Substance abuse/misuse and drug overdose Flashcards
Definition
Physiological dependance
- Signs of tolerance
- Withdrawal Sx
Risk factors
Bio:
- Genetics: variations in enzymes that metabolise drugs
- Neurochemical abnormalities in dopamine, GABA and opioid systems
Environmental:
- Peer pressure,
- life stressors,
- parental drug use,
- cultural acceptibility
- personality variability
Pathophysiology
- Biological or Environmental determinants to begin abuse (Risk factors)
- Takes substance
= Dependant on cost, availability - Positive reinforcement
= Psyhcosocial: Peers, Pleasurable effects of the drug
= Bio: mesolimbic dopaminergic reward pathways - Dependence
Substance dependence (mnemonic: Drug Problem Will Continue To Harm )
Drug Problem Will Continue To Harm
3 or more of the following must occur for >1month:
1. Desire for substance
2. Preoccupation with substance use
3. Withdrawal state
4. incapability to Control substance
5. Tolerance to substance
6. evidence of Harmful effects
Signs of IVDU
- Phlebitis, abscess or old scarring
- Blood borne infection
- HIV, Hep B&C and syphilis
Assessment
- Psychiatric Hx + MSE
- Physical exam: weight, dentition, signs of IVDU
- Signs of withdrawal
- Bloods: FBC, U&Es, LFTs, clotting profile, drug level and screen for blood-borne infections
- Urinalysis: toxicology
- ECG, echocardiogram and CXR
Opioid role
Endorphins are peptide activators of the opioid receptors
Clinical uses:
- Pain control
- Acute pulmonary oedema
- Cough suppression
- Diarrhoea
Signs of opiate intoxication
Pain relief,
Euphoria,
Sedation,
Resp depression,
Cough suppression,
Miosis,
Constipation
Skin warmth and flushing,
Seizures
Management of opiate overdose
Naloxone
Opiate withdrawal and treatment
- Appear 6-24hours after last dose
- Last 5-7 days
- Sweating,
- Dilated pupils,
- Tachycardia,
- High BP,
- Watering eyes/nose,
- Abdominal cramps,
- N&V,
- Tremor and muscle cramps
TX:
= Substitute prescribing/detoxification: Methadone, buprenorphine or dihydrocodeine
= Withdrawal symptom relief: Lofexidine
= Relapse prevention: Naltrexone
= Overdose: IV Naloxone
How does Lofexidine work?
Alpha-adrenergic agonist = alleviates a broad spectrum of opioid withdrawal symptoms
Benzodiazepine role
Enhance the activity of the inhibitory neurotransmitter GABA in the CNS
Signs of benzo intoxication
CNS depression with normal vitals
Altered mental state
Slurred speech
Ataxia
Rarely causes resp depression
Management of benzo overdose
Flumazenil
Benzodiazepines withdrawal signs and management
Tremor,
N+V,
Increased HR,
Postural hypotension,
Agitation,
Hallucintions,
Paranoid ideation,
Grand mal convulsions
TX:
- Overdose managemet: FLUMAZENIL
- Withdrawal management: Give benzos and wean off
