Substance Misuse Flashcards
What factors can influence the development of addiction?
Genetics
Neurobiological
Social
Behavioural
Attachment
What are some worrying symptoms of an alcohol related presentation?
Head injury
Confusion
Shaking/seizures
Hallucinations
Vomiting blood or coffee grounds
Severe abdominal pain
Sudden jaundice
What are the common causes of alcohol related mortality?
Fights
Falls
Liver failure
Pancreatitis
Overdose
Withdrawal
Wernike’s Encephalopathy
What are some early symptoms of alcohol withdrawal?
Tremor
Sweating
Nausea
Anxiety
Tachycardia
What are some late symptoms of alcohol withdrawal?
Delirium
Disorientation
Hallucination
Tremor
Fever
Lack of motor co-ordination
What percentage of chronic alcoholics develop Wernike’s encephalopathy?
10%
What is the mortality rate of untreated Wernike’s encephalopathy?
15-20%
What are the symptoms of Wernike’s encephalopathy?
Ataxia
Nystagmus
Ophthalmoplegia
Vomiting
Altered level of consciousness
Fever or hypothermia
Ptosis and abnormal pupillary reflexe
What causes Wernike’s encephalopathy?
Alcoholism leads to malnutrition and deficiency in Vitamin B1 (Thiamine)
What effect does thiamin deficiency have on the brain in Wernike’s encephalopathy?
Causes brain lesions in the midbrain
How long do thiamine stores typically last?
1 month
How long does it take for Wernike’s encephalopathy to present?
Can present with symptoms within one week
How is Wernike’s encephalopathy treated?
Parenteral thiamine
What does Wernike’s encephalopathy often proceed?
Korsakoff’s syndrome
How does Korsakoff’s syndrome present?
Prominent impairment of recent and remote memory
Disordering of events
Impaired ability to learn new things
Marked confabulation (not always present)
What is confabulation?
Invented memories to compensate for forgotten ones
When assessing drug addiction as part of a history, what is it important to explore?
Social history - particularly housing and support
When exploring a history of drug use, what should be considered?
What drug(s)?
How long?
How much?/How much spent?
How often?
Withdrawal symptoms?
Previous treatment?
Previous complications or OD’s?
Risk of BBV’s?
What kind of drug is heroin?
Opiate
What are some signs of heroin use?
Pin point pupils
Decreasing consciousness
Slow breathing
What are the early (~12 hours) signs of opiate withdrawal?
Clammy skin
Persistent yawning
Rhinorrhoea
Tachycardia
Restlessness
Dilated pupils
Lacrimation
Goosebumps
What are the later (2-3 days) signs of opiate withdrawal?
Nausea and vomiting
Diarrhoea
Insomnia
Abdominal cramps
Muscle pains
How can opiate addiction be treated?
Methadone
Buprenorphine
Detox and rehab
Why is methadone used to treat opiate addiction?
Less addictive than heroin so allows people to move on
How is buprenorphine administered?
Sublingual tablet once a day
How does buprenorphine exert its effects?
By acting as a partial agonist of opiate receptors
What length of rehab is recommended for people with opiate addictions?
6 months
What type of drug is diazepam?
Benzodiazepine
What are the risks associated with diazepam abuse?
Withdrawal
Overdose
Dependency
How is diazepam addiction treated?
Reduce supply
Pregabalin
What kinds of drugs are cocaine and amphetamines?
Stimulants
What can stimulant abuse lead to?
Heart attacks
Strokes
Liver problems
Psychosis
What can cause acute psychosis?
Hallucinogens
