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Psychiatry extras > Substance misuse and Alzheimer's > Flashcards

Substance misuse and Alzheimer's Flashcards

1
Q

What type of drug order elimination does alcohol undergo?

A

Zero order elimination

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2
Q

What is zero order elimination?

A

In zero-order kinetics, the rate of drug elimination is constant regardless of the concentration of the drug in the body.

Example: Alcohol metabolism follows zero-order kinetics. No matter how much alcohol is consumed, the body can only metabolize it at a certain rate per unit of time.

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3
Q

What are the inhibitory actions that occur with alcohol consumption?

A

Potentiates inhibitory GABA

Inhibits excitatory glutamate

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4
Q

What are the excitatory actions that occur with alcohol withdrawal?

A

Restlessness

Tremor

Anxiety

Tachycardia/hypertension

Seizures

Delirium tremens (confusion/hallucinations) = EMERGENCY

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5
Q

What is the typical timeframe for delirium tremens?

A

As early as 48 hours after abrupt cessation of alcohol in those with chronic use and can last up to 5 days.

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6
Q

A build up of what substance results in alcohol hangover?

A

Acetaldehyde

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7
Q

Alcohol is inhibitory and alcohol withdrawal is excitatory meaning that alcohol withdrawal should be treated with inhibitory medications. True/false?

A

True

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8
Q

Excitatory features associated with an alcohol withdrawal state?

A

Restlessness

Tremor

Anxiety

Tachycardia/hypertension

Seizures

Delirium tremens

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9
Q

What inhibitory medications are used in alcohol withdrawal?

A

Benzodiazepines
Diazepam (long acting) = preferred
Lorazepam (short acting) = if acute (e.g. DT-delirium tremens)

Carbamazepine
If benzos contraindicated

Clomethiozole
3rd line (respiratory depression if taken with alcohol)

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10
Q

When are benzodiazepines contraindicated?

A

Because of their muscle relaxant action, benzodiazepines may cause respiratory depression in susceptible individuals.

So contraindicated in:
Myasthenia gravis
Sleep apnea
Bronchitis
COPD

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11
Q

Differences in features between Wernicke’s encephalopathy and Korsakoff syndrome?

A

Wernicke: acute thiamine deficiency (ataxia, nystagmus, confusion),

Korsakoff: chronic thiamine deficiency (dementia, confabulation)

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12
Q

What are confabulations in Korsakoff syndrome?

A

Fabrication of imaginary experiences as compensation for loss of memory.

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13
Q

What are symptoms of opiates?

A

Analgesia

Sedation

Euphoria

Constipation

Nausea

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14
Q

What are features of opiate toxicity?

A

Unconsciousness

Respiratory depression (slow or shallow breathing causing poor gas exchange in alveoli).

Pin point pupils (constricted pupils)

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15
Q

What drug is used to reverse opioid toxicity?

A

IV naloxone

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16
Q

What are options for opiate substitution therapy?

A

Methadone:
Full mu opioid agonist
Oral solution

Buphrenorphine:
Partial mu opioid agonist
Oral tablet

17
Q

What are the main hallmark’s of Alzheimer’s dementia?

A

Cortical atrophy (wide sulci and narrow gyri).

Neurofibrillary tangles (abnormal tau protein accumulation in the neurons).

Senile plaques (polymorphous beta-amyloid protein deposits found in the brain in Alzheimer disease and normal aging).

18
Q

Features of opiate intoxication?

A

Drowsiness

Confusion

Decreased respiratory rate

Decreased heart rate

Constricted pupils

Track marks (needle marks) - applies if IV route has been used.
- Abscess at injection sites
- Veins thrombosed and damaged causing difficulties with IV access.

19
Q

Opiate withdrawal is life threatening. True/false?

A

False

Unlike alcohol withdrawal, opiate withdrawal is NOT life threatening.

20
Q

What are some of the features of opiate withdrawal?

A

Agitation

Anxiety and irritability

Chills

Runny nose

Piloerection (“goosebump” hairs)

Dilated pupils

Increased blood pressure and heart rate

GI disturbances (i.e. abdominal cramps, nausea, vomiting and diarrhoea).

21
Q

During opiate withdrawal, what drugs can help to treat symptoms?

A

Methadone: may cause prolonged Qtc

Loperamide (for diarrhoea)

Anti-emetics (for nausea

22
Q

When does alcohol withdrawal symptoms usually become apparent?

A

Onset usually 12 hours after last drink.

23
Q

Characteristic features of alcohol withdrawal?

A

Nausea and vomiting

Tremor

Sweating

Anxiety

Agitation

24
Q

What is delirium tremens and when does it usually occur?

A

A life threatening medical emergency, and usually occurs at day 3 of withdrawal, and lasts 3 days

25
Q

What are characteristic features of delirium tremens?

A

Characterised by:

Paranoid delusions

Visual/auditory and classically haptic (tactile) hallucinations (sensation of crawling e.g. formication)

Seizures

26
Q

What is typical management of delirium tremens?

A

Oral lorazepam as first line, and if the oral route cannot be used for whatever reason, parenteral lorazepam or haloperidol.

27
Q

What is used for prevention and treatment of alcohol withdrawal?

A

Short-acting benzodiazepines i.e. chlordiazepoxide and oxazepam (if evidence of liver injury).

28
Q

What is supportive treatment of alcohol withdrawal?

A

Fluids

Anti-emetics

Thiamine (i.e. pabrinex) - which is vitamin B1

29
Q

What does wernicke-korsakoff cause in the brain?

A

Mammiliary body atrophy

30
Q

What is Wernicke’s encephalopathy?

A

Reversible presentation (treated with high dose IV thiamine e.g. pabrinex).

31
Q

Characteristic features of Wernicke’s encephalopathy?

A

Confusion

Ataxia

Ophthalmoplegia

Nystagmus

Less clinical features include: urinary incontinence and hypothermia due to autonomic neuropathy.

32
Q

What is Korsakoff’s psychosis?

A

An irreversible manifestation of untreated Wernicke’s encephalopathy.

33
Q

Characteristic features of Korsakoff’s psychosis?

A

Retrograde amnesia (loss of memory before incident)

Anterograde amnesia (inability to make new memories)

Confabulations (fabricate imaginary experiences as a compensation for memory loss)

Psychiatry extras (4 decks)

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