Substance Missuse And Alcohol Dependance

Question 1

Opiates are mostly injected and proportion smokes
Poly substance use is common
Addictive nature
Opiates normally include production of analgesia, attention memory and appetitive regulation

Taking opiates cause what affects

Answer 1

Pain relief
Drowsy
Euphoria
Sedation

Question 2

Acute consequences of opiates causes respiratory depression what is the chronic consequence

Answer 2

Activities to fund them

Blood borne viruses
Neurological neuropathy and meningitis
Aspiration pneumonia from the smoke

Question 3

Acute respiratory depression treatment

Answer 3

Naloxone - opiate receptor antagonist

Question 4

What is acute respiratory depression

Question 5

Opiate withdrawal is not life threatening and is causes by sympathetic overdrive what are th symptoms

Answer 5

Dilated pupils
Abdo cramps and sweating
Piloercetion and shivering

Distress
Agitated and craving

Question 6

What do you use to treat opiate withdrawal
Short for symptoms and long term for stabilisation

Answer 6

Manage symptoms with adrenegeic over activity such as lofexidine alpha 2 agonist

Longer term methadone for stabilisation

Question 7

What is methadone

Answer 7

Slow acting opiate against
Slow onset and offset
Start low and gradually titration
Dispensed daily
Can cause depression if given at a too high level

Question 8

Buprenorphine

Answer 8

Partial opiate agonist called subutex
High risk of abuse - suboxone in combo with naloxone
Safer less chance of resp depression

Question 9

Abstinence based treatment

Answer 9

Methadone or buprenophine
Naltrexone - long acting competitive antagonist of opioid
Social and psych detox
High risk of death in failed detox situations

Question 10

What receptors do alcohol work on like benzos

Answer 10

GABA rector agonist - inhibits the CNS

Question 11

Current recommendation of alcohol per week

Answer 11

14 units per week

Question 12

Screen questions for alcohol

Answer 12

CAGE
HAVE YOU EVER FELT NEED TO CUT DOWN
HABE YOU EVER FELT ANNOYED BEING CRITISEX ANOUT DRINKING
GUILTY
EYE OPENER TO HAVE DRINK IN MORNING

Question 13

Symptoms and effect or alcohol

Answer 13

Memory loss, mood swing and dementia
Bleeding esophaeal varies
Breathing difficulties and lower level of nitric oxide
Swollen liver, cirrhosis and hepatitis
Irregular HR strokes and high BP
muscle weakness and wasting
Pancreatitis
Stomach ulcers, chronic gastritis and vomiting

Question 14

Alcohol psych and neurological problems

Answer 14

Depression and anxiety as psychiatric co morbidity
Pathology jealously and hallucinations

Cognitive impairments and dementia include
Wernickes and korsakoffs
Peripheral neuropathy
Increased risk of subdural haematomoas

Question 15

Signs of acute alcohol withdrawal 24-48hr

Answer 15

Fine tremor
Sympathetic overdrive - tachycardia for example
Agitation
May progress to delirium tremens

Question 16

Delirium tremens sx

Answer 16

Visual hallucinations
24-48hr after drink
Myoclonus jerks and seizures
Can be life threatening
High risk of reoffending in hospital - neglection of diet - if they start consuming normal diet body can quickly switch back producing lots of insulin and electrolytes driven into cells causing abnormalities

Question 17

What is wernickes encephalopahty

Symptoms as well

Answer 17

Thiamine b1 deficiency
Mammillary cerebellar bodies

Sx
Triad
Acute confusion
Ataxia
Opthalmoplegia - paralysis of ocular muscles

Question 18

Werncikes can go to irreversible korsakoffs what is it

Answer 18

Chronic amnestied syndrome as a consequence
Confabulation - they believe it but it’s defo not true - not aware they are confabulating
Unable to lay down me memory

High personal and social care costs associated with disease

Question 19

Treating acute alcohol withdrawal

What do you do

Answer 19

Supportive treatment , fluid resus and monitor glucose ( refeeding syndrome)
Benzodiazepines cover - diazepam or chlordiazepoxide
Vitamin cover - parbinex IM- vit B1 ) Before feeding or giving IV glucose

Question 20

What investigations would you do for alcohol abuse

Answer 20

FBC, UE , LFT, COAGUALTION PROFILE , B12 Folatw and ferritin
Us liver
Ascetic tap
CT HEAD and abdo imaging

Question 21

Treating long term alcohol dependence

Answer 21

Psychological and social preparation for detox like reviewing social setting
Then offer the detox in a planned way

AA
Local alcohol services