Substance misuse

Question 1

what is acute intoxication ?

Answer 1

administration of psychoactive substance resulting in disturbance of consciousness

Question 2

what is harmful use?

Answer 2

pattern of psychoactive use that causes mental or physical damage

Question 3

what is dependence syndrome ?

Answer 3

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

Question 4

what medication can be used to help opioid dependance ?

Answer 4

disulfiram
Lofexidine (alpha 2 noradrenergic agonist)
buprenorphine (partial agonist to u-opioid receptors)
naltrexone (opioid antagonist)

Question 5

what psychological support is available for addicts?

Answer 5

residential, out patient 
alcoholics anonymous 
counselling 
motivational therapy 
family therapy 
education

Question 6

what are 6 features of dependance syndrome ? (require 3 or more)

Answer 6

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

Question 7

what are the symptoms of delirium tremens ?

Answer 7

increased pulse 
decreased BP
tremor 
fits 
visual hallucinations

Question 8

what is the management of alcohol withdrawal ?

Answer 8

self help groups
disulfiram 200mg/24hr
naltrexone 25-50mg/24hr
acamprosate

Question 9

what does disulfiram do when alcohol is taken?

Answer 9

produces a nasty reaction

Question 10

what does naltrexone do when alcohol is taken?

Answer 10

reduces the pleasure that alcohol brings

Question 11

what is acamprosate used for?

Answer 11

improves abstinence rates

Question 12

what is the treatment for delirium tremens?

Answer 12

diazepam for
3 days (10mg/6hr)
day 4-6 (10mg/8hr)
day 7-9 (5mg/12hr)

Question 13

what are the side effects of naltrexone?

Answer 13

vomiting drowsiness dizziness, joint pain

Question 14

what are CIs for naltrexone?

Answer 14

hepatitis, liver failure

Question 15

what are the side effects of acamprosate ?

Answer 15

diarrhoea and vomiting

changes in libido

Question 16

what are the CIs for acamprosate ?

Answer 16

pregnancy
severe liver failure
renal failure

Question 17

what does chronic and binge drinking do to liver enzymes ?

Answer 17

chronic - induces liver enzymes

binge - inhibits liver enzymes

Question 18

what organ damage can alcohol cause ?

Answer 18

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

Question 19

what are the way of assessing alcohol intake/risk?

Answer 19

CAGE

TWEAC

Question 20

what does TWEAC stand for ?

Answer 20

tolerance (how many drinks can you hold)
worried (friends or family)
eye opener 
amnesia 
cut down

Question 21

how is TWEAC scored?

Answer 21

Q1 score 2 if >6 drinks
Q2 score 2 if yes
Q3-5 one point each if positive

Question 22

what deficiency causes wernickes ?

Answer 22

B1 thiamine

Question 23

what are the three symptoms of wernickes ?

Answer 23

ophthalmoplegia
confusion
wide based gait ataxia

Question 24

what are some causes of wernickes ?

Answer 24

alcoholism 
brain tumour
malabsorption 
prolonged vomiting (hypermesis gravidum)
chemo

Question 25

what damage occurs in the brain during korsakoffs?

Answer 25

hypothalamic damage and cerebral atrophy

Question 26

what additional features does korsakoffs have?

Answer 26

retrograde amnesia and confabulation, lack of insight and apathy