Substance Misuse

Question 1

Mnemonic for Dependance

Answer 1

CANT STOP 
Compulsion to take 
Aware of harms -> persist anyway 
Neglect of other activities 
Tolerance 
Stopping-> withdrawal 
Time preoccupied with substance 
Out of control use 
Persistent but futile wish to cut down

Question 2

What brain bath way is in substance misuse ?

Answer 2

Mesolimbic dopaminergic reward pathway

Question 3

What factors cause people to get into substances

Answer 3

Availability 
Peer pressure 
Trying to cope 
Impulsivity / anxiety 
Avoidance of issues

Question 4

Non pharmacological management of substance misuse

Answer 4

Residential rehab
Rewards for negative drug tests
CBT / self help groups
Needle exchange

Question 5

Overdose of opiates give?

Answer 5

Naloxone

Question 6

Drugs for opioid addiction

Answer 6

Methadone - opioide agonist
Bupernophine - partial
Lofexidine

Question 7

When would you use bupenophine over methadone why? What does lofexedine do?

Answer 7

It’s a partial agonist - less euphoric / sedative -> use in less dependant
A2 agonist - helps to mask Sx of withdrawal of norodrenic neurones
-> less sweating, nausea, abdo cramps, diarrhoea, tremors

Question 8

Sx of acute alcohol intoxication

Answer 8

Slurred speech, impaired communication / judgement

-> hypoglycaemia, stupor, coma

Question 9

Sx of alcohol withdrawal

Answer 9

Malaise, nausea, autonomic hyperactivity, insomnia, transient hallucinations
SEIZURES
DELIRIUM TREMENS

Question 10

Management of delirium Tremens

Answer 10

Lorazepam / antipsychotic

Question 11

Scale used for alcohol withdrawal sx

Answer 11

CIWA-AR scale

Clinical institute withdrawal of alcohol scale

Question 12

Signs of recent harmful alcohol use in blood?

Answer 12

Macrocytosis without anaemia

Increased GGT, ALT, AST

Question 13

Triad of sx in wernicke encephalopathy

Answer 13

Ataxia
Confusion
Opthalmoplegia (usually lateral rectus)

Question 14

What causes wernickes encephalopathy in alcohol misuse ?

Answer 14

Thiamine deficiency -> mammillary body damage

Question 15

What happens if wernickes encephalopathy is not treated ? What happens in that ?

Answer 15

Korsakoffs psychosis
Profound short term memory loss
Confabulation

Question 16

What are the neuropsychiatric complications of alcohol misuse ?

Answer 16

Wernickes 
Peripheral neuropathy 
Erectile problems 
Cerebellum dysfunction 
Dementia

Question 17

Social problems with alcohol misuse?

Answer 17

Violence, RTA, employment, marital, trauma / injuries

Question 18

Psych complications in alcohol misuse ?

Answer 18

Depressive episodes, anxiety , insomnia

Question 19

Signs of fetal alcohol syndome

Answer 19

Decreased muscle tone, poor-coordination, developmental delay , heart defects, facial abnormalities

Question 20

Management during acute detoxification of alcohol

Answer 20

Sedation Eg benzodiazepines -> prevent seizures / control withdrawal
Rehydrate, electrolyte balance,
Parenteral thiamine

Question 21

How can you help patients wanting to give up alcohol

Answer 21

Motivational interviewing
Self help groups
Set targets 
Education 
Medication

Question 22

Drugs for alcohol withdrawal

Answer 22

Disulfiram - blocks alcohol metabolism

Acamprosate - acts on GABA -> reduces cravings (could use Naltrexone)

Question 23

Prevention of alcohol dependance

Answer 23

Taxation, reduce advertising
Treat underlying societal socioeconomic differences
Education