Substance Use Disorders Flashcards
Who are the heaviest drinkers?
Young men (late teens/early 20s)
What classifies as binge drinking?
> 8 units for men
6 units for women
in one sitting
Why do asians get asian flush?
Ethanol > acetaldehyde > broken down via ADH (ALDEHYDE DEHYDROGENASE)
Asians have ineffective ADH > excess acetaldehyde accumulation > red face, nausea, palpitation
What drinks are 1 unit of alcohol?
Half a pint
small glass of wine
Single spirit shot
What phenomenon occurs with alcohol withdrawal?
Delirium tremens
How long into alcohol withdrawal does delirium tremens occur?
48h-72h
How long does DT last?
3-4 days
What are symptoms of delirium tremens?
- acute confusion
- psychotic sx (hallucinations (visual, insects, Lilluputian), delusions)
- seizures
How do you treat delirium tremens?
Long acting Benzodiazepine (chlordiazepoxide) reducing regimen
Pabrinex IV/IM
What is the cause for Wernicke’s encephalopathy?
Acute thiamine (B1) deficiency
What is triad of symptoms in Wernicke’s?
Ataxia
Confusion
Opthalmoplegia
What are two symptoms of Korsakoffs?
Amnesia
Confabulation
What is alcoholic hallucinosis?
auditory hallucinations in clear consciousness during/after heavy drinking
What are symptoms of IV opioid intoxication?
euphoria
warmth
well being
What are symptoms of IV opioid withdrawal?
dilated pupils dysphoria (miserable) restless insomnia diahrroea, vomiting sweating lacrimation rhinorrhea
What are causes of death with IV opioid?
respiratory failure
aspiration on vomit
What can you give to prevent relapse in alcoholics?
Acamprosate (anticraving drug)
Disulfiram (inhibits ADH > excess acetaldehyde > unpleasant symptoms)
What could you substitute prescribe for opioids?
Methadone
Buprenophine
what is tolerance
Larger dose of drug required for same effect
OR
Same level of drug produces lesser effect
What is withdrawal
symptoms that occur upon a substance leaving the system
What is the effect of alcohol on the brain acutely
Alcohol inhibits NMDA R > reduced excitation
Alcohol stimulates GABA R> increased inhibition
What does chronic use of alcohol cause on the brain
Upregulation of NMDA R
Down regulation of GABA R
Function remind normal as long as person keeps drinking
What occurs when someone suddenly stops drinking
Excess NMDA R, insufficient GABA R
This causes a state of hyper excitation
This leads to symptoms of withdrawal (agitation, irritability, seizures, delirium tremens)
What are symptoms of alcohol withdrawal
Headache
Nausea, retching, vomiting
Tremor, sweating, anxiety, agitation, insomnia, tachycardia
What is mortality of delirium tremens
5%
How do you assess alcohol misuse
CAGE questionnaire
DSM5 Criteria
AUDIT (Alcohol Use Disorder Identification Test)
SADQ (Severity of Alcohol Dependance Questionnaire)
Explain CAGE
Ever felt the need to Cut down
Ever get Annoyed at people criticising your drinking
Ever felt Guilty about your drinking
Eye opener
What investigations can you get specifically for alcohol misuse
FBC, B12, Folate (microcytic anaemia due to B12 deficiency)
LFTs (raised GGT in drinking, raised ALT, AST in hepatic damage)
How do you manage alcohol misuse
Assess motivation to change (Stages of Change Model)
Use BIOPSYCHOSOCIAL approach
- Social: refer to self help group (AA)
carer’s assessment
offer guided self help to families and provide resources about support groups (families anonymous)
- Psych support: offer psychological therapy
– CBT (challenges alcohol related conceptions)
- Motivational interviewing (counselling that empowers person to change)
- Bio: chlordiazepoxide (reducing dose), Thiamine
Consider admission to treat withdrawal
Relapse prevention
What things do you consider in admission to treat withdrawal
- > 30 units a day OR >30 on SADQ
- History of withdrawal fits / delirium tremens on previous withdrawal
- Regularly drinking 15-30U + comorbidity
- LOWER THRESHOLD IF VULNERABLE (e.g. homeless)
How do you prevent relapse of alcohol
BIOPSYCHOSOCIAL MODEL
Social: AA (self help, group support in community)
Psycho: CBT, Motivational interviewing
Bio: Disulfiram, Acamprosate
What re symptoms of opiate overdose
bradycardia
respiratory depression
pinpoint pupils
How do you manage opiate overdose, and what should you keep in mind
Naxolone IV
It is SHORT ACTING, so you may have to give repeated doses
How do you manage opioid misuse
Biopsychosocial
Social: support group in community (narcotics anonymous)
Psych: CBT, motivational interviewing
- appoint a key worker
Bio;:
- Harm reduction: avoid needle exchanges if IVDU, vaccination and testing for BBV
- substitute prescribing (methadone - liquid, buprenorphine - sublingual)
- withdrawal symptoms (clonidine, lofexidine)
Prevent relapse: naltrexone
How do you meet family/carers needs for alcohol abuse
Offer carer’s assessment if necessary
Offer guided self he
What formal assessment do you use to assess scale of withdrawal?
CIWA-A
Clinical Institute Withdrawal Assessment for Alcohol
What should you offer for withdrawal if >15 U per day or >20 on Audit
Community based assisted withdrawal through CGL (Change, Grow, LIve)
what are community organisations for alcohollics
AA
SMART recovery
Change, Grow, Live
How do you manage opiate misuse if not planning to be abstinent
Pragmatic approach: assessing and minimising risk rather than insisting on abstinence
Provide information on improving safety of drug use
- NO needle exchanges
- vaccination and testing for blood borne viruses
What other services should you get involved for someone who wants to stop using?
Refer to drugs and alcohol service
Appoint Key Worker
PACES STATION: outline management of patient who wants to quit
- Explain features of withdrawal - explain timescale
- Explain detox regime (give a substitute that will diminish symptoms of withdrawal)
- Explain that symptomatic treatment can also be given to reduce nausea, diarrhoea, autonomic sx
- Explain role of psychological therapy
- Explain role of key worker
- Get test for blood borne disease and vaccinations
- Support: NA, SMART Recovery
