Substance misuse Flashcards
What are the different categories of recreational drugs?
Depressants: opioids, benzodiazepines, alcohol.
Stimulants: cocaine, amphetamines, MDMA, caffeine.
Hallucinogens: LSD, PCP, ketamine.
Cannabis, nicotine.
What are novel psychoactive substances?
Club drugs: recreational drugs used in nightclubs, festivals, gigs, bars, circuit and house parties, e.g. amphetamine, metahmphetamine, MDMA, cocaine.
NPS designed to mimic controlled drugs but synthesised to evade prohibitions.
Many now banned after period as legal highs, e.g. mephedrone, methoxetamine, GHB/GBL.
Easily available online, head shops, dealers.
Synthesised to mimic existing drugs/ use the same neurotransmitter mechanisms.
Most NPS are not detected by routine urinary drug testing- false negatives.
What is the most harmful drug to an individual user? (death, illness, dependence, psychiatric, social losses).
Put the drugs in order for most to least harmful: ketamine, cocaine, heroin, mephedrone, crack cocaine, ecstasy, alcohol, tobacco, cannabis.
Crack cocaine Heroin Alcohol Cocaine Tobacco Mephedrone Cannabis Ketamine Ecstasy
What is the most harmful drug to society? (harm to others, crime, environment, family, international, economic cost, community).
Put the drugs in order for most to least harmful: ketamine, cocaine, heroin, mephedrone, crack cocaine, ecstasy, alcohol, tobacco, cannabis.
Alcohol Heroin Crack cocaine Tobacco Cannabis Cocaine Ketamine Mephedrone Ecstasy
Why do people take recreational drugs and get intoxicated, and what are some consequences?
Social lubrication. Pleasure seeking. Counter stresses/ pain. Peer pressure. Disinhibition. Risk taking. Aggression. Dyspraxia. Coma. Illness/ injury.
What is dependence syndrome? (ICD-10)
3 or more at once in the last year:
- strong desire or compulsion to use the substance
- difficulty controlling use/ amount/ recidivism
- tolerance to the effects of the drug
- neglect of other activities/ primacy
- persistent use despite adverse consequences
- withdrawal symptoms
- (narrowing of repertoire)
What are the harmful physical consequences of alcohol?
Encephalopathy Neuropathy Ambylopia Aspiration Cardiomyopathy Atrial fibrillation Gastritis Pancreatitis Hepatitis Cirrhosis Osteoporosis/ fractures Anaemia Endocrine abnormalities Impotence Infertility Cancers Depression Anxiety Dementia Behavioural disturbance
What are some symptoms of recreational drug withdrawal?
Cold turkey (opiates). Sweats Shaking Muscular aches Nausea Diarrhoea Gooseflesh Seizures Irritability Depression Delirium tremens Psychosis
Define addiction.
Chronic relapsing brain disorder characterised by neurobiological changes that lead to compulsion to take a drug (or activity) with loss of control over the activity.
Transition from recreational to obsessive use.
From positive to negative reinforcement.
Psychological factors drive the behaviour.
What is the mechanism of alcohol withdrawal?
Alcohol increases inhibitory GABA-R activity, and antagonises excitatory NMDA-R. Withdrawal increases excitatory activity.
What signs of drug use should you look out for on examination?
Signs of injecting: punctures, tack marks, cellulitis, DVTs, bacterial endocarditis.
Signs of inhaling: burns, stains, respiratory signs.
Signs of intoxication/ withdrawal (mental state, pupils).
Signs of abnormal mental state.
Signs of acquired illnesses due to drug use: hepatitis (alcohol, HBV, HCV), HIV; injuries.
Case 1:
A 47y/o woman presents with recent onset of jaundice.
On further questioning she has had bouts of pruritis for several months.
LFTs are abnormal with raised bilirubin, a very high alkaline phosphatase and normal transaminases.
Other tests include a rabies IgM and high serum cholesterol.
An auto-antibody screen shows antimitochondrial antibodies in a titre of 1.256.
Liver biopsy shows expansion of the portal tracts by lymphocytes, plasma cells and occasional granulomas.
Bile ducts are scarce.
What is the diagnosis?
a) alcoholic steatohepatitis
b) chronic hepatitis B
c) chronic pancreatitis
d) primary biliary cirrhosis
e) Wilson’s disease
Primary biliary cirrhosis.
Case 2:
38y/o publican presents to his GP with increasing symptoms of anxiety and depression.
Routine blood screen reveals LFTs which are abnormal with high transaminases but normal bilirubin and normal alkaline phosphatase.
He is referred to hospital and a later liver biopsy shows moderate-severe chronic inflammation with a moderate fibrosis.
Special stains identify antigens from a double stranded DNA virus within the cytoplasm of many hepatocytes.
What is the diagnosis?
a) alcoholic steatohepatitis
b) chronic hepatitis B
c) chronic pancreatitis
d) primary biliary cirrhosis
e) Wilson’s disease
Chronic hepatitis B.
Case 3:
56y/o man, a known chronic alcoholic, presents with repeated attacks of abdominal pain precipitated by bouts of heavy drinking.
The pain radiates to his back and is relieved by leaning forwards. On further questioning he admits to loose, pale, greasy stools that are difficult to flush.
A plain abdominal radiograph reveals calcification in the peritoneal cavity.
What is the diagnosis?
a) alcoholic steatohepatitis
b) chronic hepatitis B
c) chronic pancreatitis
d) primary biliary cirrhosis
e) Wilson’s disease
Chronic pancreatitis.
What is Wernicke/Korsakoff syndrome?
2 syndromes.
Wernicke (acute/subacute): confusion, ataxia, nystagmus/ophthalmoplegia.
Korsakoff (chronic): anterograde amnesia.
