Substance Missuse And Alcohol Dependance Flashcards
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
Pain relief
Drowsy
Euphoria
Sedation
Acute consequences of opiates causes respiratory depression what is the chronic consequence
Activities to fund them
Blood borne viruses
Neurological neuropathy and meningitis
Aspiration pneumonia from the smoke
Acute respiratory depression treatment
Naloxone - opiate receptor antagonist
What is acute respiratory depression
Opiate withdrawal is not life threatening and is causes by sympathetic overdrive what are th symptoms
Dilated pupils
Abdo cramps and sweating
Piloercetion and shivering
Distress
Agitated and craving
What do you use to treat opiate withdrawal
Short for symptoms and long term for stabilisation
Manage symptoms with adrenegeic over activity such as lofexidine alpha 2 agonist
Longer term methadone for stabilisation
What is methadone
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
Buprenorphine
Partial opiate agonist called subutex
High risk of abuse - suboxone in combo with naloxone
Safer less chance of resp depression
Abstinence based treatment
Methadone or buprenophine
Naltrexone - long acting competitive antagonist of opioid
Social and psych detox
High risk of death in failed detox situations
What receptors do alcohol work on like benzos
GABA rector agonist - inhibits the CNS
Current recommendation of alcohol per week
14 units per week
Screen questions for alcohol
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
Symptoms and effect or alcohol
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
Alcohol psych and neurological problems
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
Signs of acute alcohol withdrawal 24-48hr
Fine tremor
Sympathetic overdrive - tachycardia for example
Agitation
May progress to delirium tremens
Delirium tremens sx
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
What is wernickes encephalopahty
Symptoms as well
Thiamine b1 deficiency
Mammillary cerebellar bodies
Sx
Triad
Acute confusion
Ataxia
Opthalmoplegia - paralysis of ocular muscles
Werncikes can go to irreversible korsakoffs what is it
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
Treating acute alcohol withdrawal
What do you do
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
What investigations would you do for alcohol abuse
FBC, UE , LFT, COAGUALTION PROFILE , B12 Folatw and ferritin
Us liver
Ascetic tap
CT HEAD and abdo imaging
Treating long term alcohol dependence
Psychological and social preparation for detox like reviewing social setting
Then offer the detox in a planned way
AA
Local alcohol services
