Substance misuse Flashcards

1
Q

State the formula for working out the amount of unit of alcohol in a drink

A

ABV x volume (in mls) / 1000

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2
Q

Roughly state the definition of dependence syndrome from ICD-10

A

Cluster of physiological, behavioural, and cognitive phenomena, in which the use of a substance(s) has a much higher priority than other previously important values/behaviours

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3
Q

State the diagnostic features of dependence syndrome from ICD-10

A

Diagnosis if 3 or more have been present during previous year:

  • Strong desire to take the substance
  • Withdrawal state if reduced/stopped
  • Difficulties controlling substance-taking behaviour e.g. stopping
  • Evidence of tolerance
  • Neglect of alternative pleasures / interests because of psychoactive
    substance use
  • Persisting despite being aware of harmful consequences
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4
Q

State the name of the alcohol severity questionnaire and when should it be done

A

SADQ - severity of alcohol dependence questionnaire

Questionnaire should be done prior to detoxification treatment

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5
Q

State the 2 drugs that should be used in the process of alcohol withdrawal

A
  1. Chlordiazepoxide (benzodiazepine)
    Helps to reduce withdrawal symptoms
    Has low dependence-forming potential
  2. Pabrinex (Thiamine B1 replacement) if risk of Wernicke’s is high
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6
Q

State the recommended alcohol limits for men and women

A

Same for men and women now!

14 units per week - spread over 3 days or more

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7
Q

State some symptoms of acute alcohol withdrawal

A
  • Hand tremors
  • Sweating
  • Tachycardia
  • N&V
  • Headaches
  • Loss of appetite
  • Anxiety/depression
  • Irritability
  • Insomnia
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8
Q

State some illicit drugs that can induce a schizophrenic presentation

A
  • LSD
  • Ecstasy
  • Cocaine
  • Alcohol
  • Amphetamines
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9
Q

List some physical symptoms of opioid withdrawal

A

Unpleasant but mostly not life threatening

Symptoms can start within 6 hours, peaking at 36-72 hours
- Agitation / anxiety
- Insomnia
- Muscle aches / cramps
- Sweating
- Nausea & vomiting
- Diarrhoea
- Tachycardia
- Hypertension
- Dilated pupils

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10
Q

List some physical symptoms of opioid intoxication

A
  • Drowsiness
  • Confusion
  • Decreased respiratory rate
  • Decreased heart rate
  • Constricted pupils
  • Track marks / abscesses at injection sites
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11
Q

Outline management steps for opioid withdrawal (acute on ongoing)

A

Acute:
- Methadone
- Lofexidine (alpha-2 receptors, reduced noradrenaline release)
- Antiemetics (nausea)
- Loperamide (diarrhea)

Ongoing:
- Detox programmes
- Methadone and buprenorphine
- Relapse can be prevented using Naltrexone once detox is complete

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12
Q

Outline management steps for opioid overdose

A

Naloxone

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13
Q

Outline symptoms of alcohol intoxication

A
  • Ataxic gait
  • Slurred speech (dysarthria)
  • N&V
  • Reduced consciousness
  • Impaired judgement
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14
Q

Outline symptoms of alcohol withdrawal

A

Potentially life-threatening!

  • Anxiety / agitation
  • Tremor
  • Sweating
  • Headache
  • N&V
  • Clouding of consciousness
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15
Q

Outline how to manage acute alcohol intoxication

A

A-E approach
- Protection of airway if poor level of consciousness
- Cannula and fluids (also take alcohol blood levels)
- Antiemetics if vomiting

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16
Q

Outline how to manage acute alcohol withdrawal as well as a long term plan

A
  • Benzodiazepines e.g. Chlordiazepoxide (Librium) or Diazepam
  • IV Pabrinex (B vitamins, C vitamins and glucose)

Longer term:
- Referral to Turning Point
- Continue long acting Benzodiazepine
- Continue on Thiamine

17
Q

Outline some specific (characteristic) symptoms of delirium tremens

A

Life threatening medical emergency
Usually occurs at day 3 of withdrawal (lasting 3 days)

  • Classically tactile hallucinations (sensation of crawling)
  • Delusions of paranoia
  • Visual / auditory hallucinations
  • Seizures
18
Q

Outline first line management for delirium tremens

A

1st line = Oral Lorazepam

(2nd line IV Lorazepam or Haloperidol)

19
Q

Outline the triad of symptoms for Wernicke encephalopathy (plus others)

A
  • Ophthalmoplegia (muscle paralysis - lateral rectus most often)
  • Ataxia
  • Confusion

Others:
- Sweating
- Tremor
- Reduced conscious level
- Memory impairment

20
Q

Outline the main management step for Wernicke’s encephalopathy

A

IV Pabrinex (B vitamins complex)

Longer term:
- Long term oral thiamine supplements
- Alcohol abstinence

21
Q

Outline some causes of acute dystonia and medications that can be used to treat it

A

Causes:
- Anti-dopaminergic medications / dopamine receptor antagonists e.g. antipsychotics, antiemetics e.g. Metoclopramide

Medication:
- Benzodiazepines
- Anticholinergics

22
Q

List 3 features of Korsakoff psychosis

A
  • Confabulation
  • Anterograde amnesia
  • Retrograde amnesia
23
Q
A
24
Q

State how to manage Clozapine-induced agranulocytosis

A
  • Stop Clozapine
  • Start G-CSF (Filgrastim)