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DPD > Substance misuse in the clinical specialties > Flashcards

Substance misuse in the clinical specialties Flashcards

1
Q

categories of drugs and examples

A

depressants

  • opioids, benzodiazepines, alcohol

stimulants

  • cocaine, amphetamines, NMDA, caffeine

hallucinogens

  • LSF, PCP, ketamine

cannabis, nicotine

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2
Q

epidemiology of substance abuse

A

UK highest user in Europe of amphetamine

cocaine most used

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3
Q

what are club drugs

A

recreational drugs in parties etc

amphetamine, methamphetamine, MDMA, cocaine

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4
Q

what are novel psychoactive substances

A

Newer drugs – more recently synthesised/misused

mimic club drugs - try to avoid the illegality of them - make tweaks to the molecule

legal highs - Now illegal

  • mephedrone (meow meow)
  • methoxetamine – ketamine ,
  • GHB/GBL – solvent

Could buy on internet, shops

not detected by urinary drug testing

ask and have high degree of suspicion, and ask what expected effect

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5
Q

where do novel psychoactive substances fit into the drug categories

A

depressants

  • GBL/GHB
  • phenibut

stimulants

  • m-cat
  • NRG-1
  • BZP
  • MDAI
  • synthacaine
  • 5/6-APB

hallucinogens

  • AMT
  • methoxetamine

spice

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6
Q
A
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7
Q

most harmful drug to the user

A

crack cocaine

on basis of death, illness, dependence, psychiatric, social losses

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8
Q

brain pathways involved in addiction

A

Pathways that lead to reward in the nucleus accumbens

Mediators around dopamine/opiate receptors in nucleus accumbens that become reinforcing

Same pleasure get from drug as activities, both may be mediated through reward system in brain

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9
Q

what is the most harmful drug to society

A

alcohol

in terms of: harm to others, crime, env, family, international, economic cost, community

No rationale why harmful things are legal, and illegal things are more harmless

Just because a drug is more illegal doesn’t mean it is more harmful

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10
Q

why do people use substance

A

intoxication:

  • social lubrication,
  • pleasure seeking,
  • reason to counter stress or pain,
  • peer pressure – social industry to use illicit substances
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11
Q

what can intoxication syndrome lead to

A

disinhibition, risk taking, aggression, dyspraxia

OD = coma, illness, injury, death

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12
Q

ICD-10 classification of dependence

A

dependant of 3 or more:

  • strong desire or compulsion to use
  • difficulty controlling use/amount/recidivism (unable to quit)
  • tolerance of effect
  • neglect of activities/primacy (putting drug 1st)
  • persistent use despite adverse consequences
  • withdrawal sx

Narrowing of repertoire – narrative description but not one of criteria – focus down and use narrower type of substance or in a certain way

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13
Q

harms caused by drugs

A

drug specific mortality

drug related mortality

drug specific damage

drug related damage

dependence

drug specific mental disturbance

drug related mental disturbance

loss of tangibles

loss of relationships

injury

crime

env damage

family adversities

economic damage

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14
Q

effects of alcohol

A
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15
Q

withdrawal sx

A

vary depending on the drug

Withdrawal syndrome will vary depending on the drug

Depressants slow brain down –> brain upregulates everything to counteract. If suddenly stop taking the drug – still accelerater.

Opiate – uncomfortable:

  • sweats, shaking, muscle aches, nausea, diarrhoea, gooseflesh

GHB and alcohol – work on GABA – withdrawal seizures

irritability, depression, delerium, psychosis

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16
Q

Mx of withdrawal sx

A

Always want to predict and prevent – encourage people to wean themselves off

Or cross intoxicate something that you can gradually reduce in safe way eg heroin -> methodrone?

alcohol -> benzodiazepine eg Chlordiazepoxide

17
Q

why do people become addicted

A

chronic relapsing brain disorder - has neurobiological changes -> compulsion to taking drug and loss of control

transition from recreational to obsessive use

Go from positive reinforce because doing it is fun

To negative because not doing is not fun

psychological factors drive behaviour

d2 receptor availability does change - Need more of the substance to have the reward

shift homeostatic point downwards – to reach steady state mood need the +ve encouragement of the substance

18
Q

why do you get alcohol withdrawal

A

alcohol increases inhib GABA-R activity

antagonises excitatory NMDA-R

withdrawal = increased excitatory activity

= delerium tremor, shake and seizures

19
Q

substance misuse history

A

everyone

where - every encounter

what substances

current use - quantity, which route(s), when/why - pattern – eg if use to give confidence = address anxiety. pain – mx pain

history - first use, first regular use, heaviest use/cumulative use eg spliff yrs

features of withdrawal/dependence

negative effects - physical, psychological or social

20
Q

what is ABV

A

units you would have in 1L

21
Q

substance misuse signs o/e

A

signs of injecting:

  • punctures, track marks
  • cellulitis, DVT, bacterial endocarditis

signs of inhaled drug use

  • burns, stains, resp signs

signs of intoxication/withdrawal - mental state/pupils

signs of acquired illness due to drug use

  • hepatitis (alcohol, HBV, HCV), HIV, injuries

signs of intoxication - change to pupils

22
Q

heart features from cocaine

A

Cardiomegaly – coronary artery vasospasm

23
Q
A

Insufflation of corrosive substances

24
Q

tests for frontal lobe dementia

A

luria’s dist palm edge motor sequencing

stroop test of inhibition - ask pt to read out the colour and not the word

understanding of proverb’s and metaphors – this language is processed in the frontal lobe.

verbal fluency - ability to generate words eg beginning with F. if deficit get stuck in one set of thing – eg all kind of the same thing. Or jump to expletives

25
Q

drug use and sexual health

A

more likely to have unprotected sex under alcohol influence, that they regret or wouldnt normally find attractive

increase in legal age and tax = reduction in STIs

26
Q

crystal methamphetamine

A

stimulant

easily sythesised

smoked/injected/PO/nasal/PR

risk with HIV/HCV

association with ‘chem sex’

associated with psychosis

27
Q

epidemiology of crystal meth

A

Prevalent in small populations in UK, London in particular

more in gay men

more in gay men who use gym

HIV +ve gay men more than HIV -ve

28
Q

-ve effects of crystal meth on HIV

A

weakened immune system/nutrition

poor compliance with ART

drug interactions with ritonavir

risks of drug resistant HIV

other STIs - syphillis, HBV, HCV

29
Q

alcohol use in OBGNY

A

infertility - disrupted menstrual cycle, impotence, low sperm count/motility

pregnancy - placental transmission, spontaenous miscarriage, foetal alcohol spectrum disorder: (restricted growth, behavioural/learning difficulties, facial abnormalities)

breast feeding

need to safeguard

30
Q

substance use and DVLA

A

ensure pt knows condition affects ability to drive

make every effort to get pt to stop driving

disclose relevant info to medical advisor at DVLA

multiple substance misuse (inc alcohol) is incompatible with licensing fitness

  • alcohol persistent use - 6mo
  • alcohol dependence - 12mo
  • cannabis, e, speed - 6mo
  • heroin, cocaine, meth - 12mo
31
Q

legal limit of alcohol

A

Daily recommended allowance 1-2units a day, men 2-3. Should also have alcohol free days

Used to be <14 units/week

Massive underestimate of units

32
Q

effect of alcohol consumption as medical professional

A

medical students reporting excessive drinking were less likely to counsel patients about alcohol misuse or see it as relevant

have responsibility to offer treatment to people with alcohol problems

put career at risk - GMC

may be using alcohol for stress/depression/anxiety - get help

recreational drugs illegal so even if doesnt affect practice you can be struck off

alcohol - fine, but if becomes a problem -> struck off

33
Q

paddington alcohol test

A

Number 3 is the most important – this is a trigger to give brief advice or offer referral

As a public health intervention

This is detecting whether the patient has any insight into the idea it is causing an effect

34
Q

stages of change

A

At any stage it is possible to go back to an earlier stage

Paddington test is to move people from pre-contemplation to contemplation

This is a brief intervention

35
Q

‘identification and brief advice (IBA)’ for alcohol

A

identify problem drinkers

provide brief feedback/advice

offer further support to drinkers experiencing harm

for every 8 people who recieve simple alcohol advice - 1 will lower drinkung to within lower risk levels

36
Q

Mx if people drinking excessively

A

Stabalise people on current drinking – interventions eg drink diaries or monitor the amount they spend

Cross intoxicate eg methadone or chlordiazepoxide

Detox people – gradually reduce the amount they are consuming until abstinent – then need to rehab ie learn to live w/o the substance – need lifestyle changes

DPD (38 decks)

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