Substance Use Disorder Flashcards
What is the definition of alcohol dependence syndrome?
Occurs when an individual is physically or psychologically dependent upon alcohol.
What are some clinical features of alcohol withdrawal?
Restlessness and tremor
Sweating
Anxiety
Nausea and vomiting
Loss of appetite
Insomnia
Tachycardia and systolic hypertension
Generalises seizures
Can progress to delirium tremens (medical emergency)
Usually resolves in 5-7 days
What are some clinical features of delirium tremens?
Confusion
Disorientation and agitation
Hypertension
Fever
Visual and auditory hallucinations
Paranoid ideation
Peak onset within 2 days of abstinence
What are the criteria for diagnosing alcohol/drug dependence?
3 or more present together at some time in past year:
- Strong desire/compulsion to take drug
- Difficulty controlling use of substance (onset, termination, or level of use)
- Physiological withdrawal state
- Evidence of tolerance
- Progressive neglect of pleasures/interests
- Persistence with use despite clear evidence of harmful consequences
What is the management of assisted alcohol withdrawal?
Long acting benzodiazepine (chlordiazepoxide, diazepam)
What is the management of delirium tremens or seizures in alcohol withdrawal?
Fast acting benzodiazepine (lorazepam)
What drugs are used to reduce alcohol cravings to prevent relapse in alcohol dependence?
Acamprosate
Naltrexone
What drug is used to prevent relapse in alcohol dependence by causing the patient to become sick when they drink alcohol?
Disulfiram
What is general treatment of alcohol dependence syndrome?
Reassurance and advice
Vitamin supplementation including thiamine as Wernicke’s encephalopathy prophylaxis
Medical treatment
Relapse prevention
What is the definition of opioid dependence?
Continuous compulsion to use opioids despite physical, psychological or social harm due to use.
What drugs are opioids?
Heroin
Fentanyl
Prescription drugs (codeine, morphine)
What is the pathophysiology of opioid dependence?
Drug induced high is mediated by mesolimbic dopamine pathway
What are some clinical features of opioid intoxication?
Drowsiness
Confusion
Decreased RR
Decreased HR
Constricted pupils
Evidence of needle marks, abscesses, vein collapse at injection sites
What are some clinical features of opioid withdrawal?
Agitation/anxiety
Muscle aches/cramps
Chills
Runny nose and eyes
Sweating
Yawning
Insomnia
GI disturbance
Dilated pupils
Goose bumps
Increased HR and BP
Usually occur within 12 hours of stopping drug and are unpleasant but not life-threatening
What is the management of assisted opioid withdrawal?
Opioid replacement with Mu receptor agonists:
- Methodone (full agonist) (usually first line)
- Buprenorphine (partial agonist)
