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year three exam 2 > substance use and misuse > Flashcards

substance use and misuse Flashcards

1
Q

what are the potential harms of substance use and misuse

A
  • Psychological issues
  • Socio-economic issues
  • Physical consequences
  • Addiction or diversion
  • Physical consequences
  • Route of administration
  • Self-neglect
  • Poor pregnancy outcomes
    Withdrawal symptoms
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2
Q

what are the risk factors for substance use and misuse

A
  • Family history of substance abuse
  • History of pain
  • Easy access to medicines
  • Difficult life events
  • Time spent in secure environments
  • Chronic/severe mental/physical health problems
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3
Q

what are the behavioural warning signs for substance use and misuse

A
  • Taking a higher dose than prescribed
  • Running out early
  • Continually losing meds
  • Healthcare professional shopping
  • Requesting specific medicines
  • Stealing or forging scripts
  • Drug hoarding
  • Risky behaviours
  • Unexplained falls
  • Debt
  • Reduced social function
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4
Q

what are the physical warnings signs of substance use and misuse

A
  • Presenting as intoxicated, sedated or withdrawing
  • Unkempt appearance
  • Mood swings
  • Changes in sleep patterns
  • Avoiding drug testing
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5
Q

what are the risk factors for alcohol dependence

A

genetics
starting at a young age
regular drinking
mental health problems
ignorance

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6
Q

what are the risks of long term high alcohol intake

A

death
liver damage
accidents
cancer
GI/mental health/social issues
brain damage
pancreatitis
social issues
heart disease
osteoporosis

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7
Q

what are the risks of chronic alcohol consumption on the CNS

A

cognitive impairment
wernicke korsakoff syndrome

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8
Q

what is wernicke korsakoff syndrome

A

acute onset neuropsychiatric disorder caused by thiamine deficiency - can go on to encephalopathy - confusion, apathy, disorientation and vomiting

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9
Q

how is wernicke korsakoff syndrome treated

A
  1. IM/IV pabrinex for 3-5 days
  2. maintenance thiamine 100mg TDS
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10
Q

what are the steps in managing alcohol dependency

A
  1. assessment
  2. detox
  3. assisted maintenance
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11
Q

how are patients detoxed from alcohol

A

chlordiazepoxide/oxazepam (in hepatic impairment)
- long acting benzo
- 20-40mg QDS or PRN
- risk of accumulation in elderly

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12
Q

what medications can be used for assisted maintenance in alcohol dependency

A

disulfiram
acamprosate
naltrexone
nalmefene

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13
Q

what is disulfiram

A

§ Aversive therapy - pro-drug
§ Prevents the liver converting acetaldehyde to acetic acid and dopamine to noradrenaline
When a person consumes a small amount of alcohol, mild symptoms of acetaldehyde and dopamine excess are experienced: vasodilation, palpitations and headache

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14
Q

what is acamprosate

A

glutamate antagonist
reduces reward from alcohol

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15
Q

what is naltrexone

A

§ Opioid antagonist licensed for alcohol misuse disorder
§ Blocks opioid receptors that modulate the release of dopamine in the brain reward system - blocking reward from alcohol and heroin

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16
Q

what is nalmefene

A

§ Opioid antagonist - reduces reward
§ When required for
□ Reduction strategy for those who have failed abstinence
□ For those who cannot achieve abstinence but require intervention with psychosocial support

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17
Q

what are the symptoms of alcohol withdrawal 6-30 hours after last drink

A

hyperactivity
tremor
sweating
nausea
retching
mood fluctuation
tachycardia
increased RR
HT

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18
Q

what are the symptoms of alcohol withdrawal 48 hours after last drink

A

withdrawal seizures

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19
Q

what are the symptoms of alcohol withdrawal 12 hours to 6 days after last drink

A

auditory and visual hallucinations

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20
Q

what are the symptoms of alcohol withdrawal 48-72 hours after last drink

A

delerium tremens
- coarse tremor
- agitation
- confusion
- delusions and hallucinations

21
Q

how is opioid dependence treated

A
  1. assessment
  2. detox
  3. maintenance
  4. gradual discontinuation
22
Q

how is opioid dependence detoxed

A

Replacement that prevents withdrawal but no high with symptomatic relief

23
Q

what are the symptoms of opioid withdrawal

A

runny nose/eyes
dilated pupils
yawning
nausea
vomiting
diarrhoea
muscle aches
restlessness

24
Q

what medications are used in maintenance for treating opioid dependence

A

methadone
buprenorphine

25
Q

what is buprenorphine

A

partial opioid agonist
not absorber orally
harder to supervise
cannot use on top

26
Q

what is methadone

A

full opioid agonist
long half life to suppress withdrawals and cravings
can use on top but it is dangerous
- has street value

27
Q

what medications can be used to support opioid users to come off of maintenance therapy

A

naltrexone
long acting opioid antagonist with high affinity
minimises reward from opioids and alcohol
Test dose of 25mg at least 7 days after last opioid dose, then 50mg/day

28
Q

what are the advantages to using methadone

A

good EBM
sedating
cheap
full agonist
variety of routes and forms
easy to supervise
orally absorbed

29
Q

what are the disadvantages to using methadone

A

easy overdose
can use on top
stigma
rots teeth
accumulation in fatty tissue
3 days to steady state
long detox
does not stop cravings

30
Q

what are the CNS S/E of methadone

A

euphoria
pain relief
drowsiness
N&V - triggers CTZ
Resp depression at high doses
cough reflex suppression

31
Q

what are the histaminergic S/E of methadone

A

itching
sweating
blushing
flushing
airway constriction

32
Q

what are the non-CNS S/E of methadone

A

absent menstrual cycle
sexual dysfunction
dry mouth/eyes/nose
dental issues
constipation
constricted pupils
QTc interval prolongation - r=monitor 6-12m

33
Q

what are the risk factors for QTc prolongation in methadone use

A

other meds prolonging QTc
hx of heart disease
stimulant use

34
Q

what are the advantages of using buprenorphine

A

difficult to use on top
safer in overdose
easier to detox/switch to naltrexone
less sedating
better newborn outcomes
rapid initial titration

35
Q

what are the disadvantages of using buprenorphine

A

not orall absorbed
pooer EBM
tastes bad
only one dosage form
less sedating
expensive

36
Q

what are the symptoms of opioid overdose

A

pinpoint pupils
N&V
pale skin
blueish tinge to lips, nose, under eyes, finger and nails
low BP
slow pulse
sedation

37
Q

how is opioid overdose treated

A

naloxone - opioid receptor antagonist

38
Q

when do you need to contact the prescriber of a opioid dependent patient

A

> 3 doses missed
intoxication
unacceptable behaviour
whole dose not consumed
concerns about mental/physical health needs

39
Q

what are the effects of using synthetic cannabis

A

agitation, tremor, confusion, hallucinations
tachycardia, hypertension, palpitations
renal damage

40
Q

what are the two CB receptors and what do they control

A

CB1 - brain - appetite, movement, higher cognitive functions, stress, nausea and pain
CB2 - periphery- immune function

41
Q

how does cannabis affect schizophrenia

A

moking in a susceptible person can cause
§ Exacerbation of mental health problems
§ Anxiety/panic attacks
§ Paranoia/psychosis
○ Smoking before 15 increases risk of psychotic illness 4 fold

42
Q

which illnesses have good evidence for cannabis use

A

chronic/neuropathic pain
paediatric epilepsies
nausea associated with chemotherapy
spasticity and pain in MS

43
Q

which illnesses have modest evidence for cannabis use

A

sleep disturbances
PTSD
chronic fatigue
migraine
restless legs
anxiety and stress

44
Q

what are the 4 disorders associated with caffeine

A

○ Caffeine intoxication
○ Caffeine induced anxiety disorder
○ Caffeine induced sleep disorder
○ Caffeine related disorder otherwise not specified

45
Q

what are the recommended daily maximum caffeine intake levels

A

500mg/day is moderate
600mg/day is caffeinism
>1000mg/day is toxic

46
Q

what are the signs and symptoms of low to moderate caffeine doses

A

passing more urine
tremor
increased physical stamina
anxiety
heart palpitations
nervousness

47
Q

what are the signs and symptoms of high caffeine doses

A

chronic insomnia
anxiety
restless legs
irritability and agitation
poor concentration
disorientation
paranoia
seizures
vertigo
hallucinations

48
Q

how should pregabalin be reduced

A

daily dose at a maximum of 50-100mg/week

49
Q

how should gabapentin be reduced

A

daily dose at a maximum of 300mg every 4 days

year three exam 2 (38 decks)

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