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Public Health > Substance Abuse ILA > Flashcards

Substance Abuse ILA Flashcards

1
Q

What questionnaires could be used to screen for alcohol dependence

A
  • AUDIT
  • CAGE
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2
Q

What do the AUDIT scores indicate ?

A
  • 0 to 7 indicates low risk
  • 8 to 15 indicates increasing risk
  • 16 to 19 indicates higher risk
  • 20 or more indicates possible dependence
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3
Q

What questions are part of the CAGE questionnaire ?

A
  • Do you feel like you need to cut down on your drinking ?
  • Have you ever been angered at someone commenting on your drinking ?
  • Have you ever felt guilty about your drinking ?
  • Have you ever needed a drink in the morning to get yourself going ?
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4
Q

A CAGE score of how many indicates further assessment ?

A
  • 2
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5
Q

How can the physiological levels of alcohol use be investigated ?

A
  • Breath test – mg of alcohol per 100 ml of blood
  • Blood Test
  • Elevated MCV – raised
  • Gamma Glutamyl Transferase (GGT) – raised
  • Carbohydrate transferrin – raised
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6
Q

Describe substance Tolerance

A
  • A reduced reaction to a drug following its repeated use. Increasing the dosage may re-amplify the drugs effects however this may accelerate tolerance further reducing the drugs effects e.g. a pt who has to drink larger amounts of alcohol to obtain a similar effect
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7
Q

Describe Withdrawal

A
  • Physical and emotions problems that are experienced if you are dependent on a substance and then suddenly stop or drastically reduce your intake of a substance
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8
Q

Signs of dependence

A
  • Withdrawals
  • Cravings
  • Drinking despite negative consequences (on mental/physical health, work/social life)
  • Tolerance
  • Primacy – putting drinking before other activities
  • Rapid re-instatement – people who have stopped drinking, once they start again, rapidly get up to a level they were previously drinking
  • Narrowing of repertoire
  • As people become more dependent on alcohol the range of beverages they drink decline and they may only drink 1-2 types of drink (usually the cheapest)
  • Drinking habits also alter – now start to drink by themselves at home and at the pub
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9
Q

Reasons for people to continue to drink

A
  • Negative reinforcement – drink to avoid reinforcement symptoms
  • Positive reinforcement – drink to feel euphoric
  • Both combined leads to alcohol addiction
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10
Q

Long term effects of alcohol on the heart

A
  • Dilated cardiomyopathy
  • Arrhythmias
  • Stroke
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11
Q

Long term effects of alcohol on the liver

A
  • Steatosis
  • Steatohepatitis
  • Fibrosis
  • Cirrhosis
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12
Q

Cancers that are linked to alcohol use

A
  • Mouth
  • Esophagus
  • Liver
  • Breast
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13
Q

Conditions linked to vitamin deficiencies resulting from long term alcohol use

A
  • Thiamine – Wernicke’s encephalopathy and Korsakoff syndrome
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14
Q

What is the basic mechanism of action for ethanol on the nervous system and why is this important for withdrawal treatment ?

A
  • Ethanol = CNS depressant which enhances the effect of inhibitory neurotransmitter GABA which inhibits NMDA-type glutamate receptors
  • Same MOA as benzodiazepines there use chlordiazepoxide to treat withdrawal
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15
Q

When does onset of symptoms of alcohol withdrawal occur ?

A
  • 6-12 hours
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16
Q

When is the patient most likely to suffer a seizure during withdrawal ?

A
  • 36 hours
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17
Q

When is the most likely onset of delirium tremens ?

A
  • 48-72 hours
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18
Q

Management of a patient in alcohol withdrawal ?

A
  • Admit to hospital
  • Chlordiazepoxide
  • Thiamine (Vit B1) or Pabrinex (Vit B and C) – must be given before fluids to prevent Wernicke’s
  • IV fluids
19
Q

Psychological treatments available to patients with substance addictions

A
  • CBT
  • Motivational interviewing
  • Support groups e.g. alcoholics anonymous
20
Q

Medications to help maintain abstinence

A
  • Disulfiram – induces hangover symptoms even after minor amounts of alcohol
  • Naltrexone – blocks euphoric effects of alcohol
  • Acamprosate – reduces cravings
21
Q

How does Disulfiram help maintain abstinence

A
  • Indices hangover symptoms even after minor amounts of alcohol
  • I.e. makes alcohol unpleasant to drink
22
Q

How does Disulfiram help maintain abstinence

A
  • Indices hangover symptoms even after minor amounts of alcohol
  • I.e. makes alcohol unpleasant to drink
23
Q

How does Naltrexone help maintain abstinence

A
  • Blocks euphoric effect of alcohol
24
Q

How does Acamprosate help maintain abstinence

A
  • Reduces cravings
25
Q

What is the basic physiology of Wernicke’s and Korsakoff

A
  • Thymine deficiency as a result of neglecting to eat or not absorbing thymine efficiently
  • Petechial hemorrhages occur in a variety of structures in the brain, including mamillary bodies and ventricle walls
26
Q

Pneumonic for Wernicke’s and Korsakoff

A
  • COAT RACK
  • Confusion
  • Ophthalmoplegia
  • Ataxia
  • Thiamine deficiency
  • Retrograde amnesia
  • Anterograde amnesia
  • Confabulation
  • Korsakoff Syndrome
27
Q

Additional presenting features of Wernicke’s encephalopathy

A
  • Clouding of consciousness
  • Disorientation
  • Amnesia for recent events
  • Marked psychomotor agitation
  • Visual, auditory and tactile hallucinations - Classically Lilliputian hallucinations (tiny people/ animals seen at night)
  • Marked fluctuations in severity hour by hour (usually worse at night)
  • Severe cases – heavy sweating, fear, paranoid delusions, agitation, suggestibility, raised temp, sudden CV collapse
28
Q

Features of opioid misuse

A
  • Rhinorrhoea
  • Needle track marks
  • Pinpoint pupils
  • Drowsiness
  • Watering eyes
  • Yawning
29
Q

Complications of opioid misuse

A
  • Viral infection secondary to sharing needles: HIV, hepatitis B & C
  • Bacterial infection secondary to injection: infective endocarditis, septic arthritis, septicaemia, necrotising fasciitis
  • Venous thromboembolism
  • Overdose may lead to respiratory depression and death
  • Psychological problems: craving
  • Social problems: crime, prostitution, homelessness
30
Q

Harm reduction approach to opioids

A
  • Needle exchange
  • Offering testing for HIV, hepatitis B & C
31
Q

Opioid OD treatment ?

A
  • Naloxone
32
Q

Opioid detox/maintenance therapy

A
  • Methadone
  • Buprenorphine
33
Q

Treatment for benzodiazepine OD

A
  • Flumazenil
34
Q

Most common cause of death in MDMA and cocaine OD ?

A
  • Hyperthermia
35
Q

Triad of serotonin syndrome ?

A
  1. Autonomic hyperactivity – Agitation, tremor, sweating, HTN
  2. Altered mental state – Confusion, drowsiness, coma
  3. Neuromuscular excitation – Rigidity, hyperreflexia, myoclonus
36
Q

Management for serotonin syndrome ?

A
  • Supportive including IV fluids
  • Benzodiazepines
  • More severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine
37
Q

Give the recommended alcohol drinking limits (in units) per week for men and women

A
  • 14 units
38
Q

What is narrowing of repertoire ?

A
  • A sign of dependence when a pt will only consume one or two types of alcoholic beverages
  • Often the strongest
39
Q

Describe tolerance ?

A
  • When more of a substance needs to be taken to induce the same effect
40
Q

State 3 blood tests to screen for alcohol dependence and state how each is affected

A
  • GGT (raised)
  • RBC mean corpuscular volume (raised)
  • Carbohydrate deficient transferrin
41
Q

The patient presents with agitation, tremors and dilated pupils. He is also observed to be responding to visual hallucinations which consist of “little spiders”. What is the diagnosis ?

A
  • Delirium tremens
42
Q

A pt presents ataxia, ophthalmoplegia and nystagmus. What syndrome is he presenting with?

A
  • Wernicke’s encephalopathy
43
Q

What would you use to prevent Wernicke’s developing into Korsakoff’s ?

A
  • Thiamine
  • Pabrinex

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