Substance Misuse and Alcohol Abuse Flashcards

1
Q

Define “substance misuse”

A

Maladaptive and recurrent use of a substance, leading to significant functional impairment

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2
Q

Define “acute intoxication”

A

Transient disturbance of consciousness/cognition/behaviour as a direct effect of a substance

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3
Q

Define “harmful use”

A

Recurrent misuse resulting in bio/psycho/social consequences, but not dependence

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4
Q

Define “dependence”

A

Prolonged, compulsive substance misuse leading to addiction, tolerance and withdrawal symptoms

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5
Q

What are the key features of dependence?

A

“CANT STOP”:

  • Compulsion
  • Aware of risks but persists anyway
  • Neglect of other activities
  • Tolerance
  • Stopping causes withdrawal
  • Time preoccupied with substance
  • Out of control use
  • Persistent, futile wish to stop
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6
Q

Define “withdrawal state”

A

Physical and/or psychological effects from complete/partial cessation of a substance, after prolonged/repeated use

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7
Q

Define “substance-induced psychosis”

A

Psychosis occurs within 2 weeks of substance use and persists for at least 48 hours

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8
Q

Define “residual disorder”

A

Symptoms which persist long-term despite abstinence e.g. PD, affective disorder, dementia

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9
Q

List some aetiological factors in substance misuse

A
  • Genetics
  • Life stressors
  • Parental drug use
  • Cultural acceptability
  • Psych hx
  • Availability of drug
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10
Q

What are the 2 major perpetuating factors in drug misuse?

A
  • Biological reward - activation of mesolimbic pathway

- Social - peer pressure

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11
Q

List some important questions to ask during a drug abuse hx

A
  • Type, Route, Administration, Pattern
  • Impact on life?
  • Tried to stop?
  • Drug always on mind?
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12
Q

List 3 important investigations for someone with substance misuse

A
  • Blood borne viruses
  • LFTs and clotting
  • ECG
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13
Q

Outline the general management of substance misuse

A
  • Hep B jab
  • Movitational interviewing/CBT
  • Support with housing/employment etc
  • Narcotics Anonymous
  • Allocate keyworker
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14
Q

What pharmacological options are there for someone addicted to opiates?

A
  • Methadone - detox and maintenance
  • Buprenorphine (2nd line) - detox and maintenance
  • Naltrexone - continued abstinence
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15
Q

Define “alcohol abuse”

A

Consumption of alcohol at a level sufficient to cause physical, psychiatric and/or social harm

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16
Q

Define “binge drinking”

A

> 2x the recommended daily alcohol intake in 1 session.

i.e. >4 units in a session

17
Q

Define “harmful drinking”

A

Drinking above safe levels, with evidence of alcohol-related problems

18
Q

How do you calculate the number of units?

How many units is 500ml of 4% beer?

A

No of units = vol in L x % alcohol

so 2 units

19
Q

How quickly does a standard person metabolise alcohol?

A

1 unit metabolised per hour

20
Q

List 3 RFs for alcohol abuse

A
  • Male
  • Young
  • Stressors
  • Antisocial PD
21
Q

Why does alcohol withdrawal lead to CNS hyperexcitability?

A
  • Down-regulation of (inhibitory) GABA, and up-regulation of (excitatory) glutamate
22
Q

What are the two major effects of alcohol on the brain, and which NTs are involved?

A
  • Pleasure - dopamine

- Anxiolytic/sedative - GABA

23
Q

What are the clinical features of alcohol dependence?

A

“SAWDRIN(k)”

  • Subjective awareness of compulsion to drink
  • Avoidance of withdrawal symptoms by further drinking
  • Withdrawal symptoms
  • Drink-seeking behaviour
  • Reinstatement of drinking after attempted abstinence
  • Increased alcohol tolerance
  • Narrowing of drinking repertoire - same drink, time, place
24
Q

List some features of alcohol withdrawal

A

Malaise, tremor, nausea, insomnia, hallucinations.

Starts 6 - 12 hrs post-abstinence, peaks at 36 hours.

25
Q

What is delirium tremens?

A

Hyperadrenergic state caused by severe reaction to alcohol withdrawal

26
Q

What are the key clinical features of delirium tremens?

A
  • Cognitive impairment
  • Hallucinations
  • Paranoid delusions
  • Marked tremor
  • Autonomic arousal
27
Q

How should you treat delirium tremens?

A
  • Large dose of BZDs
  • Haloperidol if psychotic
  • Pabrinex
28
Q

What is Wernicke’s encephalopathy?

A

Acute encephalopathy due to thiamine deficiency, most often (but not always) secondary to alcohol abuse.

29
Q

What are the key clinical features of Wernicke’s encephalopathy?

A

“6th HAND”

  • 6th nerve palsy
  • Hypothermia
  • Ataxia
  • Nystagmus
  • Delirium
30
Q

What is the pathophysiology of Wernicke’s encephalopathy?

A

Multiple mini haemorrhages in mamillary bodies

31
Q

How should you manage Wernicke’s encephalopathy?

A
IV thiamine (Pabrinex)
DO NOT give any carbohydrate until this is done - i.e. no dextrose fluids
32
Q

What may Wernicke’s encephalopathy progress to?

A

Korsakoff’s psychosis

33
Q

What is Korsakoff’s psychosis?

A

Profound, irreversible short-term memory loss with confabulation (making stuff up to fill in gaps)

34
Q

How would you manage Korsakoff’s psychosis?

A

Oral thiamine to prevent further problems, but damage irreversible

35
Q

Outline some things you would cover in an alcohol history

A
  • CAGE screening tool
  • Drinking quantity and pattern across average week
  • Tolerance/withdrawal
  • Impact on life
36
Q

List 5 bloods you would do in alcohol abuse

A
  • FBC
  • LFTs
  • Clotting
  • MCV - raised
  • Vitamin B12
  • Amylase
37
Q

How would you initially begin the process of getting someone off alcohol?

A

Alcohol detox regime - high dose BZDs, tapered from days 5 - 9, and thiamine - oral or IV

38
Q

How would you manage alcohol dependence long-term?

A
  • Pharmacological
  • Motivational interviewing/CBT
  • AA