Substance misuse Flashcards
what is acute intoxication ?
administration of psychoactive substance resulting in disturbance of consciousness
what is harmful use?
pattern of psychoactive use that causes mental or physical damage
what is dependence syndrome ?
cluster of physiological behavioural and cognitive phenomena where the use of a substance takes a much higher priority than others which previously had greater value
what medication can be used to help opioid dependance ?
disulfiram
Lofexidine (alpha 2 noradrenergic agonist)
buprenorphine (partial agonist to u-opioid receptors)
naltrexone (opioid antagonist)
what psychological support is available for addicts?
residential, out patient alcoholics anonymous counselling motivational therapy family therapy education
what are 6 features of dependance syndrome ? (require 3 or more)
strong craving
difficulty controlling use
physiological withdrawal state when reducing substance
tolerance
progressive neglect of alternative pleasures
persisting use despite clear evidence of harmful consequences
what are the symptoms of delirium tremens ?
increased pulse decreased BP tremor fits visual hallucinations
what is the management of alcohol withdrawal ?
self help groups
disulfiram 200mg/24hr
naltrexone 25-50mg/24hr
acamprosate
what does disulfiram do when alcohol is taken?
produces a nasty reaction
what does naltrexone do when alcohol is taken?
reduces the pleasure that alcohol brings
what is acamprosate used for?
improves abstinence rates
what is the treatment for delirium tremens?
diazepam for
3 days (10mg/6hr)
day 4-6 (10mg/8hr)
day 7-9 (5mg/12hr)
what are the side effects of naltrexone?
vomiting drowsiness dizziness, joint pain
what are CIs for naltrexone?
hepatitis, liver failure
what are the side effects of acamprosate ?
diarrhoea and vomiting
changes in libido
what are the CIs for acamprosate ?
pregnancy
severe liver failure
renal failure
what does chronic and binge drinking do to liver enzymes ?
chronic - induces liver enzymes
binge - inhibits liver enzymes
what organ damage can alcohol cause ?
liver - fatty liver, cirrhosis
CNS - poor memory, Wernickes/korsakoffs encephalopathy
Gut - D&V, peptic ulcers, erosions, varices
Heart - arrhythmias, cardiomyopathy
osteoporosis
decreased fertility and sperm motility
GI and breast malignancy
what are the way of assessing alcohol intake/risk?
CAGE
TWEAC
what does TWEAC stand for ?
tolerance (how many drinks can you hold) worried (friends or family) eye opener amnesia cut down
how is TWEAC scored?
Q1 score 2 if >6 drinks
Q2 score 2 if yes
Q3-5 one point each if positive
what deficiency causes wernickes ?
B1 thiamine
what are the three symptoms of wernickes ?
ophthalmoplegia
confusion
wide based gait ataxia
what are some causes of wernickes ?
alcoholism brain tumour malabsorption prolonged vomiting (hypermesis gravidum) chemo
what damage occurs in the brain during korsakoffs?
hypothalamic damage and cerebral atrophy
what additional features does korsakoffs have?
retrograde amnesia and confabulation, lack of insight and apathy
