Substance Use and Addictions Pt.2 Flashcards
unit equation for alcohol
% strength x ml /1000 = units
safe recommended limits for men and women (alcohol) a week
14 units per week
excretion rate of alcohol
1 unit per hour
signs of harmful use or dependency of alcohol
drink in morning, hot/sweaty, retching, abdo pain, tremor, loss of control, restricted interests, distressed if can’t get alcohol
opiate withdrawal symptoms
Tachycardia Sweating Restlessness Dilated pupils Bone aches Runny nose GI upset Tremor Yawning Anxiety/Irritability Gooseflesh skin
criteria for harmful use
pattern of substance use that causes damage to health, damage may be: (1) physical or (2) mental (NECSAARY FOR DIAGNOSIS), adverse social consequences, includes bingeing on substances. Does not include ‘hangover’ alone,
can a patient have a diagnosis of both harmful use and dependence?
no
history taking in addiction
presenting complaint history of presenting complaint substance misuse history family history psychiatric comorbidity social history
substance misuse history
Length of current use and when last used.
Current amount and for how long at this level.
Total length of use, max use, and any periods of abstinence.
Mode/method of use
Evidence of withdrawals and severity
Any previous treatments
Any previous substance overdoses
Assess triggers to use substances/alcohol
Assess motivation to change/engage in treatment
common comorbid conditions in addiction
Depression Anxiety Suicidality Personality Disorder PTSD Bipolar Disorder
list major causes of morbidity and mortality
associated with substance abuse
Trauma (e.g. fractures) Road Traffic Accidents Homicide Suicide Overdose (deliberate, and frequently accidental) Cirrhosis (Alcohol) Endocarditis (IV) Abscesses (IV) BBV: Hepatitis B/C & HIV (IV)
aspects of examination specific to alcohol
Comment on the presence of jaundice, anaemia, clubbing, cyanosis, oedema, ascites, lymphadenopathy, DVT
aspects of examination specific to opioids
Collapsed veins / track marks Endocarditis Skin abscesses Hepatitis / HIV Pneumonia
CAGE screening for alcohol
ever felt the need Cut down?
have people annoyed you by criticizing your drinking?
ever felt Guilty about drinking?
ever felt you needed a drink first thing in the morning (Eye-opener)?
is opiate or alcohol withdrawal more dangerous?
alcohol
what withdrawal sign is considered a medical emergency?
delirium tremens
onset of alcohol withdrawal is usually?
6 hours
what happens as withdrawal continues?
worsening pattern of symptoms
what effect do opioids have?
analgesic
euphoric
what receptors are affected by opiates?
opioid receptors mu, delta, kappa
list opioid agonists
heroin
methadone
fentanyl
codeine
list partial opioid agonists
buprenorphine
list opioid antagonists
naltrexone
define opiate
refer to naturalopioidssuch as morphineandcodeine, and heroin to some extent
define opioid
refer to all natural, semisynthetic,andsyntheticopioids
list natural opioids
opium
morphine
codeine
thebaine
list synthetic opioids
fentanyl
pethidine
methadone
tramadol
list semi-synthetic opioids
heroin
hydrocodone
oxycodone
hydromorphone
signs of opiate overdose
not moving and can’t be woken, slow or no breathing, choking, gurgling or snoring, tiny pupils, clammy or cold skin, blue lips and blue nails
management of opiate overdose
inject naloxone into upper arm or thigh or nasal spray > if no response after 3 mins > repeat, provide airway support, recovery position
list alcohol abstinence drugs
acamprosate
disulfiram
naltrexone
nalmefene
list alcohol detox regimes
benzodiazepines
list opioid abstinence drugs
methadone
buprenorphine
opioid detox regime
maintenance treatment for at least 12 months to sustain changes > lifestyle reduction
list benzos/G drugs abstinence regime
maintenance on diazepam with reducing regime
benzos/G drugs detox regime
baclofen (GABA agonist)
benzos
G drugs refers to what?
GHB (gamma hydroxybutyrate)
GBL (gamma butyrolactone)
G should never be mixed with?
alcohol
can be fatal
effects of G
depressants
produces a high in small doses
sedation at higher doses
what do people report the effects of G to be?
euphoria
loss of inhibitions
increased confidence
higher sex drive
which G drug is a precursor?
GBL precursor to GHB
