substance use disorder-drugs

Question 1

history taking

Answer 1

1. initial heroin use reasons
2. cont heroin use due to pleasurable effect (euphoria,analgesis,sleep)
   3.more freq and excessive use to enjoy(positive reinforcement)
   4.development of social complications
   5.ellicit symptoms of dependence
   describe withdrawal symptoms
3. route of administration(chase,smoke,IVDU)
   7.other drug of use if any
   8.medical complication due to heroin use
   9.psychiatric disorders induced by heroin & comorbid psychiatric disorders

Question 2

state complications due to overdose

Answer 2

coma
risk of vomitus aspiration
respiratory distress due to overdose
delirium due to overdose

Question 3

state complications due to IVDU

Answer 3

blood borne infections (hepatitis B/C, HIV, bacterial endocarditis, septicemia,osteomyelitis)

air embolism
thrombophlebitis,cellultis,local abscess due to infected needles.
faulty inj into art causing ischaemia and gangrene in the limbs

Question 4

symp of opiod intoxication and antidote

Answer 4

pinpoint pupil
coma
respiratory depressin

antidote:Naloxone HCL,IV-competitive opioid recptor antagonist

Question 5

classical withdrawal symptoms of heroin
-opp of opoids pharma effect
-“ everything is running”

Answer 5

• mind:craving,anxiety,dysphoria

-eyes: pupillary dilation,lacrimation,insomnia

nose: rhinorrhoea

mouth:yawning

body:fever,muscle ache,piloerection,sweating

abdomen:nausea,vomiting,diarrhoea,cramps

genitalia: orgasmic ejaculation

Question 6

investigations

Answer 6

CBC-nitrition,infection
Urine:+ for morphine,other drug use
hepatitis B & C screening
HIV if indicated
LFT,to iniate methadone
ECG

Question 7

Management of dependence

Answer 7

total abstinence
short term(detox): manage med emergency and withdrawal
long term (rehabilitation)-relapse prevention,maintaining abstinence

Question 8

most important harm reduction strategy in Malaysia

Answer 8

methadone program

Question 9

cannabis/ganja use

Answer 9

-tetrahydrocannabinol
-hallucinogen
-no physical withdrawal symptoms
-only psychological dependence( craving & preoccupation)

psychiatric complications
-flashback experiences
-transient psychosis
-amotivational syndrome
-many users switch to heroin
-common comorbidity in schizo

Question 10

Amphetamine type stimulants (ATS)

Answer 10

-Shabu,ice,ectasy
- effect on brain
Euphoria
Inc concentration
Inc energy
Insomnia
Anorexia with weight loss

-withdrawal symptoms (opp)
depression
inattention
anergia
hypersomnia
inc appetite

complications
-CNS: dementia,delirium,hemorrhage
-CVS:arrhythmia
-schizophrenia like psychosis*

Question 11

solvent abuse/inhalant related disorders

Answer 11

exo: petrol,aerosol(spray paint),varnish remover,glues,cleaning fluid
active ingredient: toulene,benzene,acetone,halogenated hydrocarbons

effects:inital euphoria followed by drowsiness
intoxication on cont use: confusion,impaired judgement,impulsive & aggressive behavior ,stupor,coma

toxicity: respi dep,asphyxiation,accidents

chronic use: hepatorenal damage,aplastic anaemia,arrhythmia,polyneuropathy,cerebral damage