Substance Misuse Flashcards
Which scoring system is used to asses alcohol withdrawal severity?
Clinical institute withdrawal assessment (CIWA-Ar).
Which screening tools are used to identify patients who maybe have alcohol misuse problems?
Alcohol use disorders identification test (AUDIT).
CAGE questionnaire.
What are the clinical features of Wernicke’s encephalopathy?
Ophthalmoplegia, nystagmus, confusion and ataxia.
What is the link between Wernicke’s encephalopathy and Korsakoff’s syndrome?
Korsakoff’s syndrome is a complication of untreated Wernicke’s encephalopathy.
Wernicke’s encephalopathy should be treated with thiamine to prevent this.
What are the clinical features of Korsakoff’s syndrome?
Anterograde amnesia, retrograde amnesia, confabulation.
What is the first line treatment of delirium tremens and to prevent further seizures?
Chlordiazepoxide.
When is the peak incidence of seizures following alcohol withdrawal?
36 hours.
When is the peak incidence of delirium tremens after alcohol withdrawal?
72 hours.
When do alcohol withdrawal symptoms occur?
6-12 hours after last drink.
Define acute intoxication
Transient condition following the administration of alcohol or other psychoactive substance, resulting in disturbance in level of consciousness, cognition, perception, affect or behaviour.
What is the recommended alcohol intake?
No more than 14 units per week, spread across 3 days or more.
What is FRAMES in summarising the components of a brief intervention?
Feedback - on clients risk of having alcohol problems.
Responsibility - change the clients responsibility.
Advice - provision of clear advice when requested.
Menu - what are the options for change?
Empathy - warm, reflective and understanding approach.
Self-efficacy - optimism about the behaviour change.
Define binge drinking
A heavy drinking session in which someone drinks a lot of alcohol in a short period of time raising their risk of harm on that occasion. More than 6 units in a single session for females and more than 8 units in a single session for males.
What makes a substance addictive?
Pleasure producing potency, rapid onset of action, short duration of action, tolerance and withdrawal.
Addictive drugs lead to increased dopamine levels in which part of the brain?
Nucleus accumbens.
Which neurotransmitters have a role in the reinforcing effects of alcohol?
Dopamine, serotonin, GABA.
What is buprenorphine?
Mixed opioid agonist/antagonist given as a sublingual tablet and provided an alternative opiate replacement theroay to methadone. Less sedating.
What is chlordiazepoxide?
Benzodiazepines used as part of a reducing regime during alcohol detoxification.
What is methadone?
Mu opioid receptor agonist used in opiate replacement therapy.
What is naltrexone?
Opioid receptor antagonist used in relapse prevention (opioid and alcohol dependence).
Wernicke-Korsakoff syndrome results from a deficiency of what?
Thiamine (vitamin B1).
Where is thiamine stored?
Liver
Define addiction
Physically and mentally dependent on a substance. A persistent and intense urge to use a substance despite its negative consequences.
Name some screening tools for substance misuse
AUDIT (alcohol use disorders identification test).
DAST (drug abuse screening test).
DAST-A (drug abuse screening test for adolescents).
How long for a diagnosis of harmful/dependence?
Around 12 months.
A hazardous drinker has an AUDIT score of?
8-15
A harmful drinker has an AUDIT score of?
16-19
A dependent drinker has an AUDIT score of?
20+
Name the blood markers for excess alcohol use
Gamma GT (GGT) - raised.
LTFs - ALT (raised), ALP (raised), bilirubin (raised), albumin (reduced).
CDT - raised.
MCV - raised.
Clotting - raised prothrombin time (impaired clotting).
Is chlordiazepoxide long- or short-acting?
Long-acting benzodiazepine.
Name a short-acting benzodiazepine
Lorazepam
What is the treatment for an opioid overdose?
Naloxone
Which screening tool is used to assess alcohol dependence?
SADQ (severity of alcohol dependence) or LDQ (Leeds dependence questionnaire).
What is hazardous use?
Substance use that increases someone’s risk of harm.
What is harmful use?
Substance use that causes damage to health or harm to others.
What is the criteria for dependence?
String desire to take the drug.
Difficulties in controlling its use.
Persisting in its use despite harmful consequences.
Higher priority given to drug use than to other activities.
Increased tolerance.
Withdrawal symptoms.
Which neurotransmitter controls pleasure and reward?
Dopamine
List some risk factors for substance misuse
FHx or addiction, socioeconomic deprivation, homelessness, unemployment, male (illegal drugs), poor mental health.
Describe the impacts of addiction
Individual: mental health, physical health, financial, injuries at work, use in pregnancy.
Interpersonal: affects relationships and families, childhood abuse.
Community/societal: crime, violence, assault, drink driving, cost to NHS.
What is the role of health promotion?
Increases awareness of risky behaviours in order to promote change and improve health.
What are the 6 stages of the cycle of change?
Pre-contemplation, contemplation, preparation, action, maintenance, relapse.
What is the role of motivational interviewing?
Evokes own motivation for change via self-efficacy and autonomy in decision making.
Which substance is associated with the most deaths?
Tobacco
How would you test for drugs in a persons system?
Urine drug test.
Chronic alcohol consumption enhances which neurotransmitter?
GABA mediated inhibition.
What are the clinical features of alcohol withdrawal symptoms?
Tremor, sweating, tachycardia, anxiety.
Describe the symptoms of delirium tremens
Coarse tremor, confusion, visual hallucinations, delusions, fever, tachycardia.
How do you calculate alcohol units?
Volume (L) x ABV (%)
What is the detoxification treatment for chronic alcoholism?
Chlordiazepoxide.
What is acamprostate?
Anti-craving medication used in alcohol relapse prevention. Decreases excitatory neurotransmitters and enhances GABA transmission. Safe in combination with alcohol.
What is buspirone?
5-HT agonist used in alcohol relapse prevention.
What is disulfiram?
It is an irreversible inhibitor of acetaldehyde dehydrogenase, so it prevents breakdown of acetaldehyde to acetate. Therefore if alcohol is drunk it causes unpleasant side effects such as facial flushing, nausea and vomiting. It is used in alcohol relapse prevention.
What is the management of Wernicke’s encephalopathy?
IV pabrinex (thiamine replacement).
Electrolyte abnormalities seen in alcoholics?
Hypomagnesaemia
