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Public health > Substance misuse > Flashcards

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
Q

Give 5 investigations will you order if you suspect Wernicke’s?

A
  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
Q

What is the treatment for Wernicke’s encephalopathy?

A

Symptoms reversible with treatment
Stat replacement of thiamine: IM/ IV thiamine

Give Thiamine PO, plus vitamin B complex or multivitamins

27
Q

What are the features of Korsakoff’s syndrome

A

Irreversible, wernicke’s triad +

  1. Retrograde amnesia
  2. Antrograde amnesia
  3. Confabulation
28
Q

How is Korsakoff’s diagnosed?

A

Head CT

29
Q

What is the ICD criteria for drug addiction

A
  1. Craving
  2. Tolerance
  3. Compulsive drug seeking behaviour
  4. Physiological state of withdrawal
30
Q

Give 3 acute physical effects of drug addiction

A
  1. with injection: Infection, DVT, PE, accesses
  2. Overdose
  3. Poor pregnancy outcomes i.e. miscarriage
  4. Acute withdrawal
31
Q

Give 3 chronic physical impacts of drug addiction

A
  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
Q

Give 3 social impacts of drug addition

A
  1. Unemployment
  2. Homelessness
  3. Breakdown of relationships with friends and family
  4. Crime & imprisonment
33
Q

Give 3 psychological impacts of drug addition

A
  1. Craving
  2. Fear of withdrawal
  3. Guilt
34
Q

What is the mode of action of Heroin

A

µ-opioid Rs agonist inhibiting release of NA, Ach & substance P

35
Q

What is the mode of action of Cocaine

A

blocks presynaptic reuptake of dopamine, serotonin and noradrenaline

36
Q

What are the 4 aims of treatment for drug addiction

A
  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
Q

What can be offered to a newly presenting drug user?

A
  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
Q

Give 5 things you could advice around basic harm reduction to drug user

A
  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
Q

What maintenance medications can be given to patients who are addicted to heroin?

A

Methadone PO: long acting µ-opioid agonist,

Buprenorphine sublingual: partial µ-opioid agonist

40
Q

What medication can you give to a patient who has overdosed on heroin

A

Naloxone

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