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Mental health > Substance misuse: Illegal drugs > Flashcards

Substance misuse: Illegal drugs Flashcards

1
Q

What percentage of adults have tried illegal drugs in their lifetime, and how many were in the previous year?

A

33% lifetime

10% in previous year

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2
Q

What percentage of Under 25s have tried illegal drugs in their lifetime, and how many were in the previous year?

A

50% lifetime

33% in previous year

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3
Q

Name 3 risk factors for illegal drug use

A

Male (3-4:1)
Younger age (Under 25: 50%)
Lower socioeconomic class
Psychiatric illness

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4
Q

What are the 5 patterns of drug use?

A

Experimental use - typically softer drugs
Situation use - mainly stimulants and hallucinogenics
Recreational use - regular but not dependent
Dependent use
Dual diagnosis - drug users with major mental illness

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5
Q

What is the diagnostic criteria for dependence syndrome?

A

At least 3 symptoms over a 12 month period:

  • Compulsion to take substance
  • Impaired control over use
  • Salience (prioritisation above all else)
  • Tolerance
  • Withdrawal or relief use
  • Persistent use despite clear evidence of harm
  • Rapid reinstatement after abstinence
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6
Q

What are the categories of drugs of abuse?

A 
Opiates
Depressants
Stimulants
Hallucinogenics
Others
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7
Q

Name 3 opiates commonly abused

A 
Heroin
Methadone
Codeine
Pethidine
Buprenorphine
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8
Q

Name 3 depressants commonly abused

A

Alcohol
Benzodiazepines e.g. Diazepam
GHB

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9
Q

Name 3 stimulants commonly abused

A

Cocaine “Coke”
Amphetamines “Speed”
MDMA “Ecstasy”

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10
Q

Name 3 hallucinogenics commonly abused

A

LSD “Acid”
Mushrooms
Ketamine “Vitamin K”
PCP “Angel dust”

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11
Q

Name 3 other commonly abused drugs

A

Cannabis “Weed/Dope”
Volatile chemicals (Glues, gases and aerosols)
Anabolic steroids

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12
Q

What is the difference between opiates and opioids?

A

Opiates - naturally occurring

Opioids - synthetically produced

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13
Q

What are the desirable properties of opiates/opioids?

A

Euphoriant
Anxiolytic
Potent analgesic (medical use)

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14
Q

How can heroin be taken?

A

Smoking “Chasing”
Oral
Snorted
Parental IV, IM, or SC

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15
Q

What acute medical problems are associated with heroin?

A 
Constipation
NaV
Respiratory depression
Aspiration and loss of consciousness
Death
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16
Q

Name 3 complications that may occur as a result of IVDU?

A 
Local abscess
Cellulitis
Bacterial endocarditis - tends to occur in right heart
Osteomyelitis
Sepsis
Hep B and C, and HIV
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17
Q

What sign and symptoms present in heroin toxicity?

A

Coma
Respiratory depression
Mitosis - Pinpoint pupils

Track marks
Fresh puncture wounds

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18
Q

What are the early signs and symptoms of opiate withdrawal?

A 
Lacrimation and sweating
Muscle ache
Agitation
Tachycardia
Hypertension
Sleep disturbance
Anxiety
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19
Q

What are the late signs and symptoms of opiate withdrawal?

A 
Diarrhoea
NaV
Goosebumps
Stomach cramps
Cravings and depression
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20
Q

Outline the general management of substance misuse

A 
Therapeutic alliance
Harm reduction
Substitution
Detox
Maintaining abstinence
Preventing relapse
Social recovery
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21
Q

What harm reduction steps can be taken in drug misuse?

A 
Do not use while alone
Do not use with other drugs
Avoid IV route
If injecting, use safe injective advice
-Sterile needles/syringes/water
-Don't share needles
-Rotate injection site
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22
Q

What social problems are associated with illegal drug dependence?

A

Crime

Homelessness

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23
Q

Name the 2 types of drug substitution therapy, and state their indications

A

Maintenance therapy - harm reduction and stabilisation, better for longterm addicts.

Detoxification - aim to come off a drug, suitable for highly motivated individuals looking to detox from all drugs within that class. Circumstance must be stable to maintain abstinence.

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24
Q

What investigations should be done when assessing suitability for substitution therapy?

A

FBC
LFTs
ECG - QTc

25
Q

What drugs are used in maintenance treatment of opioid withdrawal? Which is preferred in the majority of cases?

A

Methadone - first choice, people settle better

Buprenorphine

26
Q

Name a contraindication to Methadone?

A

Long QTc interval. Methadone may prolong this and induce Torsades de points and sudden cardiac death.

27
Q

In what situations would Buprenorphine be used over Methadone for opioid maintenance therapy?

A

Previous bad experiences with methadone
Prefer ‘clear head’ response of buprenorphine over the ‘clouding’ of methadone and heroin
Hx of relapsing whilst taking methadone
Abnormal LFTs - buprenorphine is less affected by liver enzymes

28
Q

How is compliance to opioid maintenance therapy monitored?

A

Urine tests

29
Q

What drugs are used in opioid detox? What determines the drug of choice?

A

Methadone
Buprenorphine

Detox normally uses same opioid as that in maintenance.

30
Q

What important safety advice should be given whilst a patient is undergoing opioid detox?

A

Advise about the risks of overdose due to loss of tolerance.

This risk may be potentiated by use of alcohol or benzodiazepines.

31
Q

How quickly do withdrawal symptoms appear in opiate-dependent individuals? How long does withdrawal last?

A

6-24hrs after last dose

Withdrawal typically lasts 5-7 days

32
Q

What is the mechanism of action of Methadone?

A

Long-acting full mu-opioid agonist. 24hr half-life, OD

33
Q

Why is methadone the first choice of treatment for opioid dependency?

A

Long-acting opiate taken OD - increases compliance
Full agonist of opioid receptors
Cannot be injected due to high viscosity

34
Q

What is the mechanism of action of Buprenorphine?

A

Partial opiate agonist.

35
Q

What medication can be prescribed to prevent opioid relapse?

A

Naltrexone - opiate antagonist

36
Q

What are the desirable effects of antidepressants?

A

GABA Receptor agonists
Anxiolytic
Relaxant
Counteracts side-effects of other drugs

Hypnotic
Anticonvulsant

37
Q

How can benzodiazepines be taken?

A

Orally

Injection

38
Q

What acute medical problems are associated with benzodiazepines?

A

Forgetfulness
Drowsiness
Impaired concentration and coordination
Increased risk of accidents

39
Q

How does benzodiazepine overdose present?

A 
"Classic" isolated OD: Coma with normal vital signs
Dizziness
Confusion
Drowsiness
Anxiety and agitation
40
Q

Name 3 symptoms of benzodiazepine withdrawal

A 
Anxiety and agitation
Depression
Insomnia
Tremor
Headache and nausea
Depersonalisation

Can be complicated by seizures and delirium

41
Q

What are the main reasons for prescribing less benzodiazepines in primary care?

A

Tolerance

Dependence

42
Q

What drug is used in substitute prescribing of benzodiazepine dependency?

A

Diazepam, for is long half-life and variety of strengths and formulations.

43
Q

What is the mechanisms of action of Diazepam?

A

Long-acting GABA agonist

44
Q

When do withdrawal symptoms appear in benzo-dependent individuals?

A

Appear within 24hr of last short-acting benzodiazepine, may be up to 3 weeks for long-acting benzodiazepines.

45
Q

What are the route of cocaine abuse?

A

Inhaled/snorted
Injected
Smoked - crack cocaine

46
Q

What are the desirable effects of cocaine?

A

Increased alertness and endurance
Diminished need for sleep
Euphoria
Confidence

Local anaesthetic at mucous membranes

47
Q

Name 2 acute medical problems associated with cocaine

A

Arrhythmias
Intense anxiety
Hypertension ➔ stroke
Impulsivity and impaired judgement

48
Q

Name 2 chronic medical problems associated with cocaine

A

Necrosis of nasal septum
Foetal damage
Panic and anxiety disorders
Psychosis - esp persecutory delusions

49
Q

Outline the management of cocaine abuse

A

Harm reduction advice.

Cocaine is not associated with dependence, so there is no role for substitute prescribing.

50
Q

How is MDMA taken?

A

Orally

51
Q

What is the mechanism of action of MDMA?

A

Causes serotonin release, and inhibits reuptake

52
Q

What are the desirable effects of MDMA?

A

Feeling of increased camaraderie
Pleasurable agitation
Hallucinations
Decreased fatigue - stimulant properties

53
Q

Name 2 acute medical problems associated with MDMA

A

Increased sweating ➔ deaths associated with dehydration
Nausea
Vomiting
Decreased potency despite increased libido

54
Q

Outline the management of MDMA abuse

A

Harm reduction advice.

MDMA is not associated with dependence, so there is no role for substitute prescribing.

55
Q

How can cannabis be taken?

A

Smoked

Eaten

56
Q

What are the immediate effects of cannabis?

A 
Mild euphoria - giggles
Sense of enhanced wellbeing
Relaxation
Altered time sense
Increased appetite - munchies
57
Q

Name 2 acute medical problems associated with cannabis?

A

Mild paranoia
Panic attacks
Accidents due to delayed reaction time

58
Q

Why is it important to ask specifically about cannabis in psychiatry?

A

Cannabis use can precipitate an episode or relapse of schizophrenia.

Regular use is associated with paranoid ideation and other psychotic features.

Mental health (27 decks)

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