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Year 3 - Exams > Substance Misuse and Clinical Specialities > Flashcards

Substance Misuse and Clinical Specialities Flashcards

1
Q

What are the classes of drugs?

A

Depressant - opioids, alcohol,

Stimulants - cocaine, amphetamines, MDMA, caffeine

Halllucinogens - LSD, PCP, ketamine

Cannabis, nicotine

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2
Q

What are novel psychoactive substanced?

A

Mimic controlled drugs - most weren’t illegal when they first came out e.g. mephedrone. Just as dangerous as the drugs they were trying to mimic.

Ask patient what the drug is similar to…

  • Depressant - GBL/GHB, phenibut
  • Stimmulants - m-cat, NRG-1, BZP
  • Hallucinogens - AMT, methoxetamine
  • Other - Spice (mimics cannabis)
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3
Q

What is the problem with the NPS clinically?

A

Not detected by routine urinary testing

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4
Q

What are the most harmful drugs to the individual?

A
  1. Crack cocaine
  2. Heroin
  3. Alcohol
  4. Cocaine
  5. Tobaccco

(death/illness /dependence /psychiatric /social issues)

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5
Q

What are the most harmful drugs to society?

A
  1. Alcohol
  2. Heroin
  3. Crack cocaine
  4. Tobacco
  5. Cannabis
  6. Cocaine
  7. Ketamine
  8. Mephedrone

(harm to others/ crime/ environmental/families/international trade/economic issues)

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6
Q

What are the main 3 areas related to substance misuse that we are concerned about?

A

Intoxication

Dependance

WIthdrawal

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7
Q

Effects of alcohol.

A
  • Social lubrication
  • Pleasure seeking
  • Counter stress
  • Disinhibition
  • Risk taking
  • Aggression
  • Dyspraxia (co-ordination disorder)
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8
Q

What are the features of dependence syndrome (ICD-10)?

A

Three or more at least once in the last year:

  • Strong desire or compulsion to use the substance
  • Difficulty controlling use/amount/recidivism
  • Tolerance to the effects of the drug
  • Neglect of other activites/primacy
  • Persistent use despite adverse consequences
  • Withdrawal symptoms
  • Narrowing of repertoire e.g. only smoking one type of cigarette/drinking one type of alcohol
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9
Q

What are the physical effects of alcohol?

A
  • Encephalopathy
  • Neuropathy
  • Amblyopia (n eye fails to achieve normal visual acuity, even with prescription eyeglasses or contact lenses)
  • Aspiration
  • Cardiomyopathy
  • Atrial fibrillation
  • Gastritis
  • Pancreatutis
  • Behavioural disturbance
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10
Q

List some withdrawal symptoms.

A

“Cold turkey” (opiates)

Sweats

Shaking

Muscular aches

Nausea

Seizures

Delirium (“tremens”)

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11
Q
A

Chronic relapsing brain disorder characterised by neurobiological changes that lead to compulsion to take a drug with loss of control over activity.

  • Transition from recreational to obsessive
  • From positive to negative (you do it because not doing it will be worse)
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12
Q

What happens to the brain in addiction?

A

The more an individual uses substances the reward centres of the brain become less available so you need to use more of the substance to get the same impact.

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13
Q

What happens in alcohol withdrawal?

A

Alcohol is a depressant - increases inhibitory GABA, reduced excitatory NMDA-R

Withdrawal - increased excitatiory activity (more upregulation of “breaks”, causes delirium tremens, seizures)

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14
Q

What should you ask in a history of substance abuse?

A
  • Where?
  • What substance?
  • Use - quantity/ route/when and whey
  • First use/regular use/heaviest use
  • Features of dependance and withdrawal symptoms
  • Negative effects - physical, psychological, social.

“Joint years” - a joint a day for a year

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15
Q

How do you calculate alcohol by volume?

A

% aBV is the number of units in a litre

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16
Q

What should you look for on examination?

A
  • Injecting drug use - punctures, track marks, cellulitis, DVTs
  • Signs of inhaled drug use - burns stains, respiratory signs, stains
  • Intoxication/withdrawal
  • Abnormal mental state
  • Acquired illness due to drug use (hepatitis from alcohol, HBV etc), injuries
17
Q

What is formication?

A

Formication - sensation that resembles small insects crawling on the skin

18
Q

What is the spectrum of withdrawal symptoms?

A
  • Minor (6-24hrs)
  • Major
  • Seizures (6-48hrs) - multiple brief, generalised seizures and 3% develop status epilecticus
  • Delirium tremens - 3-10days (autonomic hyperactivity)
19
Q

What is the pharmacological treatment of alcohol withdrawal?

A
  • Chlordiazepoxide reducing regime
  • Prophylaxis vs Wernicke’s (prescribe B vitamins)
  • Seizures i.v. Diazepam
20
Q

Anti-mitochondrial antibodies

Jaundice

Liver infiltrated with plasma cells, WBC etc

A

Primary biliary cirrhosis

21
Q

2 syndromes alcohol?

A

Wenicke’s

Korsakoff

22
Q

W/K syndrome cause?

A

18 days of stores of thiamine

EtOG reduces duodenal absorption

CLD reduced activation and storage of thiamine

Nutritional deficiency –> demyelination of brain

23
Q

W/K syndrome exam?

A
  • Gait - Broad based gait (cerebellar ataxia)
  • Eye signs - Ophthalmoplegia (lateral rectus palsy)
  • Mental - Cognitive disturbance
24
Q

Why do HIV crystal meth users have higher viral loads?

A
  • Weakened immune system
  • Poor complicance
  • Drug interactions esp with ritonavir
25
Q

What are the effects of alcohol on fertility? On the female/male/fetus?

A

Placental transmission

Spontanoeus miscarriage

Fetal alcohol syndrome

  • Disrupted menstrual cycle
  • Impotence, lower sperm count
26
Q

What should you do if persuading thealcoholic patient not to drive does not work ?

A

Report to DVLA. Licence willl probably be suspended for:

Alcohol misue - 6 months

Alcohol dependancy - 12 months

27
Q

What is the recommended limit of alcohol units per week?

A

14 units

28
Q

Why is excessive drinking in the medical profession potentially problematic?

A

33% excessive drinking - less likey to counsel patients about alcohol abuse and less likely to recognise a problem related to alcohol

29
Q

What are the treatments for addiction?

A
  • Public interventions
  • Brief intervention
  • Prevent withdrawal/Wernicke’s
  • Stabilisation
  • Replacement e.g. heroin with methadone
  • Detoxification
  • Rehabilitation
30
Q

Paddington alcohol test?

A
  • How often do you drink?
  • Whats the most you drink any day?
  • Do you feel that your admission to hospital is related to alcohol?

If regularly more than twice daly limits (8units/day) or if yes to Q3 then give brief advice and offer referral/booklet.

31
Q

What are the 5 stages of change (e.g. in addiction)?

A
  1. Pre-contemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
32
Q

What should you say when you meet someone in pre-contemplation admission for alcohol?

A

Feedback for patient - “I think that your abnormal LFTS are to do with alcohol”

Advise about support and where to go

33
Q
A

Year 3 - Exams (25 decks)

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