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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
State the two reward pathways of the body?
1) Dopamine (Mesolimbic) | 2) Serotonin
26
Outline the Mesolimbic Pathway
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
Outline the Serotonergic Pathway
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
What is Psychoactive Drug Misuse?
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
Give 3 RFs for Psychoactive Drug Misuse.
* 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
What is the MOA of Opiates?
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
Give 5 Sx and S of Opiate intoxication
* 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
What is the Tx for acute Opiate toxicity?
Naloxone
33
Give the Tx for Opioid dependence?
• CBT: 3Ps (Predisposing + Ppt + Protective) + Situation + Cognitive Triad (Thoughts/Feelings/Behaviours) + • Opiate analgesics: Methadone --> Competitive antagonist of Mu receptor
34
What is the MOA of Amphetamines?
Dopamine similar (thus sympathomimetic drugs) -> inhibition of presynaptic reuptake of catecholamines + indirect sympathomimetic effects due to disruption of MAs/inhibition of MAOs
35
Give 5 Sx + S of Amphetamine usage
* 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
Give the Tx for Amphetamine addiction
• CBT
37
Give the MOA of Cocaine
Indirect sympathomimetic agent blocking DAT + release of DA in VTA -> elevation in DA -> Reward pathway
38
Give 5 Sx + S of Cocaine use
* 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
Give the Tx for Cocaine addiction
• Benzodiazepines: Lorazepam/Diazepam + • CBT
40
What is the MOA of MDMA
Increase central serotonin (5-HT) = Limbic system + DA increase = Euphoria
41
Give 5 Sx + S of taking MDMA
* 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
Give the Tx for MDMA addiction
• CBT
43
What is the MOA of LSD?
Binds 5HT-1, 5HT-2, 5HT-5, 5HT-7 receptors + Stimulant via dopamine
44
Give 5 Sx + S of LSD use.
* Hallucinations: Visual + Auditory * Illusions * Micropsia/Macropsia * Synaesthesia ``` Higher doses… Sympathomimetic effects • Dilated pupils • Tachycardia • Hypertension • Hyperreflexia • Hyperthermia ```
45
Give the Tx for LSD addiction
• Supportive: Sugar/Safe environment/Reassuring ± • Anxiolytics: Lorazepam/Diazepam
46
What is the MOA for Ketamine
Non-competitive antagonist at NMDA receptors + Enhances MA transmission (sympathomimetic) + Analgesic opioid receptor mediated effects
47
Give 5 Sx + S of Ketamine usage
* Hallucinations/Near-death * Out-of-body experience: Derealisation/Depersonalisation * Psychosis * Emergence phenomena * Cognitive impairment * Synaesthesia * Hypersalivation * Tachycardia * Hypertension
48
What is the Tx for Ketamine usage
• Supportive: Sugar/Safe environment/Reassuring
49
What is the psychoactive compound in Magic Mushrooms?
Psilocybin + Psilocin
50
Give the MOA of Magic Mushrooms
5HT-2 receptor
51
Give 5 Sx + S of Magic Mushrooms
* Hallucinations: Visual + Auditory * Illusions * Micropsia/Macropsia * Synaesthesia * Panic * Amnesia * Psychosis * Mydriasis * Acute stuporous state
52
Give the Tx for Magic Mushroom toxicity
• Supportive: Sugar/Safe environment/Reassuring ± • Anxiolytics: Lorazepam/Diazepam
53
What is the MOA of Benzodiazepines
Bind GABA-A receptor -> Cl- ion channel opens -> Hyperpolarisation
54
Give 5 Sx + S for Benzodiazepine Toxidromes
* 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
Give the Tx for Benzodiazepine Toxidrome
``` • Supportive: Airway maintenance; Cardiorespiratory monitoring; IV fluids/ Dose-tapering + • BZD antagonist: Flumazenil + • CBT ```
56
What is the main active compound in Cannabis?
THC
57
What is the MOA of Cannabis?
Binds central CB1 + peripheral CB2 receptors --> endogenous cannabinoid system --> mood, memory, cognition, sleep and appetite
58
Give 5 Sx + S for Cannabis use
* Euphoria * Increased appetite * Sedation * Perceptual awareness * Hallucinations -> Psychosis * Tachycardia * Hypertension * Bronchodilation
59
Give the Tx for Cannabis usage/addiction
• Supportive: Nutrition/Reassurance/Calm environment ± • Anxiolytics: Lorazepam/Diazepam

Psychiatry (2) (13 decks)

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