Substance Misuse

Question 1

What is the weekly alcohol limit?

Answer 1

14 units per week

Question 2

What neurotransmitter does GABA mimic the effect of in the brain?

Answer 2

GABA, hence it’s anxiolytic and sedative effects

Question 3

What tool can be used to screen for alcohol dependency?

Answer 3

CAGE

Question 4

What does the CAGE tool stand for?

Answer 4

Have you ever thought about Cutting down?
Have people Annoyed you by criticising your drinking?
Have you ever felt Guilty about your drinking?
Do you ever have a drink first thing in the morning? (Eye opener)

Question 5

What are the symptoms triad of Wernicke’s encephalopathy?

Answer 5

Opthalmoplegia
Ataxia
Delirium

Question 6

What is the cause of Wernicke’s encephalopathy?

Answer 6

Thiamine deficiency due to chronic alcohol consumption

Question 7

How does Wernicke’s encephalopathy need to be treated?

Answer 7

Parenteral thiamine, to prevent progression to Korsakoff’s psychosis

Question 8

How long after alcohol withdrawal does delirium tremens start?

Answer 8

Approx 72 hours

Question 9

What is delirium tremens?

Answer 9

Hyperadrenergic response to alcohol withdrawal (approx 72 hours afterwards)
Medical emergency
Hallucinations, confusion, paranoid delusions, tachycardia, HTN,

Question 10

How is delirium tremens managed?

Answer 10

ABCDE and tx hypoglycaemia If present
Benzodiazepines 
Thiamine 
Carbamazepine if seizures
Haloperidol if psychosis

Question 11

What is Korsakoffs psychosis?

Answer 11

Irreversible inability to make short term memories but can remember past memories
Hence confabulation and disorientation to time