Substance misuse and addiction Flashcards
What is the CAGE questions and who are they used for?
C cut
A annoyed
G guilty
E eye opener
to show people that they may have an alcohol problem
What are the opiate withdrawal symptoms?
Tachycardia Sweating Restlessness Dilated pupils Bone aches Runny nose GI upset Tremor Yawning Anxiety/Irritability Gooseflesh skin
What is opiate withdrawal measured on ?
COWS
clinical opiate withdrawal scale
What are the 6 stages of dependency?
ICD -10
3 or more in the past year
strong desire or compulsion difficulties in controlling physical withdrawal when substance cut tolerance progressive neglect persisting with substance even if clear evidence of harm
what is harmful use?
damage to health physical or mental adverse social behaviours bingeing does not fulfill any other diagnosis in within substance use
what are the DSM 5 changes to classification ?
opioid use disorder
alcohol use disorder
mild, moderate severe
no longer use abuse or dependency
what are the important things to ask in the past psychiatric history?
Ask about trauma -> neglect or abuse
screen for developmental disorders -> ADHD
Specific things to do in alcohol abuse?
seizures, delirium tremens, alcohol psychosis, haematemesis, malaena
jaundice, anaemia, clubbing, cyanosis, oedema, ascites, lymphadenopathy, DVT
investigations Fibro scan / Ultrasound Bloods (LFT, GGT, Lipids, U&E, amylase) Breathalyser Urine Drug Screen
Specific assessments for opiod use?
Examination Collapsed veins / track marks Endocarditis Skin abscesses Hepatitis / HIV Pneumonia
Investigations: Bloods (LFT, U&E, GGT, Glucose) Breathalyser Urine Drug Screen Sexual health screening/BBV
Which withdrawal is more dangerous?
Alcohol as can cause delirium tremens -> auditory and visual hallucinations, confusion, disorientations, hypertension, agitation, tachycardia, fever, and severe tremor in hands
What can opiods do?
Analgesic.
Euphoria-> endogenous endorphins which can regulate pain and mood
mu,delta, kappa are affected by opiod agonists
Opiod agonists
heroin, methadone, fentanyl codiene
opioid partial agonists
buprenorphine
opiod antagonists
naltrexone
Opiates vs opiods?
opiates -> all natural opiods such as morphine and codeine and heroin to some extend and thebaine
opiods all natural, semisynthetic and synthetic opiods
synthetic -> fentanyl, pethidine, methadone, tramadol
Semi synthetic -> heroin, hydrocodone, oxycodone, hydromorphone
Symptoms or opiate overdose?
not moving cannot be woken up slow or no breathing choking, gurgling sounds or snoring tiny pupils, clammy or cold hands blue lips and nails
Response to opiate crisis?
naloxone -> inject in upper arm or thigh or nasal spray
repeat if no response after 3 minutes
airway support and recovery position
Abstinence medication for alcohol?
Acamprosate -> increases GABA, NMDA antagonist
Disulfiram -> inhibits acetaldehyde dehydrogenase leading to nausea if mixed with alcohol
Naltrexone
Nalmefene -> opiod reverse agonist, on days of high risk of drinking
Detox regimes for alcohol?
benzodiazepines
Chlordiazepoxide
opioids abstinence regimes?
methadone
burpremorphine
opioids detox regimes?
maintain abstinence treatment for at least 12 months before reducing
What are G drugs?
GHB -> gamma hydroxybutyrate, GBL gamma butyrolactone
odourless, oily liquid, slight salty taste
effect in 15-20 minutes last up to 3-4 hours
swallowed in the liquid form and mixed with water or soft drink -> dont mix with alcohol as these can lead to death
depressant drugs which can produce a high in small doses
euphoric, loss of inhibitions, increased confidence, higher sex drive
What are the risk of g drugs?
easy to overdose
and the dose that can cause them to become unconsious and unreponsive
Very addictive -> can lead to dependency.
Abstinence for G drugs? and detox?
benzodiazepine dependence
diazepam -> would reduce by 1mg per week, but many patients stay on these drugs
for detox -> needs careful medical supervision