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YEAR 4 MENTAL HEALTH > Substance misuse > Flashcards

Substance misuse Flashcards

1
Q

Name substances commonly misused

A

Opiates - heroin
Cannabis
LSD
Amphetamines - cocaine and meth
Nitrous oxide
GHB
Alcohol
Benzodiazepines
Anabolic steriods

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2
Q

Route of administration of cocaine?

A

Snorted (powder)
Smoked (crack cocaine)

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3
Q

Route of administration of heroin?

A
  • ** injecting** either into a vein (“mainlining,” intravenous or IV use), into a muscle (intramuscular or IM use) or under the skin (“skin-popping” or subcutaneous use)
  • **snorting **the powder through the nose (also called sniffing)
  • inhaling or smoking (“chasing the dragon”), which involves gently heating the heroin on aluminum foil and inhaling the smoke and vapours through a tube.
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4
Q

Route of administration of cannabis?

A

Inhalation
Smoked - as shatter
Edibles

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5
Q

Route of administration of LSD?

A

Submucosal - on blotter paper which is put under tongue to be absorbed via mucous membranes

Injected - rarely done

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6
Q

Route of administration of nitrous oxide?

A

Inhaled

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7
Q

Route of administration of anabolic steriods?

A

Anabolic steroids come in the form of tablets, capsules, a solution for injection and a cream or gel to rub into the skin

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8
Q

Route of administration of GHB/GBL?

A

It is usually sold as a liquid in small vials.
GHB is also available as a white powder or capsule.

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9
Q

Why might a person have an addiction problem/ substance misuse issue?

A
  • Genetic
  • Neurobiological - related to dopamine receptors
  • Social - being in social settings where drugs are
  • Behavioural - pt drug use provides a high, which is like a reward.
  • Attachment - (from lecture speaker) neglect as a child led to reduced dopamine in brain, so drugs can satisfy this ‘deficiency’
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10
Q

What should you ask in Hx of pt presenting with substance misues

A
  • What drug
  • How long have you had it? (when did they 1st try it? when did it become a problem?)
  • How much? (in money terms, e.g. how much are you spending on this per day/week?)
  • How often are you taking it?
  • Withdrawal - what happens if you don’t have it?
  • Previous treatment episodes - what was it?
  • Complications to drug/ treatment?
  • Overdose - what happened? What did they do at the hospital?
  • BBV - have they been tested for HIv, HepB, HepC. Are vaccinations up to date?
  • PMHx
  • Social Hx - especially housing and support
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11
Q

How can alcohol (addiction/misuse) lead to mortality?

A
  • fights and falls - head injuries
  • liver failure
  • pancreatiitis
  • overdose –> vomit –> aspiration and choking
  • withdrawal
  • Wernike’s encephalopathy
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12
Q

How are units of alcohol calculated?

A

% alcohol X volume (ml)
then divide by 1000

For example, to work out the number of units in a pint (568ml) of strong lager (ABV 5.2%): 5.2 (%) x 568 (ml) ÷ 1,000 = 2.95 units.

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13
Q

Clincal features of alcohol intoxication?

A

Early:
* flushed skin
* impaired judgment
* reduced inhibition.

Late:
* impaired attention
* reduced muscle control
* slowed reflexes
* staggering gait
* slurred speech
* double or blurred vision.

then…
* black out
* inability to stand
* vomiting
* unresponsivness
* coma and death

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14
Q

Features of early alcohol withdrawal?

A

These symptoms start at 6-12 hours: Tremor
Nausea
Sweating
Anxiety
Tachycardia

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15
Q

Late clinical features of alcohol withdrawal?

A

At around 36hrs withdrawal: can get seizures

These usually happen at 48-72hours from withdrawal:
Delirium tremens
Disorientation/confusion
Hallucination (visual +auditory)
Coarse tremor
BP, tachycardia, fever, motor incoordination

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16
Q

How is alcohol withdrawal managed?

A

If have later features (delirium tremens, seizures, blackouts) = need to be admitted to hospital for monitoring until withdrawals stabilised.
1st line =long acting benzodiazepines e.g. chlordiazepoxide or diazepam. Given as part of a reducing dose protocol
Carbamazepine can also be effective.

+ high strength regular vitamin B replacement e.g. IM or IV

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17
Q

Clinical featurs of opiod misuse?

A
  • not much !
  • decreased consciousness

O/E:
- decreased RR
- decreased HR
- pin point pupils

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18
Q

Complications of opiod misuse (passmed)

A
  • viral infection secondary to sharing needles: HIV, hepatitis B & C
  • bacterial infection secondary to injection: infective endocarditis, septic arthritis, septicaemia, necrotising fasciitis
  • venous thromboembolism
  • overdose may lead to respiratory depression and death
  • psychological problems: craving
  • social problems: crime, prostitution, homelessness
19
Q

Emergency management of an opiod overdose?

A

A-E assessment
IM (or IV) naloxone - has a rapid onset and relatively short duration of action

20
Q

What interventions could you apply to reduce harm reduction in an IV drug user?

A

Needle exchange
Offer testing for HIV, Hep B and Hep C

21
Q

Management of opiod dependence?

passmed

A
  • patients are usually managed by specialist drug dependence clinics although some GPs with a specialist interest offer similar services
  • patients may be offered maintenance therapy or detoxification
  • NICE recommend methadone or buprenorphine as the first-line treatment in opioid detoxification
  • compliance is monitored using urinalysis
22
Q

Clinical features of cannabis intoxication/misuse?

A
  • drowsiness
  • impaired memory
  • slowed reflexes and motor skills
  • bloodshot eyes
  • increased appetite
  • dry mouth
  • increased HR
  • Paranoia
23
Q

Use of what drug can lead to psychosis?

A

Cannabis

24
Q

Clinical features of LSD intoxication?

A
  • labile mood
  • hallucinations
  • sweating
  • insomnia
  • dry mouth

Beside tests could show:
* increased BP
* increased HR
* increased temp

25
Q

What condition do we worry about in patients with alcohol dependence?

A

Wernicke’s encephalopathy
which can progress to Korsakoff’s syndrome

26
Q

What symptoms are present in early opiate withdrawal (the first 12hours)?

A
  • Sweaty, clammy skin
  • persistant yawning
  • rhinorrhoea
  • tachycardia
  • restlessness
  • dilated pupils
  • lacrimation
  • goosebumps
27
Q

What are symptoms of late opiate withdrawal (days 2-3)?

A
  • N+V
  • diarrhoea
  • insomnia
  • abdo cramps
  • muscle pains
28
Q

What are the benefits of methadone for pts who have opiate substance misuse?

A

Saves lives
Less addictive
Allows people to move on, get support and therapy

29
Q

What two drugs can be offered for opiod detoxification?

A

Methadone
Buprenorphine

30
Q

How does buprenorphine work in heroin detoxification?

(ICPP)

A
  • It is a partial agonist (aka mixed agonist-antagonist)
  • It has a higher affinity for receptors compared to heroin, so herion will be unable to access all the receptors.
  • this allows a more controlled response
31
Q

What are the clinical features of stimulant intoxication (cocaine, methamphetamine)?

A
  • euphoria
  • increased BP
  • increased HR
  • increased temp

for cocaine (pass med) - agitation, psychosis, hallucinations

32
Q

Mechanism of action of cocaine?

A

Blocks the re-uptake of dopamine, noradrenaline and serotonin
So these remain in blood for longer = pleasurable effects

33
Q

What are cardiovascular effects of cocaine?

A
  • Coronary artery spasm –> lead to MI
  • Tachycardia or bradycardia
  • HTN
  • On ECG: QRS widening and QT prolongation
  • Aortic dissection
34
Q

What are neurological effects of cocaine?

A
  • seizures
  • mydriasis
  • hypertonia
  • hyperreflexia
    aneurysmal subarachnoid haemorrhage
35
Q

What is the management of cocaine toxicity?

A
  • 1st line: Benzodiazepines
  • for chest pain - benzo + glyceryl trinitrate. If MI develops - need primary percutaneous coronary intervention
  • for HTN - benzo + sodium nitroprusside
36
Q

Mechanism of action of benzodiazepines?

A

Enhance effect of inhibitory neurotransmitter GABA by increasing the frequency of chloride channels.

37
Q
  1. How long should benzos be prescribed for?
  2. If a pt is on benzos, how should they be withdrawn?
A
  1. 2-4 weeks max
  2. withdrawn in steps based on the daily dose every fortnight.
38
Q

What is the risk of withdrawing from benzodiazepines too quickly?

A

Pt may experience benzodiazepine withdrawal syndrome

39
Q

What are features of benzodiazepine withdrawal syndrome?

A
  • Seizures
  • insomnia
  • irritability
  • anxiety
  • tremor
  • loss of appetite
  • tinnitus
  • perspiration
  • perceptual disturbances
40
Q

Who is at risk of substance misuse?

A
  • people with MH problems
  • sexually assulted / exploited
  • commercial sex work
  • unemployed
  • children who live in families who use drugs
  • homeless/ supported accomm or hostels
  • people who attend nightclubs/festivals
  • gyms - performance enhancing drugs
  • low socioeconomic background

from passmed

40
Q

How is alcohol dependence managed?

A
  • need oral thiamine
  • benzodiazepines for acute withdrawal
  • disulfram - promotes abstienence
  • acamprosate - reduces craving.

from passmed

41
Q

How long does detoxification last for substance misuse?

A

Up to 4 weeks in an inpatient/residential setting
Up to 12 weeks in the community

42
Q

What are social management options for someone who has substance misuse? (i.e. what could you implement regarding their social circumstances)

A
  • Appts / routine contact for needle exchange and offer testing for BBV
  • social support for housing
  • financial support

add any others if you find them

43
Q

What are psychological management options for someone with substance misuse?

A

Behavioural therapy
Behavioural family interventions
CBT
Motivational interviewing (?)
Group based talking therapies
Self help guides/ self help groups - e.g. Narcotics Anonymous

YEAR 4 MENTAL HEALTH (16 decks)

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