Substance misuse Flashcards
What is the recommended weekly intake of alcohol for men and women?
14 units
If someone drinks far in excess of this or they describe symptoms of dependency then you should probe further?
What features in a history would start making you concerned about alcohol dependency?
Quantity - obviously important - talk through the weekly consumption
TYPES of alcohol - people with dependencies narrow the range of what they drink and usually end up just drinking one thing
DRINKING ALONE
DRINKING IN THE MORNING - eye opener?
DRINKING TO SETTLE PHYSICAL SYMPTOMS (shaking, sweating, vomiting, feeling ‘on edge’)
INCREASED TOLERANCE - having to drink more and more to take the edge off
PSYCHIATRIC SYMPTOMS - depression, pseudohallucinations
What can you do to screen for alcohol dependency?
CAGE QUESTIONNAIRE
Cut Down - have you ever felt like you should cut down your drinking
A - Annoyed - has anyone every annoyed you by suggesting you should cut down
G- guilty have you ever woken up after a night out and felt guilty for something you’d done
E - Eye opener - have you ever had a drink to get up in the morning
Another useful questionnaire is the AUDIT (alcohol use disorders identification test) - 10qns patient can fill it out themselves
What social symptoms might someone who is dependent on alcohol have?
Absenteeism
Problems with employment and finances
Legal problems
Vagrancy and homelessness
What physical symptoms might someone who is dependent on alcohol have?
Intoxication Delirium tremens when in withdrawal Withdrawal seizures Cerebellar degeneration Haemorrhagic stroke Peripheral and optic neuropathy Wernicke's encephalopathy Alcohol dementia GI: AFLD, Pancreatitis, ulcers, cancers (pharynx, oesophagus, liver) CVS: HTN, Arrhythmias, IHD MET: Hypoglycaemia, hyperlipidaemia, hyperuricaemia, hypomagnasaemia, hypophosphataemia HAEM: Red cell macrocytosis, anaemia, neutropenia, thrombocytopenia MSK: myopathies, osteoporosis REPRO: IUGR, FAS
What are the physical signs of delirium tremens?
Shaking, sweating, increased heart rate, pseudo hallucinations, seizures
How can we treat someone withdrawing from alcohol?
Chlordiazepoxide + Pabrinex
Lorazepam in delirium tremens
What drugs can we use to help prevent relapse in alcohol dependency?
ACAMPROSATE - neuroprotective
NALTREXONE - reduces cravings
DISULFIRAM - interferes with the metabolism of alcohol meaning even small amount give unpleasant physical symptoms of headache, vomiting, facial flushing, palpitations, dyspnoea
What happens in the brain that causes an addiction to develop?
The pleasure centre in the nucleus accumbens is stimulated but with repeated stimulation it is blunted and more and more is needed to achieve same affect
The ventral segmental area (VTA) controls the compulsions which cause use to seek this reward
This eventually feeds into the pre-frontal cortex (PFC) to sustain these behaviours
What are the 4 Cs of addiction?
CONTROL - loss of control around drug
COMPULSION - feeling compelled to use drug
CONTINUED - continue to use the drug despite the consequences
CRAVINGS - experience cravings
How do people feel using cannabis, what symptoms are experienced in withdrawal and what are its adverse effects?
Feel giggly, relaxed and talkative
In withdrawal people feel paranoid, sweating, difficulty sleeping, nauseous, shaking, irritable
In the long term it can affect cognition and memory, and lead to anxiety and paranoia
How do amphetamines work and how do you feel when taking them? What symptoms are experienced in withdrawal and what are some adverse effects?
They are monoamine agonist stimulants people feel talkative, full of energy and have decreased appetite
In withdrawal people feel generally unwell and have poor concentration
Can cause tachycardia, hyperthermia, instant MI, heart failure, anxiety, HTN, seizure, depression panic attacks
What is heroine and how does it work? What symptoms are experienced in withdrawal and what are its adverse effects?
it is a synthetic form of diamorphine that acts directly on mu receptors in brain causing mild euphoria, drowsiness, analgesia, constricted pupils
Heroine withdrawal is very notable causing cold sweats, chills, bone and muscle aches rhinorrhoea, excessive yawning or sneezing, anxiety, depression, akathisia
AE include anxiety, depression, constipation and respiratory depression
How does ketamine work? What symptoms are experienced in withdrawal and what are some adverse effects?
NMDA antagonist
Causes relaxation, floating sensations, dissociations, altered perceptions, delusions
There are NO reported symptoms of withdrawal thus far
AE: an cause ulcerative cystitis, bladder pain, memory problems, dependency panic attacks, confusion
What effect does MDMA have, what symptoms are experienced in withdrawal? What adverse effects does it have?
People feel chatty, energised, alert, dilated pupils and increased affection
In withdrawal people have lethargy, memory problems and depression
AE include panic attacks, confusion paranoia, psychosis, tachycardia, dehydration and over hydration
