Substance Misuse Flashcards
What is the recommended drinking limits for men and women in the UK?
14 units per week, with 2 alcohol free days per week, for both men and women
What is a ‘unit’ of alcohol?
8 grams or 10ml of pure (100%) alcohol
How many units of alcohol in a pint of regular beer / lager / cider?
2
How many units of alcohol in a pint of premium beer / lager / cider?
3
How many units of alcohol in an alcopop, or a can / bottle of regular lager?
1.5
How many units of alcohol in a can of premium lager or strong beer?
2
How many units of alcohol in a can of super strength lager?
4
How many units of alcohol in a glass of 175ml wine?
2
How many units of alcohol in a bottle of wine?
9
What is classified as a ‘binge?
More than 6 units in one session for women, more than 8 units in one session for men
List 4 blood tests which might be useful when investigating alcohol consumpation
FBC
LFT
Gamma-GT
Clotting
Give 4 tests which might be used to identify harmful levels of drinking?
CAGE questionnaire
AUDIT (Alcohol Use Disorders Identification Test)
AUDIT-C
FAST
What is asked in the CAGE questionnaire? How are the results interpreted?
Have you ever felt you need to cut down on your drinking?
Has anyone annoyed you by criticising your drinking?
Do you ever feel guilty about your drinking?
Have you ever needed an ‘eye-opener’ i.e. a drink first thing in the morning to steady the nerves?
Score 2 or more indicates probable dependence on drinking
What does AUDIT stand for?
Alcohol Use Disorders Identification Test
What questions are included in the AUDIT-C questionnaire?
- How often do you have a drink containing alcohol?
- How many units of alcohol do you have on a typical drinking day?
- How often do you have 6/8 (women/men) or more units of alcohol on any one occasion?
How are the results of the AUDIT-C questionnaire interpreted?
Score 4 or more for women, 5 or more for men, indicates likely harmful drinking
How do you work out the number of units a person has consumed?
Units = %ABV x Volume (L)
What behaviours indicate alcohol dependence?
- Craving for alcohol
- Continuing to drink despite being aware of the harms
- Tolerance to alcohol
- Futile attempts to stop drinking despite a desire to do so
- Decreased repertoire of drinking i.e. always having the same drink (stereotyped)
- Drinking more than, or for longer than was intended
- Neglect of other activities because of drinking
- A great deal of time preoccupied with drinking
- Withdrawal if not drinking
List some symptoms which might indicate alcohol withdrawal
Tachycardia Sweating Agitation Anxiety Tremor Nausea and vomiting Seizures Delirium tremens
What is delirium tremens?
Extreme sign of alcohol withdrawal where there is clouding of consciousness, disorientation, visual hallucinations
What drug can be given in the management of alcohol dependence?
Chlordiazepoxide
Pabrinex (Vitamin B1 should also be given)
Which patients should not be given chlordiazepoxide and why? What can be given instead?
Liver failure patients cannot have chlordiazepoxide as it is metabolised by the liver so causes toxicity. They can be given oxazepam instead.
What are the symptoms of Wernicke’s encephalopathy?
Nystagmus
Ataxia
Confusion
Ophthalmoplegia
What is Wernicke’s encephalopathy?
Thiamine depletion caused by chronic alcoholism
Can you give treatment for delirium tremens?
Yes - Lorazepam or haloperidol are given
How is Wermicke’s encephalopathy treated?
IV thiamine
What is Korsakoff’s syndrome?
Sequelae of Wernicke’s encephalopathy where there is loss of short-term memory and confabulation
Suggest 2 drugs which might help someone stay off alcohol
Disulfiram
Naltrexone
What are the NICE guidelines about who to admit for detox in alcohol dependence?
- Drinks over 30 units daily
- Score over 30 on SADQ
- Needs concurrent detox from alcohol and benzos
- Hx of epilepsy or withdrawal related seizure
- Significant psychiatric or physical comorbidity
- Significant learning disability or cognitive impairment
