Substance Abuse (not alcohol) Flashcards
1
Q
What is the aetiology of substance misuse?
A
- Genetics
- Peer pressure
- Parental drug use
- Life stressors
- Personal vulnerability e.g lack of resources to cope with stresses
- Cultural acceptability
2
Q
What are the routes that opiates are taken through?
A
- Morphine (PO, IV)
- Diamorphine/Heroin (IN, IV, Smoked)
- Codeine (PO)
- Methadone (PO)
3
Q
What are psychological effects of Opiates?
A
- Apathy
- Disinhibition
- Psychomotor retardation
- Impaired judgement
- Inattention
- Drowsiness
- Slurred speech
4
Q
What are physical effects of opiate use?
A
- Respiratory depression
- Hypoxia
- Reduced BP
- Hypothermia
- Coma
- Pupillary constriction
5
Q
What are symptoms and signs shown in withdrawal state for Opiates?
A
- Craving
- Rhinorrhoea
- Lacrimation
- Myalgia
- Abdominal cramps
- Nausea and vomiting
- Diarrhoea
- Pupillary dilatation
- Piloerection
- Increase heart rate or blood pressure
6
Q
What are examples of routes for Cannabinoids?
A
- Cannabis (PO, IV)
7
Q
What are psychological effects of Cannabinoids?
A
- Euphoria
- Disinhibition
- Agitation
- Paranoid ideation
- Temporal slowing
- Impaired judgement/attention/reactions time
- Illusions
- Hallucinations
8
Q
What are physical effects of Cannabinoids?
A
- Increased appetite
- Dry mouth
- Conjunctival injection
- Increased heart rate
9
Q
What are symptoms and signs of the withdrawal state upon taking Cannabinoids?
A
- Anxiety
- Irritability
- Tremor of outstretched hands
- Sweating
- Myalgia
10
Q
What are symptoms and signs of the withdrawal state upon taking Sedatives-Hypnotics?
A
- Tremor of hands/tongue/eyelids
- Nausea and vomiting
- Increased heart rate
- Postural hypotension
- Headache, agitation
- Malaise
- Transient illusions/hallucinations
- Paranoid ideation
- Grand mal convulsions
11
Q
What are psychological effects of taking Sedatives-Hypnotics?
A
- Euphoria
- Disinhibition
- Apathy
- Aggression
- Anterograde amnesia
- Labile mood
12
Q
What are physical effects of taking Sedatives-Hypnotics?
A
- Unsteady gait
- Difficult standing
- Slurred speech
- Nystagmus
- Erythematous skin lesions
- Reduced blood pressure
- Hypothermia
- Depression of gag reflex
- Coma
13
Q
What are examples of Sedative-Hyponotics?
A
- Benzodiazepines (PO, IV)
- Barbiturates (PO, IV)
14
Q
What are examples of Stimulants?
A
- Cocaine, crack cocaine - IV, IN, Smoked
- Ecstasy - PO
- Amphetamine - PO, IV, IN, smoked
15
Q
What are psychological effects of Stimulants?
A
- Euphoria
- Increased energy
- Grandiose beliefs
- Aggression
- Argumentative
- Illusions
- Hallucinations (intact orientation)
- Paranoid ideation
- Labile mood
16
Q
What are physical effects of Stimulants?
A
- Increase HR
- Increased BP
- Arrythmias
- Sweating
- Nausea and vomiting
- Pupillary dilatation
- Psychomotor, agitation
- Muscular weakness
- Chest pain
- Convulsions
17
Q
What are signs and symtpoms of withdrawal states upon taking Stimulants?
A
- Dysphoric mood
- Lethargy
- Psychomotor agitation
- Cravings
- Increase appetite
- Insomnia
- Bizarre/unpleasant dreams
18
Q
What are examples of Hallucinogens?
A
Per Oral
- LSD
- Magic
- Mushrooms
19
Q
What are psychological effectis of Hallucinogens?
A
- Anxiety
- Illusions
- Hallucinations
- Depersonalisation
- Derealization
- Paranoia
- Ideas of reference
- Hyperactivity
- Impulsivity
- Inattention
20
Q
What are physical effects of Hallucinogens?
A
- Increased HR
- Palpitation
- Sweating
- Tremor
- Blurred vision
- Pupillary dilation
- Incoordination
21
Q
What are examples of Volatile Solvents?
A
Inhaled
- Aerosols
- Paint
- Glue
- Petrol
22
Q
What are the psychological effects of Volatile Solvents?
A
- Apathy
- Lethargy
- Aggression
- Impaired attention and judgement
- Psychomotor retardation
23
Q
What are the physical effects of Volatile Solvents?
A
- Unsteady gait
- Diplopia
- Nystagmus
- Decreased consciousness
- Muscle weakness
24
Q
What are examples of anabolic steroids?
A
Per oral and Intramuscular
- Testosterone
- Androstenedione
- Danazol
25
What are psychological effects of Anabolic Steroids?
* Euphoria
* Depression
* Aggression
* Hyperactivity
* Mood swings
* Hallucinations
* Delusions
26
What are physical effects of Anabolic Steroids?
* Increased muscle mass
* Reduced fat
* Acne
* Male pattern baldness
* Reduced sperm count
* Infertility
* Stunted growth
27
What is substance dependance?
***Substance dependence describes a syndrome including behavioural, physiological and psychological elements. Patients are physiologically dependent if they show tolerance or withdrawal.***
* _**≥ 3 of the following manifestations** must have occurred over 1 month_:
* (1) Strong Desire (compulsion) to consume substance
* (2) Preoccupation with substance use
* (3) Withdrawal state when substance ingestion is reduced or stopped
* (4) Impaired ability to control substance-taking behaviour (e.g. onset, termination or level of use)
* (5) Tolerance to substance. More consumption for desired effect.
* (6) Persisting with use, despite clear evidence of the Harmful effects
28
What are investigations for Substance abuse?
* **Bloods:** HIV screen, HEP B, HEP C, Tuberculosis testing, U&Es to check renal function, LFTs and clotting for hepatic function or Drug levels
* **Urinalysis:** drug metabolites detected in urine
* **ECG** **for** arrhythmia
* **Echo if** endocarditis
29
What are steps taken to manage patient generally in substance abuse?
* Hep B immunization for those at risk
* Motivational interviewing to help with controlling substance misuse and CBT may be offered. Contingency management which focuses on changing specified behaviours for positive behaviours
* Supportive help can be in housing, finance and employment. Help with co-exiting alcohol misuse and smoking cessation. Self-help groups useful. Consider issue of driving as well.
* Detoxification is a process which effects of drug are eliminated in a safe manner such that withdrawal symptoms are avoided in an attempt to attain abstinences. In maintenance therapy, abstinence is not priority rather the aim is minimisation of harm
30
How is Opoid dependance managed?
* **Methadone or buprenorphine** for detoxification
* **Naltrexone** is recommended for those who were former opioid dependant but have now stopped and are motivated to continue abstinence
* **Intravenous naloxone** used for antidote to opioid overdose
31
What are some complications of substance misuse?
* **Physical:** death, infections (HIV, HEP B, HEP A, HEP C, staph aureus, group A strep, clostridium difficile, TB), endocarditis, superficial thrombosis, DVT, PE
* **Psychological:** craving, anxiety, cognitive disturbance, drug-induced psychosis
* **Social:** crime, prison, homelessness, prostitution, relationship problems
