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?
Designed to mimic controlled club drugs
Banned but used to be legal highs, e.g. mephedrone, methoxetamine, GHB/GBL.
Spice.
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
What are some consequences?
Social lubrication.
Pleasure seeking.
Counter stress/anxiety/ chronic pain.
Peer pressure.
Consequences:
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 substance
- difficulty controlling use/ amount/ recidivism-relapse after quitting
- tolerance to the effects of the drug
- neglect of other activities/ primacy
- persistent use despite adverse consequences
- withdrawal symptoms
What are the harmful physical consequences of alcohol?
Encephalopathy
Neuropathy
Ambylopia
Osteoporosis/ fractures
Cancers
Anaemia
Aspiration
Gastritis
Pancreatitis
Hepatitis
Cirrhosis- jaundice, ascites
Cardiomyopathy
Atrial fibrillation
Endocrine abnormalities
Impotence
Infertility
Depression
Anxiety
Dementia
Behavioural disturbance
What are some symptoms of recreational drug withdrawal?
Cold turkey (opiates)- not actually dangerous- just v unpleasant Delirium tremens- alcohol, dangerous
Sweats
Shaking
Muscular aches
Nausea
Diarrhoea
Gooseflesh
Seizures
Irritability
Depression
Psychosis
Define addiction.
Chronic relapsing brain disorder characterised by neurobiological changes that lead to compulsion to take a drug (or activity) + loss of control over the activity.
Transition from recreational to obsessive use.
From positive [taking to gain positive effect] to negative reinforcement [taking to reduce negative effect].
Psychological factors drive the behaviour.
What is the mechanism of alcohol withdrawal?
Alcohol increases inhibitory GABA-R activity, and antagonises excitatory NMDA-R.
Excitatory activity then upregulated.
Withdrawal- still increased excitatory activity, but inhibition now gone
What signs of drug use should you look out for on examination?
Injecting: punctures, track marks, cellulitis, DVTs, bacterial endocarditis.’
Inhaling: burns,
stains- teeth, fingers, respiratory signs, poor dentition, septal deformity in nose
Intoxication/ withdrawal (mental state, pupils).
Abnormal mental state.
Acquired illnesses due to drug use: hepatitis (alcohol, HBV, HCV), HIV
Injuries- falling, self inflicted
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’s encephalopathy?
What is Korsakoff’s syndrome?
2 syndromes.
Wernicke (acute/subacute): confusion, ataxia, nystagmus/ophthalmoplegia.
Korsakoff (chronic): anterograde amnesia + confabulation.
