Substance Misuse Flashcards
How do you support alcohol withdrawal?
You give a decreasing benzo regime Nutritional support disuphuram (hangover) acamprosate (reduces cravings) naltroxone (reduces pleasure)
What is delirium tremens?
A hyperadrenergic state, 2 days after withdrawal
An emergency in alcohol withdrawal where the patient reacts badly
Most due to stopping cold turkey too quickly
Can be fatal (30% mortality)
How common is DTs?
5% of withdrawals
What are the symptoms of DTs?
Gross Tremor Sweating (ANS arousal) Agitation and Confusion Headache Convulsions (loss of GABA inhibition) Hallucinations (tactile, visual)
Hypoglycaemia
How do you treat DTs?
Anti-convulsants Decreasing Benzo regime Anti-emetic Monitor Fluids and electrolytes Prevent hypoglycaemia
Long term help for alcohol withdrawal?
Group Therapy/AA
Acamprosate (decrease cravings)
Disuphuram (gives bad hangover symptoms due to aldehyde dehydrogenase inhibition)
Support
Nutritional support - B12, folate, thiamine (pabrinex)
Diet - encourage healthy eating
What are the symptoms of dependence?
HINT: Has an acronym
Compulsion to take
Aware of risks but cannot help it
Neglecting other activities
Time preoccupied by it
Symptoms if stop
Tolerance
Out of control
Persistant wish to cut down
What does alcohol do to the body?
Alcoholic gastritis (snake skin appearance)
GORD
Varices
Liver disease
Erectile dysfunction and infertility (virilisation)
Malignancy
Brain - encephalopathy, Korsakoffs
Pancreatitis - acute and chronic
Foetal Alcohol Syndrome
Injuries whilst intoxicated
Psychosocial - job, psychosis, depression, social life, criminal
What substances are people often addicted to?
Opioids - heroin, morphine
Benzodiazapines -
Alcohol (6% men, 2% women)
How do you treat a Benzo overdose?
Flumazanil
How do you treat a heroin (opioid) overdose?
Naloxone
What substances are depressants “downers”
Opioids
Benzos
Glue/solvents
Which drugs are psychotrophic?
Cannabis
Ecstasy
LSD
Which drugs are stimulants?
Cocaine
Amphetamines
Which substances are less addictive?
Cannabis
Solvents
What are the symptoms of an opioid overdose?
Pinpoint pupils
Low consciousness/LoC
Low BP
Low HR
(Normal dose - euphoria, relaxation, analgesia)
What are the withdrawal symptoms for opioids?
Formication Painful Cramps Headaches Photophobia Diarrhoea Shivering/Hypothermia Piloerection
(everything runs)
Can cause seizures
How to help people withdraw from opioids?
Give an ant/agonist of the opioid receptor or weak agonist
Methadone
Helping people with addiction
Treat symptoms and complications
Support - help stages of change
Substitution - methodone/subutex, low alcohol wine/beer
Harm reduction (safe technique, naloxone pens, needle swapping, give blood tests for HIV and Hep B/C)
Vaccinations
Turning Point (for withdrawal and support)
How long do substances stay in urine? Methadone Opioids Cannabis Cocaine Amphetamines
7 days Methadone 2 days Opioids 2- 3 days Cocaine 3-45 days Cannabis (depends on use) 2 days Amphetamines
Risk factors for addiction
Male Young Low SE Status Unemployment Co-existing Mental Health Problem (Depression, Psychosis, Anxiety) Iatrogenic prescription of medication Culture and Religion Availability
Screening tools for alcohol addiction?
CAGE - Cut Down Anger Guilt Eye-opener (2+ needed)
FAST
What is the unit allowance for men and women?
When?
14 units BOTH a week
Have at least 2 alcohol-free days a week
don’t drink more than 3-4 units at a time
What are the symptoms of acute alcohol intoxification?
DDx?
Loss of inhibitions Arousal (hyperactive, louder) Feel warm (even though hypothermia) Loss of co-ordination Slurred speech and blurred vision Emotionally labile (aggression, depression, euphoria) Hypoglycaemia
Head Trauma
Delirium
Hypoglycaemia
What are the symptoms of alcohol withdrawal?
Very bad hangover
Headache Nausea Tremor Labile Mood Tremor
What is the scoring system for treating alcohol withdrawal?
CIWA (withdrawal assessment) Ar
Risks of substance misuse?
Psychotic Disorders
Organ damage - death
Infections (blood borne)
Risk to self and others when using
Injections - infection, abcess, DVT, PE, endocariditis, cellulitis
Dilutional hyponaturaemia - primary polydipsia with ecstasy
