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Y5 Psych > Substance Use Disorders > Flashcards

Substance Use Disorders Flashcards

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1
Q

Who are the heaviest drinkers?

A

Young men (late teens/early 20s)

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2
Q

What classifies as binge drinking?

A

> 8 units for men
6 units for women
in one sitting

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3
Q

Why do asians get asian flush?

A

Ethanol > acetaldehyde > broken down via ADH (ALDEHYDE DEHYDROGENASE)

Asians have ineffective ADH > excess acetaldehyde accumulation > red face, nausea, palpitation

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4
Q

What drinks are 1 unit of alcohol?

A

Half a pint
small glass of wine
Single spirit shot

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5
Q

What phenomenon occurs with alcohol withdrawal?

A

Delirium tremens

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6
Q

How long into alcohol withdrawal does delirium tremens occur?

A

48h-72h

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7
Q

How long does DT last?

A

3-4 days

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8
Q

What are symptoms of delirium tremens?

A
  • acute confusion
  • psychotic sx (hallucinations (visual, insects, Lilluputian), delusions)
  • seizures
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9
Q

How do you treat delirium tremens?

A

Long acting Benzodiazepine (chlordiazepoxide) reducing regimen
Pabrinex IV/IM

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10
Q

What is the cause for Wernicke’s encephalopathy?

A

Acute thiamine (B1) deficiency

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11
Q

What is triad of symptoms in Wernicke’s?

A

Ataxia
Confusion
Opthalmoplegia

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12
Q

What are two symptoms of Korsakoffs?

A

Amnesia

Confabulation

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13
Q

What is alcoholic hallucinosis?

A

auditory hallucinations in clear consciousness during/after heavy drinking

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14
Q

What are symptoms of IV opioid intoxication?

A

euphoria
warmth
well being

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15
Q

What are symptoms of IV opioid withdrawal?

A 
dilated pupils 
dysphoria (miserable)
restless 
insomnia
diahrroea, vomiting
sweating lacrimation rhinorrhea
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16
Q

What are causes of death with IV opioid?

A

respiratory failure

aspiration on vomit

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17
Q

What can you give to prevent relapse in alcoholics?

A

Acamprosate (anticraving drug)

Disulfiram (inhibits ADH > excess acetaldehyde > unpleasant symptoms)

18
Q

What could you substitute prescribe for opioids?

A

Methadone

Buprenophine

19
Q

what is tolerance

A

Larger dose of drug required for same effect

OR

Same level of drug produces lesser effect

20
Q

What is withdrawal

A

symptoms that occur upon a substance leaving the system

21
Q

What is the effect of alcohol on the brain acutely

A

Alcohol inhibits NMDA R > reduced excitation

Alcohol stimulates GABA R> increased inhibition

22
Q

What does chronic use of alcohol cause on the brain

A

Upregulation of NMDA R
Down regulation of GABA R

Function remind normal as long as person keeps drinking

23
Q

What occurs when someone suddenly stops drinking

A

Excess NMDA R, insufficient GABA R
This causes a state of hyper excitation
This leads to symptoms of withdrawal (agitation, irritability, seizures, delirium tremens)

24
Q

What are symptoms of alcohol withdrawal

A

Headache
Nausea, retching, vomiting
Tremor, sweating, anxiety, agitation, insomnia, tachycardia

25
Q

What is mortality of delirium tremens

A

5%

26
Q

How do you assess alcohol misuse

A

CAGE questionnaire
DSM5 Criteria
AUDIT (Alcohol Use Disorder Identification Test)
SADQ (Severity of Alcohol Dependance Questionnaire)

27
Q

Explain CAGE

A

Ever felt the need to Cut down
Ever get Annoyed at people criticising your drinking
Ever felt Guilty about your drinking
Eye opener

28
Q

What investigations can you get specifically for alcohol misuse

A

FBC, B12, Folate (microcytic anaemia due to B12 deficiency)

LFTs (raised GGT in drinking, raised ALT, AST in hepatic damage)

29
Q

How do you manage alcohol misuse

A

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

30
Q

What things do you consider in admission to treat withdrawal

A
  • > 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)
31
Q

How do you prevent relapse of alcohol

A

BIOPSYCHOSOCIAL MODEL

Social: AA (self help, group support in community)
Psycho: CBT, Motivational interviewing
Bio: Disulfiram, Acamprosate

32
Q

What re symptoms of opiate overdose

A

bradycardia
respiratory depression
pinpoint pupils

33
Q

How do you manage opiate overdose, and what should you keep in mind

A

Naxolone IV

It is SHORT ACTING, so you may have to give repeated doses

34
Q

How do you manage opioid misuse

A

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

35
Q

How do you meet family/carers needs for alcohol abuse

A

Offer carer’s assessment if necessary

Offer guided self he

36
Q

What formal assessment do you use to assess scale of withdrawal?

A

CIWA-A

Clinical Institute Withdrawal Assessment for Alcohol

37
Q

What should you offer for withdrawal if >15 U per day or >20 on Audit

A

Community based assisted withdrawal through CGL (Change, Grow, LIve)

38
Q

what are community organisations for alcohollics

A

AA
SMART recovery
Change, Grow, Live

39
Q

How do you manage opiate misuse if not planning to be abstinent

A

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
40
Q

What other services should you get involved for someone who wants to stop using?

A

Refer to drugs and alcohol service

Appoint Key Worker

41
Q

PACES STATION: outline management of patient who wants to quit

A
  1. Explain features of withdrawal - explain timescale
  2. Explain detox regime (give a substitute that will diminish symptoms of withdrawal)
  3. Explain that symptomatic treatment can also be given to reduce nausea, diarrhoea, autonomic sx
  4. Explain role of psychological therapy
  5. Explain role of key worker
  • Get test for blood borne disease and vaccinations
  • Support: NA, SMART Recovery

Y5 Psych (17 decks)

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