Substances Flashcards
Age related changes that can affect alcohol
-less body water (where alcohol goes)and less lean body mass - so higher concentrations
Liver metabolism of alcohol does not seem to be altered
Key features of harm reduction as per alcohol guidelines
-humanism
-pragmatism
-individualism
-autonomy
-incrementalism
Harm reduction approaches to alcohol use in elder
-sipped not gulped
-diluted with non alcohol
-alternated with caffeine free and non alcohol drinks
-drink in full stomach
-don’t drink kn risky situations or performing risky activities
-lower total intake
-drink less if Comorbidities
-for chronic heavy drinkers, thiamine 50 mg daily
Assessment for AUd should include what
-standardized assessment
-assessment of meds and other substances
-eval of physical, mental and cognitive capacity
-nutrition
-chronic pain
-social conditions
-overall functioning
-collateral
As per alch guidelines, who should receive inpatient care
-poor general health
-acutely suicidal
-have dementia
-medically unstable
-need constant one on one monitoring
Wernickes korsakoff syndrome
Ophthalmologist, ataxia, confusion
THC binds to what, what effect on body
CB1 in brain producing a high and sense of euphoria
Vasoconstriction of vessels, may increase risk of CVevents
Chronic bronchitis and respiratory symptoms
Osteoporosis
Cognitive and motor functions
THC use linked to long term negative psychiatric effects
DePression
Anxiety
Worsening ptsd
Panic attacks
Suicidal ideation/attempts/completion rates
Cannabis indicated for what
-chronic neuropathic pain*
-n/v due to chemo*
-seizures
-spasticity in MS*
-stimulate appetite in cancer and hiv patients
*substantive evidence for
Side effects of cannabis
-dizziness, drowsiness,
-driving impairment
Headaches
Short term mem impairment
Increased anxiety, paranoia, euphoria, depression
Beonchospams
Palpitations, arrhymthmiass, postural hypotension
Dry mouth, nausea vomitting
Harm reduction approach for cannabis
Avoid THC over 10 %
Low starting dose and gradually increased over time
Educate patients on different modes of use
Avoid illegal synthetic
Long term effects of cannabis use
-cognitive impairment
Reso problems
Precancerous epithelial changes
Exacerbation if mental health conditions (especially when THC high)
Cannabis withdrawal symptoms
-fluctuation behaviour and mood
Weakness,sweating, restlessness, dysphoria, sleeping problems, decreased appetite
Nervousness, aggregation, irritability
Most efficacious treatment to date for cannabis
MET/CBT/CM
Interventions to help decrease benzo use
Medication reviews
Prescribing feedback
Case conferences
Pharmacist chart audits
Educational sessions
Reasons why dsm criteria for addictions don’t apply in elderly
Memory impairment (not able to report)
Changes in activities and role obligations
Attributing manifestations to other known health issues
RFs for benzo withdrawal
Greater daily doses
Short acting agent use
Chronic sustained use
Lower edu
Depression/anxiety
Certain personality traits
RF for opioid use disorders
Male
Exposure to illicit opioid earlier in life
Social isolation/loneliness
Psychiatric disorders prior to OUD
Having pain
Things that help in the long term management of chronic non cancer pain
Patient education
Self management strategies
Movement based interventions
Mind body therapies
Alternative therapies
Psychosocial support
Harm reduction for opioid use disorders
-lowest effective dose
-Least potent immediate release
-Duration less than 3 days and rarely more than 7
-if no SUD or past psych hx
-discontinue if function does not improve
-store them safely
-return unused meds to pharm
Strategies that reduce the risk of opioid overdose
Lowest effective dose/tapering should be considered
Taper at 5% every 2-8 weeks
Dispense Naloxone kits
Educate patients on adverse events
Give info on supervised consumption sites
Indications for stopping opioid agonist treatment
Patient preference
Adverse events
Safety around work or sport
Dangerous use of other drugs or meds
Lack of benefit
As per guidelines, what are some signs that someone with pain has an OUD
Higher doses than usual
Run out early
Underlying risk factors (anxiety, depression)
Poor or deteriorating function and mood
Significant withdrawal
Resistance to tapering
Family members express concern
Conditions that increase risk of opioid overdose
Benzo use
Renal failure
Sleep apnea
Which psychosocial intervention has Most evidence for OUD
Contingency management
3 strategies you could use to deprescdibe benzos in someone who is addicted
-slow taper
-simplify regimen if possible to a single pill if multiple benzos on there
-(scheduled visits? Ways to minimize withdrawal? Referal to addictions service)
