Substance misuse Flashcards
What are the disorders of substance abuse?
- Acute intoxication
- Harmful use
- Dependence syndrome
- w drawal state
- w drawal state w delirium
- Psychotic disorder
- Amnesic disorder
What are the features of opiate w drawal?
- Agitation, anxiety
- Muscle aches and cramps, chills
- Runny eyes and nose, sweating
- Yawning and insomnia
- GI upset
- Dilated pupils
- Increased HR and BP
- Sx start 12 hours after stopping the drug
- Unpleasant but not life threatening
How do you manage opioid detox?
- Sx resolve by themselves
- Methadone (full agonist)/buprenorphine (partial agonist) is 1st line dep on preference
- Can use lofexidine in mild dependence
How is opioid tolerance managed?
Substitute prescribing - prevents risk of overdose, BBV and offending.
Daily prescriptions of methadone or buprenorphine w supervised consumption.
How do you treat opioid overdose?
Naloxone
Methadone vs buprenorphine
Methadone - higher risk of overdose, highest in first 2 weeks
Buprenorphine - lower risk of overdose, better for pt w less tolerance, higher risk of misuse by injection or intranasal
What substances are commonly misused?
- Opiates eg. heroin (injection), codeine, prescription opioids
- Alcohol
- Cannabis (smoke)
- CNS depressants - benzos
- Stimulants - cocaine, methamphetamine (any method)
- Hallucinogens - LSD (swolled)
- Ketamine and MDMA
- Prescription drugs - opioids, pregabalin, gabapentin, benzos, GHB
What are the toxic effects of opiate intoxication?
Drowsy and confused
Decreased RR - resp depression - cause of death in overdose
Decreased HR
Constricted pupils
Euphoria and sedation
Acts of opioid receptors
What are the effects of cannabis intoxication?
Drowsy, impaired memory, slow reflexes and motor skills
Increased HR and paranoia
Can induce psychosis, insomnia, hallucinations, schizophrenia
Acts on cannabidoid receptors
What are the CF of LSD intoxication?
Labile mood
Hallucinations
Increased BP, HR and temp
Sweat, insomnia, dry mouth, nausea
Not good if mental health problems, can make them worse
Acts on dopamine receptors
What are the CF of stimulant intoxication?
Increased BP, HR and temp - risk of palpitations and cardiac arrest
Meth can induce psychosis
Euphoria
Increase dopamine in the brain.
How can you assess alcohol dependency syndrome?
CAGE tool, alcoholism likely if yes to two qs
Cut down?
Annoyed? when people criticise your drinking
Guilty? about drinking
Eye opener? - drinking first thing in morning
What are CF of alcohol dependency?
- Desire for alcohol
- Out of control drinking
- Needing increasing amounts of alcohol
- W drawal sx if don’t drink
- Having little interest in other leisure activities
- Cont to drink even when it is clear harm is caused
What is the treatment for harmful drinking and alcohol dependence?
Mild - CBT, behavioural therapies, social network
Severe - successful w drawal first then can consider acamprosate or naltrexone, alcohol misuse CBT, AA
Comorbid depression or anxiety - treat alcohol misuse first, then consider treatment for depression and anxiety
What are the bio treatments of alcohol dependence?
- Acamprosate and naltrexone prevent relapse
- Disulfiram - causes bad hangover sx when drink alcohol to put off drinking = prevents breakdown of alcohol = acetaldehyde builds up
- Nalmefene - prevents dopamine release when drinking alcohol, reduced pleasure from drinking = reduced desire
What are the different stages of alcohol w drawal?
Simple w drawal - 6-12 hours after last drink
Alcohol hallucinosis - 12-24 hours later - tactile, visual and auditory hallucinations
Delerium tremens - 72 hours later
What are the CF of simple alcohol w drawal?
- Insomnia
- Tremor
- Anxiety and agitation
- N+V
- Sweat
- Palpitations
- Craving alcohol
What are the CF of delerium tremens?
Medical emergency
- Delusions
- Confusion and severe agitation
- Seizures - tonic clonic
- Tachycardia, HTN, hyperthermia, SOB, ataxia
- Alt mental status
What are the indications for admitting a pt w alcohol w drawal?
- > 30 units per day
- > 30 on SADQ score
- High risk of alcohol w drawal seizures - prev hx or epilepsy
- Concurrent w drawal from benzos
- Medical or psych comorbidity
- Vulnerable pt eg. live alone
- <18 years old
What is the management of acute alcohol w drawal?
- Benzos - eg. reducing dose of chlordiazepoxide over 5-7 days or diazepam, stop once detox complete
- Thiamine to prevent Wenicke’s encephalopathy - pabrinex IM or IV as oral thiamine poorly absorbed in dep drinkers
What is the management of delirium tremens?
- Always inpt, may need ICU
- AtoE assessment
- Treat hypoglycaemia
- Sedation w benzos - diazepam or lorazepam
- IV Pabrinex (at least 2 pairs of ampoules) TDS for 3 days in Wernicke’s
