Substance Abuse Flashcards

Question

definition of alcohol abuse

Answer 1

over a 12-this month period - Patients drinking has cause clinically significant impairment or distress (determined by the presence of at least 2 or more diagnostic criteria)

Answer 2

1) Alcohol is often taken in large amounts or over a longer period than was intended 2) persistent desire or unsuccessful efforts to cut down or control alcohol uses 3) great deal of time spent in activity necessary to obtain alcohol, use alcohol, to recover from its effects 4) craving or a strong desire or urge to use alcohol 5) recurrence alcohol use resulting in failure to fulfil major role obligation at work, school or home 6) continued alcohol use despite having persistent or recurrent social or interpersonal problems causing or exacerbated by the effect of alcohol 7) Important social, occupational, or recreational activities are given up or reduced because of alcohol use 8) recurrent alcohol use in situation in which is physically hazardous 9) alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have caused or exacerbated by alcohol 10) tolerance a. a need for marked Lee increased amounts of alcohol to achieve intoxication or desire effect b. a markedly diminished effect with continued use of the same amount of alcohol 11) withdrawal

Answer 3

CAGE AUDIT screening (Alcohol use disorder investigation test - the severity of alcohol misuse LFT - inc GGT, AST> ALT

Answer 4

o Initial structured brief advice [FRAMES model] o Extended brief intervention – up to 5 sessions of motivational interviews, undertaken by a those with relevant training o CBT/behavioural therapy o Referral to a specialist alcohol treatment service - Can be given chlordiazepoxide (benzo) or sometimes diazepam o Risk of malnourishment – oral thiamine o Wernicke encephalopathy – IV thiamine Feedback about the personal risk of impairment Responsibility - personal responsibility Advise to cut down Menus of alternative drinking pattern Empathic consultations self-efficacy - an interview-style which improves the patient's self-efficacy

Answer 5

alcoholic liver disease, cirrhosis, pancreatitis Wernicke's encepathalopathy chronic thiamine deficiency - Korsakoff syndrome (dementia)

Answer 6

* prevent relapse with local core services, psychiatry and alcohol nurse specialists * frequent counselling and follow up  AA 12 steps CBT programme • medications o Acamprosate (GABA analogue) – stops the effect of alcohol o Naltrexone - opioid receptor antagonist that can modify the effect of alcohol by blunting its pleasurable effect and reducing cravings o Disulfiram - causes unpleasant symptoms i.e. flushing, palpitations, nausea, and headache

Answer 7

as classified by The National Institute on Alcohol Abuse and Alcoholism (NIAAA) = drinking pattern that leads to a blood alcohol concentration (BAC) level of 0.08 g/dL and above • For adult women, that’s typically around 4 drinks (5 for adult men) within a couple of hours of each other.

Answer 8

* Vomiting * Anterograde amnesia * Sleep impairment * Dysarthria * Delayed reaction time * Euphoria * Decreased inhibitions * Emotional instability * Ataxia * Nystagmus * Hypoglycaemia * Drowsiness * Confusion

Answer 9

* Confusion * N+V * Slowed/irregular breathing * Cyanosis * Pale skin * Hypotension * Hypothermia * Unconsciousness * Seizures

Answer 10

``` subclinical euphoric excitment confusion stupor coma death ```

Answer 11

blood-alcohol level

Answer 12

Behavioural techniques +/- medication like alcohol abuse behaviroual technique to avoid getting into a fight with an alcohol-intoxicated person

Answer 13

``` • simple - start within first 12 hours of stopping/ reducing alcohol intake o anxiety o restlessness o Tremor o Insomnia o N+V o sweating o tachycardia o ataxia ```

Answer 14

• complicated – A history of o Withdrawal seizures – self-limiting grand Mal (tonic chronic)seizure occurring hours to days after last drinks ``` o delirium tremens  uncommon  significant mortality  starts >48 hours after stopping  combined simple withdrawal with • autonomic hyperactivity (Tachycardia , hyper-reflexia, hypertension, fever, visual or tactile hallucination, sinister delusions, disorientation and confusion) ``` o Alcoholic ketoacidosis  after stopping drinking, vomit profusely and do not eat  present with vomiting, signs of chronic alcohol use, high anion gap metabolic acidosis

Answer 15

• ↑ HR, BP and temp * ABG: * ↓ pCO2, ↓HCO3-, normal pO2. * pH variable as metabolic acidosis may be altered by metabolic alkalosis from vomiting and possible respiratory alkalosis (due to hyperventilation) • CIWA (Clinical Institute Withdrawal Assessment for Alcohol) – quantify the severity of alcohol withdrawal

Answer 16

Simple • Managed as an outpatient or day patient • May commence treatment for uncomplicated withdrawal but should not prescribe long term o Diazepam 5-10mg PO or Chlordiazepoxide 10-30mg + thiamine Complicated • Withdrawal seizures – Check BM and treat as epileptic fits. Examine for head injury. • DTs – Monitor closely, check BM, give IV lorazepam as appropriate and refer to medics. • Alcoholic ketoacidosis – Give IV 0.9% saline with 5% glucose and thiamine supplementation (Pabrinex), whilst monitoring U&E, glucose. Refer to medics and consider HDU/ICU Admitted: • Nurse in a well lit room to prevent disorientation • Monitor BM • Rehydrate – if IV required avoid saline if known chronic liver disease + monitor urine output • IV or oral thiamine for 1 week • Chlordiazepoxide or diazepam for agitation • Watch out for severe hypophosphatemia – treat with IV phosphate • Arrange follow up to alcohol dependence clinic

Answer 17

questions 1) how many cigarettes do you smoke a day 2) how soon after waking do you smoke your 1st cigarette 3) any previous attempt - how successful 4) did you try any treatment 5) did you have any support eg the stop smoking service 6) did you have any withdrawal symptoms or craving?

Answer 18

Carbon monoxide level

Answer 19

• very brief advice o Current impasse smoking history o verbal and written information on risks of smoking and the benefits of stopping smoking o Advise on options for quitting smoking including behaviour supports, medication and E-cigarettes o Refer to local stop smoking services if they wish to stop smoking * Set a quit day and stick to it  abrupt cessation is the best way to quit * advised that the first few days of the most difficult (withdraw symptoms) the best way to quit is with behaviour support her medication • craving are often set off by o stress - breathing techniques o seeing others smoke o becoming intoxicated - try not to drink alcohol in the first week ``` • manage craving /keep distracted o short bouts of moderate exercise o talk to family member or friend o keep busy playing a game on your phone o go to another environment ``` • supporting quitting o information on smoke free national helpline o support from family and friends o quit with someone else

Answer 20

nicotine replacement therapy (short and long acting forms being used together = best) - patch (16/24 hrs) + short acting eg inhaled varenicline - best used alone, start 7-14 days before quit date Bupropion - least effective out of all 3 start 7-14 days before quit date

Answer 21

agitation, depressed mood, suicidal thought (stop), N+V, constipation/diarrhoea, dry mouth, insomnia

Answer 22

agitation, depressed mood, suicidal thoughts = stop

Answer 23

methadone/buprenorphine

Answer 24

activated charcoal if ingested recently benzodiazepines (Diazepam) dexamphetamine (used to treat dependence)

Answer 25

chlordiazepoxide (to help with withdrawal) Carbamazepine/clomethiazole (acute withdrawal)

Answer 26

longer acting benzodiazepine (Diazepam)

Answer 27

* deliberate inhalation of a volatile substance to achieve and altered mental state * detoxification not necessary as no withdrawal symptoms have been identified (bar gammahydroxyburate/GLB)

Answer 28

volatile solvents from household and industrial products aerosol propellants gases from household industrial and medical products nitric oxide children

Answer 29

``` dec RR/HR hypoxia drunk feeling - ataxia visual disortion heart failure ```

Answer 30

``` hearing loss peripheral neuropathies liver and kidney damage weight loss depression ```

Answer 31

* Most solvent do not have withdrawal symptoms * healthy lifestyle advise * beta-blocker – protect the heart * support from self-help groups * abstinence

Answer 32

Flumazenil

Answer 33

IV bicarbonate - reduce risk of seizures and arrhythmias in severe toxicity

Answer 34

activated charcoal if within 1 horu NAC liver transplant

Answer 35

IV bicarbonate

Answer 36

* mild-moderate toxicity may respond to volume resuscitation with normal saline * hemodialysis may be needed in severe toxicity • sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretion

Answer 37

Vit K _ prothrombin complex

Answer 38

protamine sulphate

Answer 39

if bradycardia - atropine | in resistant cases - glucagon may be used

Answer 40

fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol ethanol - works by competing with ethylene glycol for enzyme alcohol dehydrogenase

Answer 41

fomepizole or ethanol | hemodialysis

Answer 42

Digoxin-specific antibody - fragmentcalcos

Answer 43

Desferrioxamine - a chelating agent

Answer 44

dimercaprol, clalcium edetate

Answer 45

100% oxygen | hyperbaric oxygen

Answer 46

hydroxocobalamin + combination of amy nitrite, sodium nitrite and sodium thiosulfate