WK 7-ALCOHOL, TOBACCO AND CANNABIS Flashcards
What are the drinking guidelines
- MEN and WOMEN no more than TWO standard drinks daily to decrease LIFETIME RISK of DEATH from DISEASE or INJURY due to alcohol (chronic harms)
- MEN and WOMEN no more than FOUR on any ONE OCCASION to decrease risk of INJURY or HARM from that occasion (acute harms)
- Under 18 NO ALCOHOL because of increased risk of dependence associated with age on onset
- NO ALCOHOL during pregnancy or breastfeeding
Why is smoking and consuming alcohol at the same time more detrimental for health (why is there an increase in head/neck cancer)
Alcohol can cross membranes (without breaking the membrane)→ can take molecules with it (like tobacco) → move tobacco molecules into the fat of the head/neck
What are some of the psychological effects of alcohol
- Insomnia
- Fatigue
- Anxiety/depression
- Suicidal ideation
- Exacerbation of mental health issues
What is the difference between intoxication and overdose?
Intoxication= immediate, short term effects
Overdose (poisoning)= long term effects including withdrawal and tolerance
What is foetal alcohol syndrome- what are some of the characteristics
When the foetal brain is exposed to alcohol during development it can cause structural malformations (disrupts connections between hemispheres)
Features; flat midface, short nose, thin upper lip, short palpebral fissures, indistinct philtrum, epicanthal folds, low nasal bridge, minor ear anomalies
What are 2 types of screening mechanisms used to screen for alcohol dependence
C.A.G.E and AUDIT (Audit C is the shorter version)
What are the 4 questions asked in a C.A.G.E screening
- Have you ever felt you should cut down on your drinking?
- Have people annoyed you by criticising your drinking?
- Have you ever felt bad or guilty about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?
What are the 3 questions asked in AUDIT-C- what score is a ‘positive’ result in women/men
1: How often did you have a drink containing alcohol in the past year?
Q2: How many drinks did you have on a typical day when you were drinking in the past year?
Q3:How often did you have six or more drinks on one occasion in the past year?
Men= 4+
Women= 3+
What are the national guidelines for treatment of alcohol problems
- Level A recommendations: ASK
- Screening with AUDIT for the general population should be widely implemented in GP and ED
- Screening with indirect biological markers (LFT-liver function test) should only be used as an adjunct to AUDIT – less sensitive and specific
Where should ‘brief interventions’ for alcohol use be used? What kind of people should they not be used on?
Brief interventions are useful in GP/ED settings and are effective in reducing alcohol use in people with risky drinking patterns but are not dependent–> they should not be used for people who are alcohol dependent
What acronym is used for ‘brief interventions’ of alcohol use
FLAGS F= feedback L= listening A= advice G= goals S= strategies
What are 3 examples of psychosocial interventions used in alcohol use
Motivational interviewing (first line or stand alone treatment), Behavioural self management (if low or no dependence) and Coping skills
What are the 3 drugs used to treat dependent drinkers
- Acamprosate
- Naltrexone
- Disulfiram
What is the MOA of acamprosate in the treatment of alcoholism- what is the precaution
Acamprosate blocks glutamate receptors and activates GABA receptors–> provides fewer side effects of alcohol
-need to have normal renal function
What is the MOA of naltrexone in the treatment of alcoholism- what is the precaution
Blocks opioid receptors-> taken once daily
-need normal liver function
What is the MOA of disulfiram in the treatment of alcoholism
Aversive agent-> blocks alcohol dehydrogenase increasing the ‘unwell’ feeling you get when drinking alcohol-> closely supervise
What is the major concern that can occur with alcoholism (disorder)
Wernickes Encephalopathy/Korsakoffs Psychosis
What is Wernickes Encephalopathy/Korsakoffs Psychosis- how does it occur, what are the symptoms, how can it progress?
Alcoholism can lead to thiamine deficiency which then leads to developement of WE/KP-> WE is the physiological component and causes nystygmus, ataxia and opthalmalgia-> KP is the psychological symptom and causes confabulation/memory loss
-> It is preventable but can be irrevesible and leave people in a constant state of confusion
How do you treat WE/KP
If there is nystgymus/thought that the patient may have WE/KP administer large doses of thiamine
What is the role of thiamine
Thiamine is required for myelin/fatty acids/steroids and glycolysis to work (the enzymes in this pathway require thiamine)-> without thiamine the brain will not function
What are the complications of alcohol withdrawal
seizures, vomiting, confusion, delirium tremors, extreme agitation, tachycardia, paranoia, hypertension, high temp-> can be fatal
What medication is given to alcoholics going through withdrawal-> why must administration be monitored
Benzodiazepines-> need to monitor patient and only give small doses and benzodiazepines are also highly addictive-> don’t want to replace one addiction with another
What is the CIWA- Alcohol-> what is it used for
Clinical Institute Withdrawal Assessment -> used to assess the physical and psychological symptoms of withdrawal and determine whether the patient may be in danger (ie. escalation of symptoms)
What patients should be asked about their smoking status and interest in quitting
Any patient over the age of 10 years old
What are the 4 things that all patients who smoke should be asked about? (3 A’s, 1 R)
Asked: about their interest in quitting
Assessed: on whether they are nicotine dependent and if so given pharmacotherapy
Advised: to stop smoking
Referred: offered a referral to cessation hotlines such as quitline
What questionnaire is used to determine a patients dependence on nicotine
Fagerstrom questionnaire (lengthy)
What are the 4 D’s given to patients as distraction techniques
Delay (urge wil pass), Drink water (slowly sip to distract), Deep breathe, Do something else
What are some brief intervention techniques for smokers
Motivational interviewing, Five A’s (depending on stage of change), Pharmacotherapy, Quitline
What 3 questions are asked to determine nicotine dependence - what answers indicate dependence
- How many minutes after waking up do you have your first smoke? (if within 30 min=dependent)
- How many cigarettes do you have per day (if above 15= dependent)
- Have you had cravings/withdrawal symptoms in previous quitting attempts (if yes= dependent)
What are symptoms of nicotine withdrawal
Dysphoria or depressed mood, insomnia, irratibility, frustration, anxiety, decreased HR, increased appetite/weight gain (due to wanting to put something in mouth), breathlessness
What are the 3 types of pharmacotherapies for nicotine dependence
- Nicotine replacement therapy
- Champix (verenicline)
- Buproprion
What is the MOA of NRT-> who is it suited too, how long should a pt utilise NRT
Replaces nicotine at lower concentration (like using nicorette spray)-> good for all paitnets (can be used in children, pregnant)-> should use about 10 wks of NRT
What is the MOA of champix- who is it contraindicated in, what side affects can it cause, how long should treatment with champix last
Nicotinic acetylcholine- partial receptor agonist but not to be use din pregnancy/childhood/ or those with sign. mental health issues as it can cause suicidal ideation
-lacks serious side effects-> treatment should last 12 wks.
What is the MOA of buproprion
Non-competitive nicotine receptor antagonist and can inhibit noradrenergic receptors in the locus caeruleus (making it an antidepressant)
- Contraindicated in pregnancy, seizure activity, MAO inhibitors
- treatment should last 7 weeks
Which population in Aus has the highest use of cannabis
ATSI- the more rural, the higher the rates
What risks are associated with using cannabis during adolescence
increased risk of developing mental healt problems, attempting suicide, using other drugs, not completing school, low life opportunities
What is cannabis induced psychosis
Short lived and usually from prolonged/heavy cannabis use- characterised by hallucinations and delusions, memory loss and confusion
What are the harms associated with cannabis use
Dependence, psychosis, exacerbation of other mental health disorders, exacerbation of resp conditions (1 bong=3-5 cigs), impaired healing (inhibits NKC), demotivation
What are the symptoms of cannabis withdrawal
Anger, aggression, irritability, decreased appetite, restlessness
- less common symptoms= chills, night sweats, shaking, stomach pain
- overweight people have less withdrawal effects as cannabis is fat soluble
What are some medical uses of cannabis
Evidence is positive in MS and AIDS related cachexia
