Substance Misuse Flashcards by Ella Knight

What are the ICD-10 types of substance misuse?

Acute intoxication 
Harmful use
Dependence syndrome
Withdrawal state
Psychotic disorder
Amnesic syndrome
Residual disorder

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What is acute intoxication?

Acute, usuall transient, effect of the substance

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What is harmful use?

Recurrent misuse associated with physical, psychological and social consequences without dependence

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What is dependence syndrome?

Prolonged compulsive substance use leading to addiction, tolerance and withdrawal

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What is withdrawal state?

Physical/psychological effects from cessation of substance after prolonged use

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What is psychotic disorder?

Onset of psychotic symptoms within 2 weeks of substance use. Must last >48 hrs

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What is amnesic syndrome?

Memory impairment in recent memory and ability to recall past experiences

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What is residual disorder?

Specific features due to substance misuse

Features

flashbacks
personality disorder
affective disorder
dementia
persisting cognitive impairment

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What are the main classes of drugs abused?

Opiates
Cannabinoids
Sedative-hypnotics
Stimulants
Hallucinogens

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What are examples of opiates?

Morphine
Heroin
Codeine

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What are the physical effects of opiate use?

Respiratory depression
Hypoxia
Hypotension
Hypothermia

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What are the psychological effects of opiate use?

Apathy
Disinhibition
Psychomotor retardation
Impaired judgement

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What are the signs of opiate withdrawal?

Craving 
Rhinorrhea
Lacrimation 
Myalgia
N+V

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What is an example of an cannabinoid?

Cannabis

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What are the physical effects of cannabis?

Increased appetite
Dry mouth
Tachycardia

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What are the psychological effects of cannabis?

Euphoira
Disinhibition
Agitation
Paranoid ideation

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What are the signs of cannabis withdrawal?

Anxiety
Irritability
Tremor of outstretched hands

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What are examples of sedative-hypnotics?

Benzodiazepines

Barbiturates

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What are the physical effects of sedative-hypnotics?

Unsteady gait
Slurred speech
Hypotension
Nystagmus

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What are the psychological effects of sedative-hypnotics?

Euphoris 
Disinhibition 
Apathy 
Aggression 
Labile mood

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What are the signs of sedative-hypnotics withdrawal?

Tremor - hands, tongue, eyelids
N+V
Tachycardia
Postural hypotension

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What are examples of stimulants?

Cocaine
Crack cocaine
Ecstasy 
MDMA
Amphetamine

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What are the physical effects of stimulants?

Tachycardia
Sweating
Hypertension
Arrhythmias

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What are the psychological effects of stimulants?

Euphoria 
Increased energy 
Grandiosity 
Aggressive
Labile mood

Whar are the signs of stimulant withdrawal?

Dysphoric mood Lethargy Psychomotor agitation Craving

What are examples of hallucinogens?

LSD | Magic mushrooms

What are the physical effects of hallucinogens?

Tachycardia/palpitations Sweating Tremor Blurred vision

What are the psychological effects of hallucinogens?

``` Anxiety Illusions Hallucinations Depersonalisation Paranoia ```

What are the signs of hallucinogen withdrawal?

None

What are the physical complications of drug misuse?

Death Infection - BBV Endocarditis Superficial thrombosis

What are the psychological complications of drug misuse?

Craving Anxiety Cognitive disturbance Drug-induced psychosis

What are the social complications of drug misuse?

Crime Imprisonment Homelessness Relationship problems

How is drug dependence defined?

>3 over 1 month - strong compulsion - preoccupation with substance use - withdrawal state - inability to control use - tolerance - persisting despite harm

How is opiate dependence managed?

Methadone

What is alcohol abuse?

Consumption of alcohol at a level sufficient to cause physical, psychological or social harm

What is binge drinking?

Drinking over twice the recommended level of alcohol per day in one session

What is harmful use?

Drinking above safe levels with evidence of alcohol related problems

What is the UK recommended maximum intake?

14 units per week

What is 1 unit?

10ml alcohol

How is units calculated?

% (ABV) x volume (ml) / 1000

What are the medical effects of alcohol consumption?

``` Hypertension Hepatitis Pancreatitis Peptic ulcers Varices ```

What are the psychological effects of alcohol consumption?

Mood disorders Anxiety disorders Self-harm

What are the social effects of alcohol consumption?

``` Domestic violence Drink driving Financial problems Relationship problems Employment problems ```

What are the features of alcohol intoxication?

Slurred speech Labile affect Impaired judgement Poor coordination

What are the features of alcohol dependence?

``` Subjective awarenss of need to drink Avoidance/relief of withdrawal symptoms Withdrawal symptoms Drink-seeking behaviour Restarting drinking after trying to stop Increased tolerance Narrowing of repetoire ```

What are the early signs of alcohol withdrawal?

Tremor Swating Nausea Anxiety

What are the late signs of alcohol withdrawal?

Delirium tremens Disorientation Hallucinations

When does delirium tremens occur?

24hrs -> 1 week after cessation

What are the features of delirium tremens?

``` Dehydration Electrolyte disturbances Cognitive impairment Vivid perceptual abnormalities Paranoid delusions Marked tremor Autonomic arousal ```

How is delirium tremens managed?

Benzodiazepines Haloperidol IV pabrinex

What is Wernicke's encephalopathy?

Thiamine deficiency

How does alcohol abuse cause thiamine deficiency?

Poor nutritional intake Alcohol destroys thiamine pump

What are the features of Wernicke's?

Nystagmus Ataxia Ophthalmoplegia

How is Wernicke's managed?

IV thiamine

What is Korsakoff's psychosis?

Profound memory loss due to alcohol

What are the features of Korsakoff's?

Short term memory loss Confabulation Disorientation to time

How is alcohol withdrawal managed?

Oral/IV thiamine | Chlordiazepoxide

How is alcohol dependence managed?

Biological - disulfiram - Acamprosate Psychological - motivational interviewing - CBT Social - AA