1: Addiction Flashcards by Grace Poole

What is addiction

Maladaptive pattern of substance abuse leading to clinically significant distress

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What is the DSM-5 criteria for addiction

Requires 3 of the following:

Tolerance
Using Large amounts or long time period
Use despite knowledge of harm
Craving
Withdrawal
Unsuccessful attempts at control
Time spent in activities to obtain, use or recover
Important activités given up

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What are the 4 syndromes ICD-10 describe for addiction

Acute intoxication
Harmful Use
Dependence Syndrome
Withdrawal state

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Define acute intoxication

Transient condition following administration of alcohol or substance causing disturbed consciousness or other psychophysiological functions

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Define harmful use

Use of substance abuse that is damage to health. Can be physical or mental;

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Define dependence syndrome

Cluster of physiological, behavioural and cognitive phenomenon in which use of a substance takes higher priority that other values that once had greater value

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Define withdrawal state

Symptoms occurring on absolute or relative withdrawal of a substance

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Define tolerance

Using more of a substance to achieve same effects

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Define hazardous drinking

Binge drinking and consumption of:

22-50 units in men
15-35 units in females

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What defines hazardous drinking in men

Consumption 22-50 units

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What defines hazardous drinking in females

Consumption 15- 35 units in females

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Define harmful drinking in males

Consumption >50 Units in males

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Define harmful drinking in females

Consumption >35 Units in females

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What is normal advice regarding alcohol

Do not consume more than 14-units per week
Try to spread alcohol consumption over 3-days
Do not drink if pregnant

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What is used to measure drinks strength

ABV (Alcohol By Volume)

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How is units calculated

(ABV x mL)/1000

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What are 5 risk factors for alcohol misuse

Young
Male
FH
Low socio-economic group
Occupation - doctors

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What are 5 features of alcohol mis-use disorder

Tolerance
Narrowing repotoir of drinks
Failure abstinence
Withdrawal symptoms
Maintaining intake is a priority

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What can alcohol withdrawal lead to

Delirium tremens

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When does delirium tremens usually occur

48-96h after

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Define delirium tremens

State of impaired consciousness and sympathetic over-activity due to alcohol withdrawal

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What are the symptoms of delirium tremens

Impaired consciousness
Generalised tonic-clonic seizures
Visual and tactile hallucinations - insects crawling
over them
Hyper-reflexia
Intention tremor

Sympathetic Over-Activity:

Sweating
Tachycardia
HTN
Nausea

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What is a common hallucination in delirium tremens

Insects crawling over them (tactile of visual)

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What is wenicke’s Encephalopathy

Neuropsychiatric disorder caused by deficiency in thiamine

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What is the triad of symptoms in Wernicke's encephalopathy

1. Ophthalmoplegia 2. Confusion 3. Ataxia

If untreated what does Wernicke's encephalopathy progress to

Korsakoff syndrome

What is Korsakoff's syndrome

Symptoms of Wernicke's (ophthalmoplegia, confusion, ataxia) with: - Anterograde or retrograde amnesia - Confabulation

What are screening tests for alcohol misuse disorder

- CAGE | - AUDIT

What is the CAGE questionnaire

Cut down Annoyed at drinking Guilty about drinking Eye-opener

What score on CAGE indicates hazardous consumption

>2/4

What score in AUDIT tool should indicate referral to specialist alcohol services

>15

What does AUDIT stand for

Alcohol Use Disorder Identification Test

What is used in assessment for alcohol misuse disorder

Alcohol history and psychiatric assessment

What conservative measures are offered for alcohol mis-use disorder

- SMART therapy - Motivational Interviewing - If wernicke-korsakoff's offer supported living Harmful drinking: - CBT - Behavioural Therapies - Social network and environment therapies

What is used for acute alcohol withdrawal

- Benzodiazepines - Pabrinex - 10% Glucose

How much pabrinex is given

2 ampoules IV over 2-days

If an alcoholic is hypoglycaemia what is given

Give pabrinex | Then give glucose

What is given to treat alcohol-withdrawal seizures

Chlordiazepoxide or diazepam

What is preferred if alcoholic has liver impairment

Lorazepam

When is inpatient program for withdrawal indicated

> 30 SADQ > 30 Units Concurrent benzodiazepine withdrawal History epilepsy

Explain legal aspects of alcohol misuse disorder

Alcohol mis-use disorder is not classified under mental health act - so individuals cannot be detained

What are 3 medications that help long-term with withdrawal

Disulfram Acamprosate Naltrexone

What is the MOA of acamprosate

NMDA antagonist. Reduces Craving

What is the MOA of naltrexone

Opioid receptor antagonist - reduces reward of drinking

What needs to be checked prior to starting disulfram

U+E, LFT

What is MOA of disulfram

Acetaldehyde dehydrogenase - which causes accumulation of acetaldehyde

What can vitamin B12 deficiency cause

Microcytic anaemia | Subacute combined degeneration of spinal cord

What is alcohol ketoacidosis

Raised anion gap metabolic acidosis - due to impaired glucose metabolism (alcohol, malnutrition)

How does alcoholic ketoacidosis present

Abdominal pain Nausea and vomiting Tachypneoa

What are 5 features of foetal alcohol syndrome

- Hypoplastic upper lip - Smooth philtrum - Microcephaly - VSD - Down-slanting palpabrae fissures

What are the 5 ICD-10 criteria to define nicotine dependence

1. Tolerance 2. Withdrawal 3. Impaired Control 4. Ongoing use despite risks 5. Social adverse effects

What do NICE recommend for assessing nicotine dependence

Nicotine dependence should be assessed at each appointment using pack years, then very brief advice should be use

How are pack years calculated

(Number Packs Smoked Per Day x Years)/ 20

How are pack years calculated

(Number Packs Smoked Per Day x Years Smoked)/ 20

What are the two questions to assess nicotine dependence

- How many cigarettes smoker per day | - How soon after waking up do you smoke

What are 4 conservative manages to stop smoking

1. Refer to stop smoking services 2. Behavioural support 3. Set a quite date 4. Advice

What advice is given to stop smoking

- Not a puff rule - Discuss methods to stop cravings - Avoid people smoking - Discuss barriers

What are three medications for smoking cessation

Varencline Buproprion NRT

What nicotine replacement therapy should be used

Use long-acting such as nicotine patch and short-acting such as gum to treat cravings

What is the MOA of varencline

Partial nicotine receptor agonist

How do you remember the MOA of varencline

V(arencline) is V similar to nicotine

What is the brand name of varnecline

Champix

What is the MOA of buproprion

Dopamine and Noradrenaline re-uptake inhibitor

Explain NICE recommendation on smoking in pregnancy

- Test with CO detector | - Any women who stopped smoking, stopped in 2W or CO >7 refer to stop smoking services

What medications are CI in pregnancy for smoking cessation

Varencline | Buproprion

What is experimental use of drugs

Using drugs to try effects

What is situational drug use

Using drugs in certain situations

What is recreational drug use

Regular, non-dependent use

What is dependent use

Fits criteria for dependence syndrome

What opioid is usually abused

Heroine

What is clinical presentation of opioids

Euphoria | Relaxation

What are side effects of opioids

N+V Constipation Injection has risk of abscess, cellulitus, HIV, Hep B and Hep C

What are 4 symptoms of OD in opioids

- Pin point pupils - Resp distress - Bradycardia - Hypotension

How will pupils present in opioid over-dose

Pin-point

What symptoms does withdrawal of opioids cause

- Sweating - Rhinorrhoea - Anxiety - Cold sweats - Severe muscle pain - Diarrhoea

What is a key symptoms of opioid withdrawal

Severe muscle pain

Describe symptom-onset in opioid withdrawal

Symptoms onset 6-24h | Persist 5-7d

Explain harm-reduction for opioid abuse

Describes methods to ensure users take opioids in safer way

What are 5 methods of harm-reduction in opioid abuse

1. Needle Program 2. Safe Injecting Advice: sterile water, rotate sites, avoid neck and groin 3. Methadone - come to clinic to take 4. Naloxone - give rescue naloxone incase they OD

What are two medications that can be used to aid withdrawal of opioids

Methadone | Buprenorphine

What is the mechanism of methadone in opioid withdrawal

Methadone is a long-acting opioid, is saturates opioid receptors causing no additional benefit to injecting

What is the mechanism of action of buprenorphine

Partial opioid receptor agonist

What can be given to treat OD of opioids

Naloxone

1: Addiction Flashcards

(83 cards)