Substance misuse Flashcards
(27 cards)
What are the questions to ask in the CAGE screening tool?
Have you ever felt like you should CUT DOWN from drinking?
Have people become ANNOYED/criticised your drinking?
Have you ever felt GUILTY about your drinking?
Have you ever had a drink first thing in the morning to steady your nerves/get rid of a hangover? Or any other EYE-OPENING experience?
What are some clinical features of alcohol dependency?
Compulsion to drink
Stereotyped patterns of drinking
Prominent drink-seeking behaviours (prioritising)
Difficulty controlling onset, termination, quality
Physiological withdrawal state
Tolerance
Neglect of alternative pleasures/interests
Persistence despite evidence of self harm
What is the Mx for alcohol dependence?
Individual/supporting psychotherapy, eg AA, behavioural therapy.
Disulfiram (Antabuse) as adjunctive therapy,
Acamprosate for cravings,
Drinking diary
What is the indication for Acamprosate?
Reduces cravings, useful in maintaining abstinence in alcohol dependence. Take TDS in combo with counselling for ≥1y.
What is the indication for Disulfiram (Antabuse)?
Prophylactic adjunctive therapy for alcohol dependence.
Ingesting even the tiniest amount of alcohol leads to v unpleasant systemic rxns, inc facial flushing, headache, tachycardia, nausea, vomiting.
Large amounts of alcohol can lead to arrhythmias/severe hypotension.
What are the symptoms of alcohol withdrawal?
Malaise, nausea, autonomic hyperactivity, lability of mood, insomnia, transient hallucinations
Severe = delerium tremens
Occurs w/in 1-2 days of abstinence
What is the treatment for alcohol withdrawal?
Support and explanation
Rehydration, correct electrolyte imbalance
Oral thiamine
Reducing regimine of 5-7/7 with benzodiazapines or chlormethiazole (prevents seizures, controls hallucinations)
What is Delirium Tremens?
Potentially life-threatening confusional state (mortality = 15%)
Tremor, clouding of consciousness, autonomic instability, disorientation, mood instability, illusions, nightmare, hallucinations, delusions, convulsions
What is the management for delirium tremens?
Exclude alternative cause (e.g. head injury, infections)
Chlordiazepoxide / benzodiazepine reducing regimen
Correct fluid / electrolyte imbalances
Supportive measures
General treatment for an acute confusional state
What is Wernicke’s encephalopathy, and how is it managed?
Most dramatic neuropsychiatric complication of withdrawal
Secondary to thiamine (Vitamin B1) deficiency
Px: ataxia, nystagmus, opthalmoplegia and acute confusion
May recover with acute administration of thiamine
If untreated, may develop in to Korsakoff’s psychosis
What is confabulation?
Disturbance of memory, defined as the production of fabricated, distorted, or misinterpreted memories about oneself or the world, without the conscious intention to deceive.
(Korsakoff’s psychosis)
What are the two types of memory loss in Korsakoff’s psychosis?
Retrograde amnesia – pathological inability to recall events that occurred prior to the onset of the illness
Anterograde amnesia – pathological inability to lay down new memories after the onset of the illness
What are the features of Korsakoff’s psychosis?
Prominent impairment of recent and remote memory with preservation of immediate recall, in the absence of generalised cognitive impairment.
Confabulation (recalling fake memories in absence of real memories, without realising)
What are the symptoms of acute heroin overdose?
Drowsiness, nausea, vomiting, respiratory depression, hypotension, pinpoint pupils
How is opiate overdose treated?
NALOXONE
What is the presentation of opiate withdrawal?
Agitation, anxiety, hot and cold sweats, intense cravings, piloerection, muscle aches, stomach cramps, diarrhoea, restlessness, insomnia, mood swings
~6-12h, lasts ~5/7 (but cravings for 6/12)
What are the physical effects of opiates?
Nausea, vomiting, sweating, itching
Decrease respiratory rate, pulse, BP and temperature
Pinpoint pupils, reduced gag reflex
Constipation, weight loss
What are the effects of amphetamines? (early effects, risks)
Monoamine agonist/antagonist
Wide awake, excited, talkative, reduced
hunger/appetite, more energy.
Risks/negative effects: Dependency insomnia, poor concentration, anxiety, depression, irritability, aggression and paranoia, psychosis, cardiac problems
What are the effects of cannabis? (early effects, withdrawal, risks)
Chilled out, relaxed and
happy, giggles, very talkative.
hungry
Withdrawal: Irritability, mood changes, feeling sick, loss of appetite, difficulty sleeping; and even sweating, shaking and diarrhoea in some people.
Risks/negative effects: Cravings & psychological dependency, anxiety, paranoia, poor concentration, poor memory, apathy, psychosis, precipitate schizophrenia
What are the early effects/withdrawal px/risks of cocaine?
Early effects: feel on top of the world, wide awake, confident , reduces hunger, short acting.
Withdrawal: Low mood, generally unwell,
Risks: psychological dependence, tachycardia, raised temperature, MI, heart failure, hypertension, seizure, depression, anxiety, panic attacks, paranoia
What are the early effects/withdrawal px/risks of MDMA?
Early effects: Energised, happy, alertness,
increased affection, chatty, dilated pupils
WIthdrawal: Lethargy, depression,
memory problems
Risks: Anxiety, panic attacks, confused episodes, paranoia, psychosis, tachycardia, hyperpyrexia, electrolyte disturbances, de- and over -hydration
What are the early effects, withdrawal symptoms, and risks of benzodiazapines?
Early effects: GABA agonist. Relaxed, calm, less anxious, sedated
Withdrawal: decreased concentration, tremors, nausea, vomiting, headaches, anxiety, panic attacks, confusion, depression, seizures
Risks: Respiratory depression, falls, hangover, memory loss, sedation, death with injection
What are the early effects, withdrawal symptoms, and risks of GHB/GBL?
Early effects: GABA agonist. Euphoria, reduced inhibitions and drowsiness.
Withdrawal: insomnia, anxiety, tremor,
delirium
Risks: nausea, dizziness, drowsiness, agitation, visual disturbances, respiratory depression, unconsciousness, coma, death (esp. if mixed with alcohol)
What are the effects and risks of ketamine?
NMDA antagonist
Early effects: Relaxation, altered bodily sensations, floating feelings, dissociation, altered perceptions, hallucinations
Used as an anaesthetic (WHO Model List
of Essential Medicines
injectable general anaesthetic (also propofol)
Risks: ulcerative cystitis, bladder pain, memory problems, dependency, panic attacks, confusion, agitation
