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PSYCHIATRY > Substance Misuse > Flashcards

Substance Misuse Flashcards

1
Q

What is considered to be ‘high risk’ drinking?

A

> 35 units per week regularly

increased risk is from 15 units +

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2
Q

Does heroin have a long or short half-life? What is the significance of this?

A

Heroin has a short half-life which means it causes a quick high but doesn’t stay in the system for that long which leads to cravings

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3
Q

What volume of pure alcohol = 1 unit?

A

10ml pure ethanol = 1 unit

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4
Q

How are alcohol units worked out?

A

(% x volume ) / 10

The % is expressed as a decimal e.g 40% = 0.4
The volume is in mls

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5
Q

What different drink quantities = 1 unit? (how much beer/ wine etc…)

A

1 single measure of spirits

1/2 a pint of beer

1/2 a small glass of wine

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6
Q

What are the recommended alcohol guidelines?

A

<14 units a week spread over 3 days or more

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7
Q

What are some of the physical consequences of alcohol consumption?

A

Gastritis

Peptic ulcers

Mallory-Weiss tear

Oesophageal varices

Cirrhosis

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8
Q

What factors are suggestive of alcohol dependence syndrome?

A

Tolerance

Withdrawal

Strong desire/ compulsion to drink

Difficulty with control

Neglect of other pleasures and interests

Persistence of use despite evidence of harm

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9
Q

What effect does alcoholism have on MCV?

A

Alcoholism is the most common cause of raised MCV

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10
Q

What are some of the detection tools which are used for alcoholism?

A

AUDIT

CAGE

TWEK

FAST

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11
Q

Which alcohol detection tool is used to detect hazardous drinkers?

A

AUDIT

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12
Q

Which alcohol detection tool is used to screen for alcohol abuse and DEPENDENCE?

A

CAGE

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13
Q

Which alcohol detection tool is used to screen for alcohol problems in pregnant women?

A

TWEK

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14
Q

Which alcohol detection tool is best for A&E testing?

A

FAST

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15
Q

Which toxicology parameter is a useful indicator of liver injury?

A

GGT

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16
Q

How does alcohol affect NMDA ion channels?

A

Alcohol inhibits the action of excitatory NMDA glutamate controlled channels

Chronic alcohol use leads to up regulation of these receptors

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17
Q

How does alcohol affect GABA channels?

A

Alcohol potentiates the actions of GABA controlled ion channels

Chronic alcohol use leads to down regulation of these receptors

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18
Q

How does alcohol withdrawal affect glutamate and GABA activity?

A

Alcohol withdrawal leads to excess glutamate activity and reduced GABA activity

*CNS excitability and neurotoxicity

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19
Q

Which receptors does chronic alcohol use upregulate and downregulate?

A

Chronic alcohol use causes up regulation of NMDA glutamate channels and down regulation of GABA channels.

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20
Q

When do withdrawal symptoms peak?

A

At 24-48 hours

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21
Q

What are some of the symptoms of withdrawal?

A

Restlessness

Tremor

Sweating

Anxiety

N&V

Loss of appetite

Insomnia

22
Q

What happens to HR and BP in withdrawal?

A

Tachycardia

Systolic hypotension

23
Q

How does delirium tremens present?

A

Acute confusion, disorientation and agitation

Visual hallucinations

Paranoia

24
Q

How is alcohol withdrawal managed?

A

Benzodiazepines (gradually reduce over 7 days or more)

Thiamine

Antiemetics, analgesia, hydration

25
Q

What can be done as relapse prevention for alcoholics?

A

CBT

Family and couple therapy

12 step facilitation therapy e.g AA

Medications

26
Q

What medications can be used for relapse prevention for alcoholics?

A

Disulfiram

Acamprostate

Naltrexone

27
Q

Disulfiram can be used as relapse prevention from drinking, how does it work?

A

Inhibits acetaldehyde dehydrogenase causing an accumulation of acetaldehyde if alcohol is ingested - this is unpleasant for the patient so deters them from drinking

28
Q

Acamprosate can be used as relapse prevention from drinking, how does it work?

A

Acts centrally on glutamate and GABA systems to reduce cravings

29
Q

Naltrexone is first line for relapse prevention in alcoholics, how does it work?

A

Naltrexone is an opioid antagonist which reduces the rewards from alcohol

30
Q

Where does heroin come from?

A

Heroin = diamorphine / diacetylmorphine

Poppy seeds!

31
Q

What are the different ways in which heroin can be taken?

A

IV

Smoking

Suppository

Insufflation (snorting)

Ingestion

32
Q

How does drug testing for heroin work? What is the metabolic pathway for heroin breakdown and what compound are you trying to detect?

A

The metabolic pathway =
Diacetylmorphine (heroin) - 6 mono acetyl morphine - morphine

If 6 mono-acetyl morphine is detected, the patient has taken heroin

If morphine only is detected, don’t know if the patient has taken morphine or heroin

33
Q

What are some of the signs you would expect to see on examination in a patient who has taken heroin?

A

Reduced consciousness
Low respiratory rate (respiratory depression)
Hypotension and bradycardia
Pupillary constriction

34
Q

Why does heroin cause euphoria?

A

Injecting heroin causes a release of histamine which is what is though to cause the feeling of euphoria

35
Q

Why do patients who take heroin often have poor dentition?

A

Poor self care

Heroin has an analgesic effect so often aren’t aware of pain from dental problems such as abscesses

36
Q

When do withdrawal symptoms from heroin typically occur?

A

After 6-8 hours

37
Q

How often do regular heroin users tend to inject?

A

3x per day

38
Q

What are some of the withdrawal symptoms from heroin?

A

Agitation

Diarrhoea

N&V

Joint pains

Yawning

Runny nose and watery eyes

39
Q

What are some of the physical signs of heroin withdrawal that may be seen on examination?

A

Piloerection (hairs stand one end) and goosebumps

Tachycardia

Hypertension

Dilated pupils

40
Q

Is heroin withdrawal dangerous?

A

No unlike alcohol withdrawal it is just very unpleasant

41
Q

What are some of the complications of IV drug use?

A

Infections (local - cellulitis, abscess, necrotising fasciitis and distant - infective endocarditis and systemic - Hep and HIV)

DVT/ PE

42
Q

Which drug is used to reverse the effects of opioid overdose?

A

Naloxone

43
Q

Heroin causes psychosis and delirium. T/F

A

No!

Heroin doesn’t cause psychosis or delirium

Drug-induced psychosis is most often due to cannabis

44
Q

What drugs are used for opiate substitution therapy?

A

Methadone

Buprenorphine

45
Q

How do methadone and buprenorphine differ? (opiate substitution options)

A

Methadone is a long acting full agonist and is usually in liquid form

Buprenorphine is a long acting partial agonist which is usually taken as a tablet dissolved under the tongue

46
Q

Which is usually the preferred management of opiate addiction?

A

Opiate substitution therapy

Opiate detoxification has a higher risk of overdose

47
Q

Why is opiate detoxification associated with overdose?

A

Patients are no longer tolerant but still psychologically dependent so if they take the same dose of heroin as before they may overdose

48
Q

What psychological interventions are options for opiate addiction?

A

CBT

Behavioural couples therapy

49
Q

What is the triad of wernicke’s encephalopathy?

A

Confusion

Ataxia

Nystagmus

50
Q

Wernicke’s can progress to Korsakoffs syndrome. What does this involve?

A

Inability to make new memories

Confabulation to fill in the gaps

51
Q

What are lilliputian hallucinations and when do they occur?

A

Seeing little people/ animals

Occur in delirium tremens

PSYCHIATRY (11 decks)

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