstinence / relapse
Accidental overdose
