Substance Disorders Flashcards
Symptoms of alcohol withdrawal
CNS feature - Anxiety, Tremor, Sweating, agitation, and distractibility
Nausea
Vomiting
Tonic clonic seizure
Headache
Severe withdrawal - DT - hyperactivity, fluctuating confusion, paranoid ideation and visual hallucination.
Coarse of alcohol withdrawal
Symptoms start within 6 to 24 HR of last drink
Can seizure or delirium
Duration 72hr to several weeks
Ix for alcohol withdrawal
LFT - GGT
FBC - MCV
Creatinine
Electrolytes
Mx for alcohol withdrawal - short term
Supportive care - education, reassurance, monitoring and low stimulus environment.
Alcohol withdrawal chart - CIWA-AR or AWS
Med - Benzodiazepine Iv or Oral, 20mg PO PRN 2hourly until symptoms resolve (max of 100mg
- Thiamine PO, IM, IV 100-300mg for 3-5 days
Mx of Alcohol withdrawal Long term
Diazepam for 2-7 days if symptoms return
Thiamine 300mg orally for several weeks.
ATODS
Areas looked at in the CIWA-AR and scoring system
Nausea and vomiting Tremor Paroxysmal sweats Anxiety Agitation Tactile disturbances Visual disturbances Headaches, fullness in head Orientation and clouding of sensorium Total out of 67 with 20 Severe.
Alcohol intoxication
Depressed conscious level - stupor to coma
Ataxia
Respiratory depression
Risk of inhalation of vomit and asphyxiation
Death if BAC above 0.4g
Condition due to alcohol abuse
Alcoholic liver disease - fatty liver, alcoholic hepatitis or cirrhosis.
- Fatty liver - a symptomatic to abdo pain and vomiting
- Alcoholic hepatitis - jaundice, fever, R sided abdo pain, sometimes as cites
- Cirrhosis - non specific GI symptoms and as cite, encephalopathy or varicella haemorrhages
Alcoholic pancreatitis - acute: epigastric pain, nausea, vomiting and hypotension to renal failure. Chronic: chronic upper abdominal pain and wt loss, exocrine deficiency eg steatorhoea, Diabetes.
Gastritis and peptic ulcer
GI cancers
CVS - Cardiomyopathy, arrhythmia, HTN,
Resp - aspiration pneumonia and lobar pneumonia
Musculoskeletal - acute myopathy, acute rhabdomyolysis, Osteoporosis, GOUT.
Endo - pseudo Cushing, Gonadal atrophy - sexual issues
Haem- Macrocytosis (folate deficiency), thrombocytopenia (marrow toxicity and hypersplenism)
Brain - Wernicke-Korsakoff syndrome - Thiamine deficiency. Short term memory defective but preserved immediate recal and remote memory. Frontal lobe syndrome, Cerebellar atrophy - ataxia and gait,
Stroke - Haemorrhage or thrombotic
Peripheral neuropathy - Numbness, dysaesthesiae and paraesthesiae in a glove and stocking distribution or weakness of proximal or distal muscle groups,
Trauma
Fetal alcohol syndrome - Characteristic faces - depressed nasal bridge, thinning upper lip and low set ear. Intellectual and cardiac defects.
Wernicke’s
Ataxia affecting gait
Vestibular dysfunction
Confusion
Ocular motility abnormalities - horizontal nystagmus, lateral orbital palsy and gaze palsy
Sluggish reaction to light and anisocoria
Tx
IV thiamine
Cx
Korsakoff’s - amnestied syndrome - impaired mental syndrome esp recent memory, and anterograde amnesia in an alert and responsive patient. May have confabulation
Cerebellar examination
Gait- walk, heel-toe walking, Romberg’s test
Speech - “West register street”, “British Constitution”, Ataxic dysarthria or staccato speech.
Nystagmus - Horzontial jerking to the side of lesion
Coordination- Hand - finger to nose, rebound, Pronator drift. Legs: Heel-shin, foot tapping, toe-finger.
Truncal Ataxia
Knee reflexes.
Symptoms and signs of Opiod overdose
Decreased pain perception, sedation, decreased sex drive, nausea/vomiting, decreased GI motility (constipation and anorexia), and respiratory depression
typical syndrome includes shallow respirations, miosis, bradycardia, hypothermia, decreased level of consciousness
Tx of Opioid overdose
ABCs
IV glucose
naloxone hydrochloride (Narcan®): 0.4 mg up to 2 mg IV for diagnosis
treatment: intubation and mechanical ventilation, ± naloxone drip, until patient alert
without naloxone (up to >48 h with long-acting opioids)
• caution with longer half-life; may need to observe for toxic reaction for at least 24 h
Withdrawal of opioids
symptoms: depression, insomnia, drug-craving, myalgias, nausea, chills, autonomic instability (lacrimation, rhinorrhea, piloerection)
• onset: 6-12 h; duration: 5-10 d
• complications: loss of tolerance (overdose on relapse), miscarriage, premature labour
• management: long-acting oral opioids (methadone, buprenorphine), α-adrenergic agonists
(clonidine)
Tx of opioid use disorder
Methadone
Buprenorphine
Scoring system for cirrohosis
Child pugh score Based on Albumin Bilirubin INR Ascites Encephalopathy
