Substance misuse and addiction

Question 1

What is the CAGE questions and who are they used for?

Answer 1

C cut
A annoyed
G guilty
E eye opener

to show people that they may have an alcohol problem

Question 2

What are the opiate withdrawal symptoms?

Answer 2

Tachycardia
Sweating
Restlessness
Dilated pupils
Bone aches
Runny nose
GI upset
Tremor
Yawning
Anxiety/Irritability
Gooseflesh skin

Question 3

What is opiate withdrawal measured on ?

Answer 3

COWS

clinical opiate withdrawal scale

Question 4

What are the 6 stages of dependency?

Answer 4

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

Question 5

what is harmful use?

Answer 5

damage to health 
physical or mental 
adverse social behaviours 
bingeing 
does not fulfill any other diagnosis in within substance use

Question 6

what are the DSM 5 changes to classification ?

Answer 6

opioid use disorder
alcohol use disorder

mild, moderate severe

no longer use abuse or dependency

Question 7

what are the important things to ask in the past psychiatric history?

Answer 7

Ask about trauma -> neglect or abuse

screen for developmental disorders -> ADHD

Question 8

Specific things to do in alcohol abuse?

Answer 8

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

Question 9

Specific assessments for opiod use?

Answer 9

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

Question 10

Which withdrawal is more dangerous?

Answer 10

Alcohol as can cause delirium tremens -> auditory and visual hallucinations, confusion, disorientations, hypertension, agitation, tachycardia, fever, and severe tremor in hands

Question 11

What can opiods do?

Answer 11

Analgesic.
Euphoria-> endogenous endorphins which can regulate pain and mood

mu,delta, kappa are affected by opiod agonists

Question 12

Opiod agonists

Answer 12

heroin, methadone, fentanyl codiene

Question 13

opioid partial agonists

Answer 13

buprenorphine

Question 14

opiod antagonists

Answer 14

naltrexone

Question 15

Opiates vs opiods?

Answer 15

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

Question 16

Symptoms or opiate overdose?

Answer 16

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

Question 17

Response to opiate crisis?

Answer 17

naloxone -> inject in upper arm or thigh or nasal spray
repeat if no response after 3 minutes

airway support and recovery position

Question 18

Abstinence medication for alcohol?

Answer 18

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

Question 19

Detox regimes for alcohol?

Answer 19

benzodiazepines

Chlordiazepoxide

Question 20

opioids abstinence regimes?

Answer 20

methadone

burpremorphine

Question 21

opioids detox regimes?

Answer 21

maintain abstinence treatment for at least 12 months before reducing

Question 22

What are G drugs?

Answer 22

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

Question 23

What are the risk of g drugs?

Answer 23

easy to overdose
and the dose that can cause them to become unconsious and unreponsive

Very addictive -> can lead to dependency.

Question 24

Abstinence for G drugs? and detox?

Answer 24

benzodiazepine dependence
diazepam -> would reduce by 1mg per week, but many patients stay on these drugs

for detox -> needs careful medical supervision