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Substance misuse Flashcards

1
Q

How is units of alcohol calculated?

A

(% (ABV) x mls ) / 1000

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2
Q

What is the recommended weekly unit intake for women

A

14

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3
Q

What is the recommended weekly unit intake for men

A

14

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4
Q

Name 2 screening questionnaires for alcohol dependence

A
  1. CAGE

2. AUDIT

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5
Q

Define hazardous drinking

A

A pattern of drinking which brings about the risk of physical or psychological harm

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6
Q

Define harmful drinking

A

A pattern of drinking that is causing physical/ mental damage to health

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7
Q

Define alcohol dependence and 7 features of alcohol dependence

A

A set of behavioural, cognitive, and physiological responses that develop after repeated drinking:

  1. Primacy of alcohol
  2. Compulsion
  3. Narrowing of drinking repertoire
  4. Continual withdrawal symptoms
  5. Drinking to prevent withdrawal
  6. Tolerance
  7. Reinstatement after abstinence
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8
Q

Like 5 investigations you would request for a patient who is dependent on alcohol and why

A
  1. FBC: macrocytic anaemia, MCV raised
  2. LFTs: chronic hepatitis
  3. Gamma GT: raised
  4. Serum B12, thiamine and folate levels: reduced
  5. Blood alcohol/ alcohol breath test
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9
Q

What is the recommended amount of units for a pregnant women?

A

Abstain altogether in the first trimester

No more than 2 units after this

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10
Q

Units calculation:

  1. How many units of alcohol in a 250ml glass of 14% wine?
  2. 330ml bottle of 5% lager?
A
  1. 3.5

2. 1.65

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11
Q

Give 5 social/ psychological risk factors for problem drinking

A
  1. Drinking within the family
  2. Early drinking or nicotine use
  3. Depression as a cause of drinking
  4. Poor coping strategies to stressful life events
  5. Low socio-economic status
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12
Q

Give 5 health problems that can result from alcohol dependence

A
  1. Liver cirrhosis - fatty liver disease
  2. Mental health issues i.e. Wernicke’s, Korsakoffes, Delerium tremens, Alcohol induced dementia
  3. Malnutrition
  4. Poor CVS health: htn, high cholesterol, IHD, AF
  5. Obstetrics: fetal alcohol syndrome, miscarriage
  6. Increased risk of head and neck Ca: mouth, larynx, pharynx oesophagus
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13
Q

Give 5 dysmorphic facial features for fetal alcohol syndrome

A
  1. Ptosis
  2. Thin upper lip
  3. Flat nasal brigde
  4. Smooth philtrum
  5. Epicanthic folds
  6. Short palpebral fissure
  7. Microcephaly
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14
Q

Give 5 physical features of fetal alcohol syndrome

A
  1. Small, & underweight babies
  2. Hypotonia
  3. Mental retardation, behavioural and speech problems
  4. Cardiac, renal and ocular abnormalities
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15
Q

List 4 types of non-pharmacological treatment to help support patients with alcohol dependence

A
  1. Techniques to control drinking i.e. set weekly limits, don’t buy rounds
  2. Support groups i.e. AA
  3. Psychological therapy: cognitive behavioural therapies, behavioural therapies
  4. Inpatient detoxification
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16
Q

A patient comes in for planned alcohol detoxification name 2 medications that will be given to him?

A
  1. Benzodiazepine: chlordiazepoxide

2. Pabrinex: thiamine (B1)

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17
Q

Give 8 symptoms of alcohol withdrawal that you would look out for for patients with a history of alcohol abuse?

A
  1. Autonomic hyperactivity
    - Tachycardia
    - Tremor
    - Hypertension
    - Hyperthermia
    - Excessive sweating
  2. Anorexia; insomnia; headache
  3. Psychiatric: anxiety; emotional lability; irritability
18
Q

What is the triad for delirium tremens?

A
  1. Tonic clonic seizures
  2. Extreme autonomic hyperactivity - esp marked coarse tremor
  3. Psychiatric disturbance: confusion, delirium, hallucinations of any modality but usually visual, tactile, clouding of consciousness
19
Q

Give 5 investigations you would request for if you suspect delirium tremens

A
  1. Blood alcohol levels
  2. FBC
  3. Thiamin, B12 and folate
  4. Amylase ? pancreatitis
  5. Glucose
  6. U&Es? electrolyte imbalance
  7. LFTs? cirrhosis
20
Q

In addition to chlordiazepoxide and Pabrinex what 2 additional medications can you give to a patient with delirium tremens?

A
  1. Lorazepam for seizures

2. Antipsychotic i.e. haloperidol for hallucinations

21
Q

Give 3 medications that can be used to prevent relapse/ maintain abstinence from alcohol and their mode of action

A
  1. Acamprosate: Inhibits GABA → reduced cravings
  2. Disulfiram: inhibits alcohol dehydrogenase → unpleasant effects when drinking i.e. vomiting, headache
  3. Naltrexone: antagonises the effects of endogenous endorphins released by alcohol consumption → ↓desire
22
Q

What is the classic triad for Wernicke’s encephalopathy

A
  1. Opthalmoplegia
  2. Confusion
  3. Ataxic gait
23
Q

What can the patient complain off if they have opthalmoplegia?

A

Double vision

24
Q

List 5 things you may find O/E of a patient with Wernicke’s encephalopathy

A
  1. Nystagmus
  2. Other ocular motor signs
  3. Altered GCS
  4. Peripheral sensory neuropathy
  5. Bradycardia, hypothermia
25
Give 5 investigations will you order if you suspect Wernicke's?
1. FBC, especially MCV 2. U+E to exclude hypernatraemia, hypercalcaemia and uraemia 3. LFTs 4. Glucose 5. Blood arterial gasses to exclude hypercapnia or hypoxia 6. Serum thiamine levels 7. Pyruvate: ↑ 8. CT head can be useful in the acute phase, but is less sensitive than MRI
26
What is the treatment for Wernicke's encephalopathy?
Symptoms reversible with treatment Stat replacement of thiamine: IM/ IV thiamine Give Thiamine PO, plus vitamin B complex or multivitamins
27
What are the features of Korsakoff's syndrome
Irreversible, wernicke's triad + 1. Retrograde amnesia 2. Antrograde amnesia 3. Confabulation
28
How is Korsakoff's diagnosed?
Head CT
29
What is the ICD criteria for drug addiction
1. Craving 2. Tolerance 3. Compulsive drug seeking behaviour 4. Physiological state of withdrawal
30
Give 3 acute physical effects of drug addiction
1. with injection: Infection, DVT, PE, accesses 2. Overdose 3. Poor pregnancy outcomes i.e. miscarriage 4. Acute withdrawal
31
Give 3 chronic physical impacts of drug addiction
1. Blood born infections i.e. HIV and hepatitis 2. Effects of poverty i.e. - Malnutrition - Vitamin deficiency 3. Sexual dysfunction i.e. ED
32
Give 3 social impacts of drug addition
1. Unemployment 2. Homelessness 3. Breakdown of relationships with friends and family 4. Crime & imprisonment
33
Give 3 psychological impacts of drug addition
1. Craving 2. Fear of withdrawal 3. Guilt
34
What is the mode of action of Heroin
µ-opioid Rs agonist inhibiting release of NA, Ach & substance P
35
What is the mode of action of Cocaine
blocks presynaptic reuptake of dopamine, serotonin and noradrenaline
36
What are the 4 aims of treatment for drug addiction
1. Reduce harm to use/family/society 2. Improve health 3. Stabilise lifestyle and reduce illicit drug use though detoxification & maintenance 4. Reduce crime
37
What can be offered to a newly presenting drug user?
1. Health check 2. Screening for STIs 3. Screening for blood born infections i.e. hepatitis B and C, HIV 4. Immunisation status check and vaccinations 5. Sexual health advice: contraception, smears 6. Signpost for additional help 7. Information of local drug services
38
Give 5 things you could advice around basic harm reduction to drug user
1. Avoid injecting 2. Don't use drugs alone 3. Practice safe sex 4. Dont share needles 5. Call ambulance if necessary 6. Referral when appropriate
39
What maintenance medications can be given to patients who are addicted to heroin?
Methadone PO: long acting µ-opioid agonist, | Buprenorphine sublingual: partial µ-opioid agonist
40
What medication can you give to a patient who has overdosed on heroin
Naloxone

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