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Psychiatry > Substance misuse > Flashcards

Substance misuse Flashcards

1
Q

How does alcohol work on the CNS

A

enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors

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2
Q

How does alcohol withdrawal work on the CNS?

A

Decreased inhibitory GABA and increased NMDA glutamate transmission

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3
Q

What are features of alcohol withdrawal

A
  • symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety
  • peak incidence of seizures at 36 hours
  • peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
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4
Q

When is the peak seizure time in alcohol withdrawal

A

36 hours

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5
Q

When is the peak incidence of DT in alcohol withdrawal

A

48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

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6
Q

How do you manage an acute DT

A

Benzodiazepines e.g. chlordiazepoxide. Typically given as part of a reducing dose protocol

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7
Q

What medicine causing cushings can induce anxiety?

A

Corticosteroids .

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8
Q

When should the temperature be taken in investigating alcohol?

A

Pulse and temperature 2 hourly in the first 24hrs then at least twice daily during detox

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9
Q

What scoring systems are used to measure the severity of alcohol withdrawal and dependence?

A

SADQ (Severity of Alcohol Dependence Questionnaire) and CIWA-AR (Clinical Institute Withdrawal Assessment for Alcohol scale)

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10
Q

What are the features of Wernicke

A

COAt

Confusion, opthalmoplegia and ataxia

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11
Q

What are the features of korsachoff?

A

Problems learning new information, inability to remember recent events and long-term memory gaps. Memory problems may be strikingly severe while other thinking and social skills are relatively unaffected. For example, individuals may seem able to carry on a coherent conversation, but moments later be unable to recall that the conversation took place or to whom they spoke.

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12
Q

When can you start giving disulfram?

A

Only 24 hours after last drink

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13
Q

What are some peripheral stigmata of chronic liver disease in alcoholics?

A

Palmar erythema, duputryens contracture, spider naevi, gynaecomastia, clubbing, caput medusa, oesophageal varices

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14
Q

On the blood film of investigation of alcoholism, what feeature do you see pointing to a diagnosis of severe dehydration

A

Low urea

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15
Q

What investigations are done for alcohol withdrawal

A

FBC, U+E (dehydration and low urea), LFT including gamma GT, blood alcohol concentration, MCV, vitamin B12 and folate and TFT as these are alternative causes of raised MCV, amylase (pancreatitis), hepatitis serology, glucose, albumin (malnourishment), alcohol questionnaires like AUDIT, FAST, SADQ, CT head, ECG

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16
Q

When is relapse commonest in alcoholism

A

First 12 months

17
Q

How are pack years calculated

A

Number of cigarretes daily * years smoked/ 20

18
Q

Management of alcohol long term

A

Bio- exercise, feel better, 1 week chlordiazepoxide inpatient,
Psych- CBT, support via group therapy
Social- AA,

19
Q

Management of smokin

A

Bio- conservatie- exercise, medical- NRT- patches, gums, sprays, varenicline or bupropion

20
Q

When should the stop smoking adjuncts be given?

A

NRT, varenicline or bupropion should normally be prescribed as part of a commitment to stop smoking on or before a particular date (target stop date

21
Q

Smoking cessation key points 2008

A

Prescription of NRT, varenicline or bupropion should be sufficient to last only until 2 weeks after the target stop date. Normally, this will be after 2 weeks of NRT therapy, and 3-4 weeks for varenicline and bupropion, to allow for the different methods of administration and mode of action. Further prescriptions should be given only to people who have demonstrated that their quit attempt is continuing. If unsuccessful using NRT, varenicline or bupropion, do not offer a repeat prescription within 6 months unless special circumstances have intervened

22
Q

What are some adverse effects of NRT

A

Nausea & vomiting, headaches and flu-like symptoms
NICE recommend offering a combination of nicotine patches and another form of NRT (such as gum, inhalator, lozenge or nasal spray) to people who show a high level of dependence on nicotine or who have found single forms of NRT inadequate in the past

23
Q

How does varencriline work?

A

a nicotinic receptor partial agonist

24
Q

When should you give varencriline

A

1 week before the patients target date to stop. Contraindicated in pregnancy and breast feeding

25
Q

How long is varencriline given for?

A

12 weeks. nausea, headache, insomnia, abnormal dreams. Use with caution in patients with a history of depression or self-harm. There are ongoing studies looking at the risk of suicidal behaviour in patients taking varenicline

26
Q

How does bupropion work

A

Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist which should be started 1 to 2 weeks before the patients target date to stop

27
Q

What are some common SE of bupropion and in which two groups particularly should it be avoided in?

A

As ther is a small risk of seizures (1 in 1,000), contraindicated in epilepsy, pregnancy and breast feeding. Having an eating disorder is a relative contraindication

28
Q

What are withdrawal SE of delirium tremens SHIT CANT Fant

A

Sweating, Hallucination, Insomnia, Tremor, Convulsions, Anxiety and Agitation, Nausea+vomitting, Fever> 38, Ants crawlking

WHEN WAS LAST DRINK

29
Q

What 5 things must you always rule out in a psych history

A

SPADD

Self harm and suicide, Psychosis, Anxiety, Depression, Drugs and then risk asess

30
Q

Can you give chlordiazepoxide in outpatients?

A

No. Lorazepam may be required in the elderly or those with liver impairment

31
Q

What is the conversion of chlordiazepoxide to lorazepam

A

25mg Chlordiazepoxide =10mg Diazepam=1mg Lorazepam

32
Q

When will you avoid giving chlordiazepoxide

A

Elderly or those with liver impairment

33
Q

What vitamins must you give prophylactically to harmful drinkers?

A

ONE pair IM pabrinex daily for at least 3-5 days to all harmful or dependent drinkers who may possibly be malnourished or have decompensated liver disease.

34
Q

What vitamins do you give in an emergency of wernickes?

A

TWO pairs IV High potency Pabrinex TDS for 3 days, followed by ONE pair daily for 3-5 days depending on response. (Pabrinex is diluted in 50-100mg of normal saline, and given by IV infusion over 30 minutes).

Oral: After parenteral treatment offer oral thiamine 100mg QDS and vitamin B Co strong 2/day.

Psychiatry (9 decks)

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