Substance Misuse And Addiction 2 Flashcards
Intoxication
transient syndrome → recent substance use → clinically significant psychological/physical impairment. These changes disappear when drug is eliminated from the body
ICD 10/11 classification criteria of harmful use?
pattern of substance use that causes damage to health (self or others)
damage can be physical or mental
adverse social consequences
does not fulfil any other diagnosis e.g. dependence
ICD 11 criteria for dependence?
fulfil one of:
impaired control over substance use
increasing precedence of substance use over other aspects of life
neuroadaptation to substance
Usually evident over a period of 12 months but diagnosis may be made if there’s continuous use (ie daily or almost) for at least three months
additional elements of addiction history?
how long used, when last, current amount, time at this level
total length of use, abstinence periods
mode of administration
evidence and severity of withdrawal syndrome
previous treatments and overdoses
triggers to use, willingness to be treated
Include family history
common comorbid conditions to keep an eye out for?
ADHD, depression, previous trauma, personality disorders
addiction can cause suicidality
Also screen for domestic violence,neglect,abuse and ADHD
potential clinically relevant elements of medical Hx?
cirrhosis (alc)
endocarditis, abscesses, hep B/C, HIV (IV use)
- how to calculate alcohol units?
%strength x ml/1000
recommended limits for alcohol consumption
14 units spread over 3 or more days
how is alcohol metabolised?
liver → ethanol broken down to acetaldehyde by alcohol dehydrogenase → broken down to CO2 and water via oxidation via acetaldehyde dehydrogenase
1 unit per hour
Illicit brew may contain methanol which is broken down into formaldehyde
stages of liver damage?
healthy → fatty → fibrosis → cirrhosis
relevant examination findings?
jaundice, bruising, oedema, ascites,clubbing and spider naevia
what is wernicke’s encephalopathy?
confusion, ataxia, ophthalmoplegia (paralysis of eye muscles) Korsakoff’s syndrome (memory impairment)
Caused by thiamine deficiency (vit b1)
what is korsakoff’s syndrome?
involves memory impairment
liver investigations?
ultrasound, fibroscan, blood tests e.g. LFTs,breathalyzers,drug screen
what is CAGE screening?
have you ever felt you needed to cut down on drinking
have people annoyed you by criticising your drinking
have you ever felt guilty about drinking
do you need alcohol first thing in the morning (eye-opener)
alcohol withdrawal symptoms?
- 6-12 hours afterminor withdrawal symptoms e.g. vomiting, anxiety, tremulousness,diaphoresis(sweating)
- 12-24 hours afteralcoholic hallucinosis usually accusatory or deragotory
- 12-48 hours afterwithdrawal seizures as early as 2 hours after cessation of alcohol and before blood levels fall to 0
- 48-72 hours afterdelirium tremens
What is delirium tremens
medical emergency
fever, tachycardia, hallucinations, confusion, hypertension, agitation, severe tremor
Pt may need observation 72 hours later too
Risk factors for DT include age,heavy alcohol use (60+),abnormal LFTs
risk factors for development of DT?
concurrent acute illness, deranged LFTs, history of DTs and alcohol withdrawal symptoms, heavy daily alcohol use
what is the difference between opiates and opioids?
opiates are natural opioids such as morphine and codeine
opioids refers to natural and synthetic opioids
what do opioids do?
analgesic effect, euphoria in high doses
endogenous regulate pain and mood
what receptors are relevant in opioid use
kappa, mu and delta opioid receptors
Opioid agonist
Partial agonists include buprenorphine
examination findings for opioid addiction?
collapsed veins, endocarditis, skin abscesses, signs of pneumonia/hepatitis/HIV
opioid withdrawal symptoms?
tachycardia, sweating, dilated pupils, abdominal pain, anxiety,bone pain,rhinorrhoea,tremor,yawning,goose flesh skin
Use clinical opiate withdrawal scale (cows)
signs of opioid overdose?
unresponsive, slow/no breathing, choking/gurgling/snoring, tiny pupils, clammy skin, blue lips or nails
treatment for opioid overdose
naloxone (intramuscular or intranasal spray) used in overdose,inject into upper arm or thigh and if no response then repeat
examples of medications used to assist abstinence?
alcohol: acamprosate(increases GABA,NMDA antagonist), naltrexone,disulfiram(inhibits acetaldehyde dehydrogenase so feel sick if have alcohol),nalmefene(given on days of high risk drinking)
opioids: methadone, buprenorphine
benzodiazepines: reducing doses of diazepam but many pt struggle and so remain in addiction services
examples of medications used in detox regimes?
alcohol: benzodiazepines
opioids: maintenance treatment of methadone, buprenorphine before dose reduction
benzo: baclafen (GABA agonist). G drugs detox requires medical supervision which can be done in the community
Tolerance
After repeated administration drug produces a decreased effect so larger doses are needed
Alcohol absorption and pharmacodynamics
Alcohol is well absorbed and reaches max concentration in 60 mins of ingestion. Its absorption is slowed by food and sped up by effervescent drinks.
Alcohol enhances neurotransmission at GABA-A causing anxiolysis. Also stimulates dopamine release in mesolimbic system and inhibits NMDA mediated glutamate release
Types of opioids
Natural (alkaloids)-opium,morphine,codeine,thebaine
Synthetic-
Fentanyl,pethidine,methadone,tramadol
Semi synthetic-
Heroine,hydrocodone,oxycodone,hydromorphone