Substance Abuse (Alcohol and Drug) Flashcards
state the spectrum of substnace use (4 stages)
recreational use-> acute intoxication-> harmful use-> Dependence syndrome
define acute intoxication
transietn condition follwoing use of alcohol or drugs
-closely related to dose and following which recovery is usually complete
define harmful substance use
-what does diagnosis of this need
*-what does not qualify for diagnosis
pattern of substnace use that causes damage to physical health, mental health or social circumstances
diagnosis requires damage to physical or mental health of use
*-social disapproval or adverse social consequences for example:
-ingestion of excessive amounts
-idosyncratic relations
-Iv adminsiosntr
-chronic use (considered misuse not harmful use)
define dependence syndrome
-what is a central characteristic
cluster of physiological behvaiourla and cognitive phenoma where a substance takes on much higher priority for a given individual than other behaviours that once had greater value
-strong, sometimes overpowering, desire to take psychoactive drugs, alcohol or tobacco
what is needed for a dependence syndroem diagnosis 6
3 or more of:
-strong desire or sense of compulsion
-diificulteis controlling substance taking behaviour
-physiological withdrawal state
-build up of tolerance
-neglect of alternative pleasures or interests
-persistent use of substance despite clear evidence of overtly harmful consequences
define a withdrawal state 4
group of syx of variabl clustering, severity and duration depending on substance
occurs on withdrawal or reduction of use
occurs after repeated use of a substance
indicates dependence
examples of withdrawal state syx from benzos
anxeity
agitation
irritability
diaphoresis
confusion
nauseas
examples of withdrawal state syx from opioids
rhinitis
lacrimation
yawning
dilated pupils
diaphoresis
insomia
how is delirium tremens characteristed 6
Hx of alochol
confusion-nocturnal worsening
hallucinations
illusisons( insects)
anxiety
fear
autonomic increase
define alcohol withdrawal syndrome
set of physical and psycholgoical syx occur following a reduction in alcohol intake after period of excessive use
when do alcohol withdrawal syndrome syx start
begin 6-8hrs afeer abrupt reduction in alcohol intake
can peak at 10-30hrs since last drink
can last 3-7days
mild to moderate syx of alcohol withdrawal syndrome 7
N+V
diarrhoea
tremoors- hands arms lefs
hyperacitivty,anxietym, agitatio
muslce pain
sweating
insomnia
severe syx of alcohol withdrawal syndrome 3
seizures
delirium tremenes
wernicks encephalopathy
management of alcohol withdrawal syndrome seizures 1
lorazepam IV
management of delirium trememns 2
chloridazepoxide (2-3 doses)
if no response
lorazepam
define Wernicke encephalopathy
acute neuropsychatric disorder resulting fom thiamine deficiency which develops rapidly or sub-acutely over a number of days
syx of delrium termenrs 6
24-72hrs after alchhol cessation
syx
-severe tremor
-delusions
-tachycarida
-pyrexia
-visual and auditory hallucaitons
-confusion
inital managemnt of Wernicke encephalopathy 2
prophllyactilcaly give pabrinex
-after which give thiamine
-even of clinical suspsicion is low
signs of Wernicke encephalopathy4
ataxia
opthalmoplegia
loss of memory
confusion
signs of patient with a high risk of developing Wernicke encephalopathy 4
hypotension
hypothermia
malnourished
hyperglycaemia
managemnt of alcohol withdrawal
benzos -chlordiazepoxide
why is chlordiazepoxide used first line for alcohol withdrawal syndrome
more gradual onset
long half life
less risk of rebound syx
when is diazepam used for alcohol withdrawal syndrome
in A&E
or if patient is unlieklyu to be admitted to hospital
define korsakoof syndroem
memory disorder results from vit B1 deficiency
associated with alcholhil
syx of korsakoff syndrome 3
problems learning new info
inability to rememebr recent events
long term memory gaps
what pathway in the brain is implicit in drug use
mesolimbic dopamine rewarrd pathway
aetiology of addiction
social learning model
-observing others and copying
disease model
-altered brain structure and functioning
genetic vulnerability
children of alcoholic 4x likely to themselves
assessment of substance use disorders
use
problems
phsycial adaptaion
behvaioural dependence
medical harm
cognitive impairment
motivation to change
psychosocial interventions in additviosn 8
motivational enhancement interviweing
brief interventions
relapse prevention (CBT)
12 step programmes (AA,NA,CA)
peer support
contingency management
therapeutic community/ residential rehab
describe motivational interviewing 4
facilitatinf and engaging intrisinc motivation to change
collaborative
goal-orientated
client centres
describe the FRAMES model
F- Feedback of risks
R- Responsibility Highlighted
A - Advice to abstain or cut down
M- Menu of alternative options and activities offered
E- Empathic Interviewing
S- Self efficacy enhanced
main cause of drug related deaths in Scotland
> 80% assoc w opiods
> 50% assoc w benzos
most abused type of opiods
Most abused substances are μ receptor agonists
effects of μ opiods 5
mediate analgesia
respiratory depresion
europhia
drowsiness
consitpation
managment of opiod addicts 2
either detox or maintenance presciption
lofexidine or buprenorphine for detox
-high relapse rates
methadone and buprenoprhine for maintenance
issues with maintenance prescription for opiods addicts 4
respiraitory depresion in overdose
rapid loss of tolerance
high risk of OD if misse doses o& reinstated at usual dose
need for re-titration after 3 days
syx of opiod overdose 3
respiratiory depresion
pinpoint pupils
decreased level of conscious es
treatment of opioid overdose
naloxone -usualy IM
competitiev opiod antagonis
-reverses depression of CNS and respiratory syx
MOA of benzos
enhance GABA at GABA (A) receptors
effects of benzos 4
sedative
hypnotic
anxiolytic
muscle relaxant effects
overdose of benzo syx (5) and managemnt 2
sedation
drowsiness
slurred pseech
coma
respiraoty depression
Mx-supportive, flumanzenil(watch use as can cause seizures)
define ketamine bladder
affects of ket on bladder
erosion of urothelium
-inflam leads to revasculaition
30% of regular ket users
decreased bladder compliance and volume
detrusor overacititvu
painful haemturiatin
can cause bilateral hydronephrosis and renal papillary necorisi
on stopping use:
-1/3 recover
a third no change
a third deteriroitate
