substance misuse Flashcards
alcohol intake men and women
14 units a week spread evenly over 3+ days
how is units calculated
milimeters x ABV/ 1000
what is a binge
8 units in one sitting for men and 6 for women
what is hazardous drinking
8-14 units a week / not impacting life
what is harmful drinking
15+ units / harmful to help
mechanism of alcohol withdrawal
alcohol enhances GABA (inhibitory pathway) and inhibits NMDA (excitatory pathway) // so withdrawal is opposite (decreased GABA and increased NMDA)
when do withdrawal alcohol symptoms occur
6-12 hours after last drink
symptoms alcohol withdrawal
tremor, sweating, tachycardia, anxiety
peak incidence seizures alcohol withdrawal
36 hours
when does delirium tremens occur
48-72 hours
symptoms delirium tremens
coarse tremor, confused, delusions, hallucinations, fever, tachy
1st line mx alcohol withdrawal
decreasing dose of long acting benzos eg chlordiazepoxide or diazepam
mx alcohol withdrawal if hepatic failure
lorazepam
what AED can be used in alcohol withdrawal
carbamazepine
questionnaires to assess drinking
CAGE (cut down? annoyed? guilty? ever drink for neves?) // audit (20+)
what supplement should all alcoholics take
thiamine
meds to help alcoholics cut down
disulfram (makes hangovers horrific) // acamprosate (reduces cravings)
what causes wernickes
thiamine deficiency –> petechial haemorrhages in brain
triad of wernickes
opthalmoplegia/ nystagmus, ataxia, encephalopathy // (+ peripheral sensory neuropathy)
invx wernickes
decreased red cell transketolase // MRI
mx Wernickes
thiamine
what can wernickes develop into
korsakoff
symptoms korsakoff
anterograde amnesia (cant make new memories), retrograde amnesia, confabulation
which part of brain is damaged in korsakoffs
mammillary bodies of hypothalamus and medial thalamus
symptoms opioid misuse
runny nose, needle tracks, pinpoint pupils, drowsy, watery eyes, yawning
complications opioid misuse
viral infection HIV, hep B+V // endocarditis, septic arthitis, nec fasc // VTE // resp depression // social problems
symptoms opioid overdose
pinpoint // low GCS // resp depression // hypotension + tachy
mx opioid overdose
IV or IM nalaxone (short duration)
mx opioid dependence
methadone or buprenorphine
how long should opioid detox last
4 weeks inpatient // 12 weeks community