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Psychiatry (2) > Substance-misuse Disorder > Flashcards

Substance-misuse Disorder Flashcards

1
Q

What is Alcohol Use Disorder?

A

Mental health condition featuring maladaptive pattern of alcohol use featuring dependence, characterised by ≥ Sx in 12 months of: increased consumption; increased duration; impulses alcohol; craving alcohol; missing obligations/roles; hazardous alcohol use; development of tolerance and withdrawal symptoms.

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2
Q

Where is alcohol metabolised?

A

Liver

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3
Q

What enzyme(s) acts to degrade alcohol in the common pathway?

A

Ethanol (+ Alcohol Dehydrogenase - ADH)  Acetaldehyde (+ Aldehyde Dehydrogenase – ALDH)

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4
Q

What enzymes produce acetaldehyde in the alcohol metabolism pathway?

A

p450; ADH; Catalase

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5
Q

How do you calculate a unit of alcohol?

A

1 unit = 10mL of pure alcohol

ABV (%) x V (L) = Units

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6
Q

How many units are there in 50mL of 40% Vodka?

A

0.05 x 40 = 2

2 Units

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7
Q

What is the pathophysiology of Alcohol Use Disorder?

A

NMDA down regulated

GABA increased

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8
Q

What are the categories of alcohol use disorders?

A
  • Hazardous: Above limits but no harm
  • Harmful: Above limits and experiencing harm (physical or psychological)
  • Dependent: Above limits and experiencing harm (physical or psychological) with a central evaluation/plan being strong creating the impulse and motive to perform addictive behaviour
  • Binge Drinking: Episodic heavy drinking in a single session – 2x daily limit
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9
Q

Give the Sx and S of Alcohol misuse

A

• Withdrawal (hyperexcitability develops when use reduced - AWS): Seizures/Delirium/Hallucinations/Mood swings/Depression/Anxiety
-> Uncomplicated (4-12 hours post-drink, lasting 5 days) vs Seizures (5-15% AWS results in Grand-Mal seizures) vs Delirium tremens
• Tolerance (physiological adaptation)
• Recurrent intoxication/Admissions
• Impulsivity: Drink driving/Accidents/Crime/Domestic violence
• Anxiety
• Insomnia
• Nausea + Vomiting: Alcohol-related gastritis / Pancreatitis
• Abdominal pain: Alcohol-related gastritis / Pancreatitis
• Haematemesis: Alcohol-related gastritis / Pancreatitis
• Muscle cramps/Pain/Tenderness/Paraesthesia: Peripheral neuropathy from B1 (thiamine) deficiency

  • Skin changes: Telangiectasia/Spider naevi/Flushing/Psoriasis/Pruritus
  • Hepatosplenomegaly: Steatosis/Hepatitis
  • Liver shrinking: Cirrhosis
  • Jaundice
  • Ascites
  • Tremor
  • Sweating
  • Malnutrition: Sarcopenia/Atrophy
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10
Q

What clinical tools can you use to identify alcoholism?

A
  • CAGE: 1) Cut down (suggested); 2) Annoyed (others); 3) Guilty (felt guilty); 4) Eye-opener (drink in the morning)
    Note: Positive = ≥ 2 Yes responses
    + Quick
  • FAST Screening Test: 1) Fucked (Binge Drinking); 2) Anti-social (Unable to complete activity); 3) Shit memory (forgetful); 4) Thought (other people been concerned). Each domain scored from 0-4 (Never/Less than monthly/Monthly/Weekly)
    Note: Positive = ≥ 3
  • AUDIT (Alcohol Use Disorders ID Test): Series of Qs
    Note: Positive = ≥ 8/40
    + Gold-standard: High sensitivity and High Specificity
  • Does not determine level of brief intervention
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11
Q

What drug can be used to treat acute alcohol withdrawal?

A

Chlordiazepoxide

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12
Q

Give the Tx for Acute Alcohol Withdrawal

A 
•	Detoxification: Chlordiazepoxide/Diazepam/Lorazepam + Thiamine (IV 100mg OD) 
±
•	Supportive care: Reassurance/Low-stimulation environment/Hydration/Vitamin infusion (Pabrinex – Vitamin B and C) for 3/5 or Oral Thiamine (B1) TDS 
-> Inpatient/Residential Tx 
±
•	Non-pharmacological: AA/CBT/MET 
±
•	Skeletal muscle relaxants: Baclofen
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13
Q

Give the Tx for Chronic Alcohol Misuse

A

• Supportive: Advice to reduce intake (motivational interviewing + SMART goals)
±
• Therapy : AA/CBT/MET
±
• Opioid antagonist: Naltrexone (50-100mg PO OD) or Nalmefene (18mg PO OD)
OR
• Alcohol antagonist: Disulfiram (“Antabuse”)
 Inhibits ALDH thus strong hangover effect post-consumption
OR
• Sulfonic Acid: Acamprosate
-> Enhance GABA + antagonise NMDA to reduce craving/impulses
±
Skeletal muscle relaxants: Baclofen

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14
Q

What is the MOA of Acamprosate?

A

Enhance GABA + Antagonise NMDA to reduce craving

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15
Q

What is the MOA of Disulfiram?

A

Inhibits ALDH thus strong hangover effect post-consumption

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16
Q

What is a drug?

A

Psychoactive substance causing alteration in mood, behaviour, perception and consciousness

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17
Q

What is a reward?

A

Likeability of a drug due to activation of pleasure circuits in the brain

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18
Q

What is acute intoxication?

A

Pattern of reversible physical and mental abnormalities caused by direct effects of the substance

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19
Q

What is risk use?

A

Pattern of substance use whereby individual is susceptible to psychiatric or medical complications/damage

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20
Q

What is harmful use?

A

Pattern of continued substance use whereby repeated use results in psychiatric or physiological (medical) damage to the individual

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21
Q

What is tolerance?

A

State of reduced responsiveness resulting in increased doses of substance to feel effects previously felt due to repeated administration

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22
Q

What is Craving?

A

Powerful desire or urge

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23
Q

What is Dependence?

A

State of psychological or physiological dependence from psychoactive substance characterised by impulses and motivations to take the drug to seek resulting effects

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24
Q

What is Addiction?

A

Dependence on a substance whereby tolerance increases (amount needed to detect substance’s effects) and removal of substance leads to withdrawal effects (unpleasant physiological side-effects).

25
Q

State the two reward pathways of the body?

A

1) Dopamine (Mesolimbic)

2) Serotonin

26
Q

Outline the Mesolimbic Pathway

A

Dopaminergic cell bodies in Ventral Tegmental Area (VTA) with axons projecting and terminating in Nucleus Accumbens (NAc) in the ventral striatum

  • Reward
  • Pleasure, euphoria
  • Motor function
  • Compulsion
  • Preservation
27
Q

Outline the Serotonergic Pathway

A

Serotonergic (5-HT) cell bodies present in the Raphe Nucleus, with axons projecting towards the hippocampus and throughout the forebrain.

Functions:
•	Mood
•	Cognition
•	Memory
•	Sleep
28
Q

What is Psychoactive Drug Misuse?

A

Use of drugs, a psychoactive substance causing alterations in physiology or psychology of a person, which results in either harmful substance abuse or substance dependence.

29
Q

Give 3 RFs for Psychoactive Drug Misuse.

A
  • Psychological: Self-esteem/Inadequacy/MHDs/FHx obesity and complex needs/Compulsive/Impulsive/Impressionable
  • Social: Trauma/ Pressure to achieve
  • External: Peer pressure/ Dieting/Inability to deal with stress/History of bullying
30
Q

What is the MOA of Opiates?

A

Bind to Mu and Kappa opiate receptors in limbic system + GI -> inhibition of GPCR = inhibit AC in ATP cyclisation to cAMP -> block pain receptor

31
Q

Give 5 Sx and S of Opiate intoxication

A
  • Sedation
  • Nausea
  • Vomiting
  • Mood change: Euphoria/Intense pleasure
  • Analgesia
  • Pupillary constriction
  • Respiratory depression
  • Bradycardia (Decreased SNS outflow)
  • Hypotension (Decreased SNS outflow)
  • Hypothermia
  • Cough reflex suppression
  • Analgesia
32
Q

What is the Tx for acute Opiate toxicity?

A

Naloxone

33
Q

Give the Tx for Opioid dependence?

A

• CBT: 3Ps (Predisposing + Ppt + Protective) + Situation + Cognitive Triad (Thoughts/Feelings/Behaviours)
+
• Opiate analgesics: Methadone
–> Competitive antagonist of Mu receptor

34
Q

What is the MOA of Amphetamines?

A

Dopamine similar (thus sympathomimetic drugs) -> inhibition of presynaptic reuptake of catecholamines + indirect sympathomimetic effects due to disruption of MAs/inhibition of MAOs

35
Q

Give 5 Sx + S of Amphetamine usage

A
  • Euphoria
  • Hyperarousal: Energy + Alertness
  • Self-confidence
  • Reduced inhibitions + Impulsive behaviour
  • Reduced appetite (Appetite suppression)
  • Pupillary dilation
  • Blurred vision
  • Dry mouth
  • Tachycardia
  • Arrhythmia
  • Hypertension
  • Hyperthermia
  • Hyperhidrosis
  • Tremor
  • Dehydration -> Xerostomia
  • Agitation
36
Q

Give the Tx for Amphetamine addiction

A

• CBT

37
Q

Give the MOA of Cocaine

A

Indirect sympathomimetic agent blocking DAT + release of DA in VTA -> elevation in DA -> Reward pathway

38
Q

Give 5 Sx + S of Cocaine use

A
  • Euphoria
  • Hyperarousal: Energy + Alertness
  • Self-confidence
  • Reduced inhibitions + Impulsive behaviour
  • Reduced appetite (Appetite suppression)
  • Pupillary dilation
  • Blurred vision
  • Tachycardia
  • Arrhythmia
  • Hypertension
  • Hyperthermia
  • Hyperhidrosis
  • Tremor
  • Dehydration
  • Agitation
39
Q

Give the Tx for Cocaine addiction

A

• Benzodiazepines: Lorazepam/Diazepam
+
• CBT

40
Q

What is the MOA of MDMA

A

Increase central serotonin (5-HT) = Limbic system + DA increase = Euphoria

41
Q

Give 5 Sx + S of taking MDMA

A
  • Euphoria
  • Nausea
  • Vomiting
  • Hallucinations: Visual + Auditory
  • Insomnia
  • Impulsivity
  • Anorexia
  • Weight loss
  • Psychological Sx: Anxiety/Paranoia/Psychosis  Suicidal feelings
  • Low mood (come down)
  • Dilated pupils
  • Blurred vision
  • Dry mouth
  • Teeth grinding
  • Jaw tightening (bruxism)
  • Tachycardia
  • Hypertension
  • Tachypnoea
  • Hyperthermia
  • Hyperhidrosis
  • Dehydration
  • Tremor
  • Psychomotor activity increased
  • Agitation
42
Q

Give the Tx for MDMA addiction

A

• CBT

43
Q

What is the MOA of LSD?

A

Binds 5HT-1, 5HT-2, 5HT-5, 5HT-7 receptors + Stimulant via dopamine

44
Q

Give 5 Sx + S of LSD use.

A
  • Hallucinations: Visual + Auditory
  • Illusions
  • Micropsia/Macropsia
  • Synaesthesia
Higher doses…  Sympathomimetic effects 
•	Dilated pupils
•	Tachycardia
•	Hypertension
•	Hyperreflexia
•	Hyperthermia
45
Q

Give the Tx for LSD addiction

A

• Supportive: Sugar/Safe environment/Reassuring
±
• Anxiolytics: Lorazepam/Diazepam

46
Q

What is the MOA for Ketamine

A

Non-competitive antagonist at NMDA receptors + Enhances MA transmission (sympathomimetic) + Analgesic opioid receptor mediated effects

47
Q

Give 5 Sx + S of Ketamine usage

A
  • Hallucinations/Near-death
  • Out-of-body experience: Derealisation/Depersonalisation
  • Psychosis
  • Emergence phenomena
  • Cognitive impairment
  • Synaesthesia
  • Hypersalivation
  • Tachycardia
  • Hypertension
48
Q

What is the Tx for Ketamine usage

A

• Supportive: Sugar/Safe environment/Reassuring

49
Q

What is the psychoactive compound in Magic Mushrooms?

A

Psilocybin + Psilocin

50
Q

Give the MOA of Magic Mushrooms

A

5HT-2 receptor

51
Q

Give 5 Sx + S of Magic Mushrooms

A
  • Hallucinations: Visual + Auditory
  • Illusions
  • Micropsia/Macropsia
  • Synaesthesia
  • Panic
  • Amnesia
  • Psychosis
  • Mydriasis
  • Acute stuporous state
52
Q

Give the Tx for Magic Mushroom toxicity

A

• Supportive: Sugar/Safe environment/Reassuring
±
• Anxiolytics: Lorazepam/Diazepam

53
Q

What is the MOA of Benzodiazepines

A

Bind GABA-A receptor -> Cl- ion channel opens -> Hyperpolarisation

54
Q

Give 5 Sx + S for Benzodiazepine Toxidromes

A
  • Impaired mental status: Attention; Memory; Inappropriate behaviour
  • Drowsiness
  • Slurred speech
  • Ataxia
  • Respiratory depression
  • Coma
  • Decreased deep tendon reflexes
  • Nystagmus

Note: Might observe
• Paradoxical stimulation: Excessively agitated if hyperactive, aggressive, or other MHD Disorders

55
Q

Give the Tx for Benzodiazepine Toxidrome

A 
•	Supportive: Airway maintenance; Cardiorespiratory monitoring; IV fluids/ Dose-tapering
\+
•	BZD antagonist: Flumazenil
\+ 
•	CBT
56
Q

What is the main active compound in Cannabis?

A

THC

57
Q

What is the MOA of Cannabis?

A

Binds central CB1 + peripheral CB2 receptors –> endogenous cannabinoid system –> mood, memory, cognition, sleep and appetite

58
Q

Give 5 Sx + S for Cannabis use

A
  • Euphoria
  • Increased appetite
  • Sedation
  • Perceptual awareness
  • Hallucinations -> Psychosis
  • Tachycardia
  • Hypertension
  • Bronchodilation
59
Q

Give the Tx for Cannabis usage/addiction

A

• Supportive: Nutrition/Reassurance/Calm environment
±
• Anxiolytics: Lorazepam/Diazepam

Psychiatry (2) (13 decks)

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