Substance abuse (F1) Flashcards
1
Q
1.*
Quantify alcohol misuse
- Define unit
- Calculation for standard drink
- Safe drinking limit
A
2
Q
Volume of alcohol to unit
A
3
Q
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Neuropsychiatric complications of alcohol abuse
A
4
Q
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Cardiovascular, GI and Hematological complications of alcohol abuse
A
5
Q
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Endocrine, MSS, Reproductive complications of alcohol abuse
A
6
Q
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Metabolic, fetal and psychosocial complications of alcohol abuse
A
7
Q
Alcohol abuse
Criteria
A
8
Q
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Define use disorder, dependence, acute intoxication #
A
9
Q
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Define withdrawal, tolerance, dangerous drinking #
A
10
Q
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ICD 10
Criteria of harmful use #
A
11
Q
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ICD - 10
Dependence syndrome criteria #
A
12
Q
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DSM-5
Alcohol use disorder criteria #
A
Craving
Desire to stop/ unsuccessful efforts
Larger amount or longer time
Time to obtain, use or recover
Despite interpersonal and social problem
Despite knowledge of physical and psychological problem
Despite use in situations that are physically harzardous
Failure to fulfil major role obligations
Reduce important social, occupation, recreational activities
Tolerance
Withdrawal
13
Q
Alcohol abuse
Pathophysiology
A
14
Q
Etiologies of alcohol abuse
A
15
Q
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Alcohol abuse
Approach to effect of abuse, drinking history
A
CAGE
- Cut-down, annoyed by others, guilt, eye-opener
16
Q
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Alcohol abuse
Ix
A
17
Q
Outline AUDIT questions for alcohol dependence
A
18
Q
Alcohol abuse
Questions to assess pattern of use
A
19
Q
Alcohol abuse
Questions to assess dependence
A
20
Q
Alcohol abuse
Questions to assess impact and complications
A
21
Q
Alcohol abuse
Questions to assess quitting, attitude
A
22
Q
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Approach to management of alcohol misuse
A
23
Q
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Alcohol abuse
Drug options for maintaining abstinence
A
Disulfiram – Aldehyde dehydrogenase for unpleasant reaction
Naltrexone – opioid antagonist
Acamprosate – Increase GABA effect, Lower Glutamate effect
Topiramate = Increase GABA effect at AMPA receptors
Antidepressant
24
Q
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Alcohol abuse
Psychosocial treatment options
A
25
Acute intoxication
S/S at different alcohol level
26
Define alcohol blackouts and alcoholic hypoglycemia
27
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Acute alcohol intoxication
Management
IV fluid +/- Glucose
Thiamine
BZD
Antipsychotic if needed
28
Alcohol withdrawal syndrome
Clinical presentation
29
Alcohol withdrawal syndrome
Ix
30
# *
Alcohol withdrawal syndrome
DSM-5 criteria
## Footnote
ATIN-PHAS
Autonomic
Tremor
Insomnia
N/V
Psychomotor agitation
Hallucination
Anxiety
Seizure
31
# *
Alcohol withdrawal syndrome
Management
Alcohol withdrawal
- Inpatient detox
- NPO, fluid, electrolyte
- Thamine + glucose, Multivitamin + folate
- BDZ (diazepam) for agitation
- Barbiturates or propofol for refractory Delirium Tremens
- Status epilepticus
32
Alcohol withdrawal syndrome
Prophylaxis
Indication
33
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Alcohol related amnesic syndromes
Definition
Causes
D/dx
34
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Alcohol related amnesic syndromes
Clinical presentation
Korsakoff syndrome
- Confabulation (imaginative thinking as reality)
- No insight
- Other cognitive function normal
- Apathy/ inertia
- Diencephalic lesion
35
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Thiamine deficiency in alcoholism
Cause
Consequence
36
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Wernicke's encephalopathy
S/S
Dx
Mx
S/S:
Encephalopathy
Oculomotor dysfunction
Truncal ataxia
Test: Caine criteria, Red cell transketolase, Blood Thiamine level, CT for diencephalon abnormalities
Mx: Thiamine (Oral or IV)
37
Alcohol related dementia
Pathophysiology
S/S
Dx
Neurological findings/ features
38
Alcoholic cerebellar degeneration
Pathogenesis
S/S
Dx
Mx
39
Marchiafava-BIgnami disease
Pathology
S/S
Neuroimaging feature
40
Vitamin B deficiency in alcoholism
Physiology
S/S
41
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Long-term psychiatric sequalae of alcoholism
Mood: Depression, Anxiety, Bipolar I
Antisocial personality disorder
Schizophrenia
Drug abuse
42
Alcohol related sleep disorders
43
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Alcohol related psychotic disorders
Types
S/S
Management
Othello syndrome (jealousy) > Antipsychotics
Alcoholic hallucinosis > Antipsychotics and abstinence
Schizophrenia > Abstinence
44
Effect of alcohol on suicide
45
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Substance dependence
Define: Misuse, Craving, dependence, addiction
46
# *
Substance dependence
ICD-10 criteria
CANT Control Withdrawal
at least 3/6
47
Outline stages of substance abuse
48
First biological stage of addiction
49
Second stage of addiction and neurbiological effects
50
Third stage of addiction and neurobiological effects
51
Etiologies of substance abuse
52
Common drugs of abuse
Stimulants – Meth, Cocaine, MDMA
Hallucinogens – LSD, PCP, Ketamine
Depressants – Opiates, Barbituates, Sedatives, Cannabis
53
# *
CNS stimulants
Examples
Effects
Withdrawal effects
Effect – Sympathetic overdrive + Positive psychotic symptoms (hallucinations, paranoid ideas) + Positive mood symptoms (Disinhibition, high activity, aggression)
Withdrawal is opposite – depression, anxiety, lethargy, sleep
54
# *
Hallucinogens
Examples
Pharmacology
Effects
Hallucinogens
Effect: Weaker sympathetic effect + Strong disturbance of senses (paranoid ideas, senses distortion) + Variable mood
Withdrawal: no dependence, no withdrawal symptoms
55
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Depressants
Examples
Pharmacology
Effects
Depressants
Effect: Parasympathetic overdrive, negative mood changes (relaxation, anxiolytic, drowsy)
Withdrawal: Sympathetic rebound
56
Route of administration and effect on addiction
Injection fastest = more addicting
Oral longest
57
Assessment of substance abuse
Clinical presentation of SA
Injection marks
Behavior/ miss olbigations
Medical complications
58
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Substance abuse
History taking questions
Use: start, type, amount, pattern, dependence
Effect and problem list: Medical, Psychiatric, Social
Person: Coping, support, personality, reason for drug abuse (pleasure, medication, pleasure)
Lab test
59
Management of drug abuse
Aim
60
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Substance abuse
Management options
Bio – Medical complications, Detox/ withdrawal, Maintenance
Psycho – MI, CBT, Psychoeducation, Psychiatric diseases mx
Social – Rehab programs, harm reduction programs
61
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Opioids
Examples
Pharmacology
Medical use
RoA
Agonist at opioid receptors
Inhibit GABA >> Increase DA activity at VTA
Withdrawal = Sympathetic overdrive
62
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Ketamine
Clinical S/S
Withdrawal S/S
Dependence rate
Complications
Tx
Ketamine = Hallucinogen
Effect: Mood depressing and parasympathetic
Withdrawal: Sympathetic overdrive, Positive mood (anxious, craving, restless)
Fast Tolerance, Fast OD
Tx
ABC
Naloxone until RR>12
Chronic:
Non-opioid: Anti-emetics, NSAIDs, a2 agonist
Opioid: Methadone + tapering, Buphrenorphine
Naltrexone
63
Ketamine
Treatment
64
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BDZ
Examples
Pharmacology
Medical use
S/S
Tx
Benzo = depressant
Use = CNS depressant, anxiolytic/ hypnotics
Withdraw = Sympathetic overdrive, psychosis, seizure
Withdrawal is life threatening
Tx:
Urgent
ABC
IV Flumazenil
Chronic
Long acting BDZ (Diazepam) + Slow tapering over 8 weeks
65
BDZ
Clinical presentation
Dependence
66
BDZ abuse
Treatment
67
Cannabis
Examples
Pharmacology
Medical use
Misuse
68
# *
Cannabis
Clinical presentation
Dependence
Treatment
Cannabis = Depressant. CBD, THC most important
Use: Physiological sympathetic drive + Psychological CNS depressant
Chronic use: High risk of schizophrenia, low risk dependence
Withdraw: Mild irritable, insomnia, anorexia
Treatment: BDZ sedation, Psychotherapy (MI, CBT)
69
# *
LSD
Examples
Pharmacology
Misuse
Clinical presentation
Dependence
Treatment
LSD = Hallucinogen
Use: Mild sympathetic + Strong sensory distortion + Variable mood changes
Withdrawal: Minimal
Treatment: No antidote. BZD, IV Haldol
70
PCP
Examples
Pharmacology
Medical use
Clinical presentation
Dependence
Treatment
71
Meth
Examples
Pharmacology
Medical use
Misuse
72
# *
Meth
Clinical presentation
Dependence
Treatment
Meth = Stimulant
Use: Sympathetic overdrive
Withdrawal: Parasympathetic crash
Treatment:
Urgent: ABC, IV BDZ for agitation/ hyperthermia, Antipsychotics
Chronic: CBT/MI mainly, BDZ for acute withdrawal +/- Mirtazapine/ Bupropion
73
# *
Cocaine
Pharmacology
Use
Clinical presentation
Cocaine = Stimulant
Use: Sympathetic overdrive + Positive psychological symptoms
Withdrawal: CNS depression (fatigue, sleep, anhedonia, depression), no physiological symptoms
Tx:
Urgent: ABC, BDZ +/- Phentolamine
Chronic: CBT, Dopamine agonist, Disulfiram
74
Cocaine
Dependence
Treatment
75
# *
MDMA
Pharmacology
Use
Presentation
Dependence
Treatment
MDMA = Stimulant
Use: Sympathetic overdrive + Serotonin syndrome + Positive psychological symptoms
Withdrawl: CNS depression crash, no physical symptoms
Tx:
Urgent: ABC, BDZ, Cyproheptadine (Serotonin syndrome)
Chronic: CBT/ MI, Harm reduction
