Substance misuse Flashcards
How does alcohol work on the CNS
enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors
How does alcohol withdrawal work on the CNS?
Decreased inhibitory GABA and increased NMDA glutamate transmission
What are features of alcohol withdrawal
- 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
When is the peak seizure time in alcohol withdrawal
36 hours
When is the peak incidence of DT in alcohol withdrawal
48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
How do you manage an acute DT
Benzodiazepines e.g. chlordiazepoxide. Typically given as part of a reducing dose protocol
What medicine causing cushings can induce anxiety?
Corticosteroids .
When should the temperature be taken in investigating alcohol?
Pulse and temperature 2 hourly in the first 24hrs then at least twice daily during detox
What scoring systems are used to measure the severity of alcohol withdrawal and dependence?
SADQ (Severity of Alcohol Dependence Questionnaire) and CIWA-AR (Clinical Institute Withdrawal Assessment for Alcohol scale)
What are the features of Wernicke
COAt
Confusion, opthalmoplegia and ataxia
What are the features of korsachoff?
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.
When can you start giving disulfram?
Only 24 hours after last drink
What are some peripheral stigmata of chronic liver disease in alcoholics?
Palmar erythema, duputryens contracture, spider naevi, gynaecomastia, clubbing, caput medusa, oesophageal varices
On the blood film of investigation of alcoholism, what feeature do you see pointing to a diagnosis of severe dehydration
Low urea
What investigations are done for alcohol withdrawal
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
When is relapse commonest in alcoholism
First 12 months
How are pack years calculated
Number of cigarretes daily * years smoked/ 20
Management of alcohol long term
Bio- exercise, feel better, 1 week chlordiazepoxide inpatient,
Psych- CBT, support via group therapy
Social- AA,
Management of smokin
Bio- conservatie- exercise, medical- NRT- patches, gums, sprays, varenicline or bupropion
When should the stop smoking adjuncts be given?
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
Smoking cessation key points 2008
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
What are some adverse effects of NRT
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
How does varencriline work?
a nicotinic receptor partial agonist
When should you give varencriline
1 week before the patients target date to stop. Contraindicated in pregnancy and breast feeding
