Substance Use Disorders Flashcards
Stages of change
1) precontemplation
2) contemplation
3) determination
4) action
5) maintenance
6) recurrence
3 most commonly used drugs in Singapore
1
1) methamphetamines
2) cannabis
3) heroin
What are the two types of alcoholism?
Type I: ‘millieu-limited’ and Type II: ‘male-limited’
Type I affects both men and women, has a later onset, and involves more environmental factors. Type II is male-limited, has an early onset, and is associated with genetic factors.
What characterizes Type I alcoholism?
Later onset, less family history, anxious, harm avoidant, low novelty-seeking, low criminality, more environmental factors
Type I alcoholism is often influenced by environmental factors rather than genetic predisposition.
What characterizes Type II alcoholism?
Early onset, usually men, family history, risk-taker, aggressive, antisocial personality disorder, less environmental factors
Type II alcoholism is typically inherited from father to son.
What is Wernicke Encephalopathy?
Secondary to thiamine deficiency; triad: ataxia, confusion, ophthalmoplegia
Wernicke encephalopathy is a serious condition that requires immediate medical attention.
What is Korsakoff syndrome?
Amnesia secondary to chronic alcohol abuse, involvement of mamillary bodies
Symptoms include impaired recent memory, inability to recall past events, and confabulation.
What is the most sensitive indicator of alcoholism?
Carbohydrate deficient transferrin (CDT)
CDT is commonly used in clinical settings to identify alcohol abuse.
What does an increased Gamma-glutamyltranspeptidase (GGT) level indicate?
Earliest indicator of alcohol relapse; specific: 4+ drinks/day for 2 weeks will increase GGT ≥ 30 units/L
GGT is a liver enzyme that can rise with alcohol consumption.
What is the mean corpuscular volume (MCV) threshold for male alcoholics?
≥95 in male alcoholics, ≥100 in females
MCV can be used as a diagnostic tool in assessing alcohol-related conditions.
What is the management for moderate to severe alcohol withdrawal?
Thiamine IM (vitamin B1) to prevent Wernicke encephalopathy; benzodiazepines for withdrawal seizures
Thiamine is critical for preventing neurological complications.
What is Naltrexone used for?
Opioid receptor antagonist; reduces euphoria and craving for alcohol
It is particularly effective for individuals with a family history of alcohol dependence.
What is Acamprosate?
Used for alcohol use disorder
NMDA glutamate receptor antagonist; useful to maintain abstinence and decrease cravings
It is beneficial for patients with anxiety, physiological dependence, and negative family history.
What is Disulfiram and how does it work?
Aversive agent that blocks aldehyde dehydrogenase, causing acetaldehyde accumulation
Only used in compliant patients who are highly motivated to prevent relapse
This leads to symptoms like sweating, headache, and nausea, thereby deterring alcohol use.
True or False: Type II alcoholism is associated with a higher environmental influence compared to Type I.
False
Type II alcoholism has less environmental influence and is more genetically driven.
Fill in the blank: The triad of Wernicke Encephalopathy includes ataxia, confusion, and _______.
ophthalmoplegia
This condition is critical and requires immediate treatment to prevent further neurological damage.
What contraindication is associated with Acamprosate?
Severe renal impairment
Renal function should be assessed before prescribing Acamprosate.
What are the forms of Nicotine Replacement Therapy?
- Patch
- Gum
- Inhaler
These are common methods to help manage smoking cessation by providing a controlled dose of nicotine.
What is the duration for using Bupropion to prevent relapse?
8 weeks, up to 1 year
Bupropion is used in smoking cessation to reduce cravings and withdrawal symptoms.
What are some contraindications for using Bupropion?
- Seizure
- CNS tumour
- Bipolar disorder
- Alcohol withdrawal
- BZD withdrawal
- Use of MAOI
- Anorexia
- Bulimia
- Liver disease
These conditions may increase the risk of adverse effects or complications when taking Bupropion.
What is Varenicline classified as?
Nicotinic agonist
Varenicline works by stimulating nicotine receptors in the brain, helping to reduce withdrawal symptoms and cravings.
Stages of Alcohol Withdrawl Syndrome
1) Initial withdrawal: 6-8 hours
- tachycardia, HTN, insomnia, anxiety
2) Alcoholic hallucinosis: 12-24 hrs
3) Withdrawal seizures: 12-48hrs
- GTC seizures
4) Delirium tremens: 3-5 days
- rapid onset
- fluctuating attention/cognition + withdrawal symptoms and autonomic instability
- 1-4% mortality
What is the first stage of opioid withdrawal?
Craving for drug, lacrimation, rhinorrhea, yawning, diaphoresis
Stage 1 occurs within hours of the last dose.
What symptoms characterize Stage 2 of opioid withdrawal?
Mild-moderate sleep disturbance, mydriasis, anorexia, piloerection, irritability, tremors
Stage 2 begins at 12 hours and peaks at 72 hours.
List the symptoms of Stage 3 opioid withdrawal.
- Severe insomnia
- Violent yawning
- Weakness
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Chills
- Fever
- Muscle spasms
- Flushing
Stage 3 is the most severe stage of withdrawal.
What are the management strategies for opioid withdrawal?
- Rest
- Nutrition
- Assurance
- Methadone
- Clonidine
- NSAID for pain
- Imodium for diarrhea
Methadone is a mu receptor agonist and clonidine is a presynaptic alpha2-adrenergic agonist.
Fill in the blank: Methadone is a _______.
[mu receptor agonist]
Methadone is used in the management of opioid withdrawal.
What medication to reverse benzodiazepine overdose
Flumezanil
DO NOT use in chronic BZD abuse - can cause withdrawal seizures
What are some psychiatric comorbidities associated with cocaine use?
Depression, appetite problems, panic attacks, psychosis
These comorbidities are common in individuals using cocaine.
What receptor site does cocaine primarily act on?
Dopamine receptors
Cocaine’s action on dopamine receptors leads to significant effects on mood and behavior.
What is the result of dopamine release from neurons in the nucleus accumbens due to cocaine?
Intense euphoria
This is a key reason for cocaine’s addictive properties.
What are the management options for cocaine overdose?
- Benzodiazepines
- Alpha/beta blockers
These medications can help mitigate the symptoms of overdose.
What is a notable effect of methamphetamine (ice) on users?
Rapid aging effect
Users of methamphetamine can appear to age much more quickly than non-users.
Management of methamphetamine abuse is similar to the management of which condition?
Pheochromocytoma
This suggests overlapping treatment strategies for managing symptoms.
What are some common names for cannabis?
Grass, ganja, weed
What is one risk associated with cannabis use?
Risk of developing schizophrenia
Which genotype is associated with an increased risk of developing schizophrenia after cannabis use?
VAL/VAL homozygous genotype
List some cannabis induced disorders
- Intoxication
- Intoxication delirium
- Cannabis-induced psychotic disorder
- Cannabis-induced anxiety disorder
What are some behavior changes associated with cannabis use?
- Impaired motor coordination
- Euphoria
- Anxiety
- Sensation of slowed time
- Impaired judgement
- Social withdrawal
What are some signs of cannabis intoxication?
- Conjunctival injection
- Increased appetite
- Dry mouth
- Tachycardia
What is PCP?
Phenylcyclidine (Angel dust)
PCP increases dopamine and glutamate levels in the brain.
What are the symptoms of PCP use?
- Psychosis
- Impulsive behavior
- Aggression
- Agitation
- Nystagmus
Nystagmus refers to involuntary eye movement.
What is a special form of PCP?
Ketamine
Ketamine can lead to ulcerative cystitis and symptoms like cramps, fatigue, depression, and irritability.
What condition is Esketamine used to treat?
Treatment-resistant depression
Esketamine is administered only under supervision in medical wards.
How is LSD typically consumed?
As a sticker that dissolves on the tongue
LSD is also known as Acid.
What is synesthesia?
The ability to see music or associate colors with smells
Synesthesia is often reported during LSD use.
What is a ‘bad trip’ in relation to LSD?
Drug effects that persist even without drug use
This can lead to lasting psychological effects.
What are psilocybin mushrooms commonly known as?
Magic mushrooms
Psilocybin is not addictive but can lead to tolerance with repeated use.
What are the effects of psilocybin similar to?
LSD
Effects include illusions, pseudohallucinations, and synesthesia.
What happens if psilocybin is consumed two days in a row?
Tolerance develops
This means the user may need more of the substance to achieve the same effects.
