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YR3 - R1: General Medicine > Neoplasia & Addiction > Flashcards

Neoplasia & Addiction Flashcards

1
Q

What is Palliative care?

A
  • An approach to someone’s care
  • Recognition that they can’t be cured but that they can be helped
  • Suffering is a key component
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2
Q

When is palliative care indicated?

A
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3
Q

Why is Palliative care important? (4 improved outcomes)

A
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4
Q

Is palliative care effective?
How to measure success in palliative care pharmacology?

A

Outcome measures of drug therapy in palliative care:
- Hard to define and measure
- Not curing
- Not reducing disease burden
Therefore outcomes = Subjective patient experience

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5
Q

Who has access to Palliative care? Which factors influence this?

A
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6
Q

List 10 possible side effects of opioid medications prescribed in palliative care?

A
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7
Q

When do you need to avoid oral medications in palliative care?
List 4 factors affecting drug gut absorption.

A

Factors affecting drug gut absorption
- IBD - Crohn’s & UC
- Bowel resection (eg. Tumour removal)
- Iron & Calcium deficiency
- Delayed gastric emptying in Parkinson’s & Diabetes

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8
Q

What impact does reduced body weight in palliative care have on drug elimination?

A
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9
Q

In which liver diseases should you avoid paracetamol?

A

When to avoid paracetamol = when transaminases (ALT/AST) are three times upper limit of normal

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10
Q

What affect does deranged liver function have on drug elimination in palliative care?

A

Example = Targin (oxycodone + naloxone for constipation) – If your liver is not metabolising naloxone, you get a lot of systemic absorption so your pain relief gets skewed.
- Eg. Valproate (seizures or neuropathic pain) = hepatotoxicity

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11
Q

Which organ system is most important to consider when prescribing in palliative care? Which equation should be calculated?

A
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12
Q

Where and how is morphine metabolised? What is M6G?

A
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13
Q

How is morphine excreted?
What is Hyperaesthesia?

A

Hyperaesthesia = allodonia but specific to opioid excess = upregulators to the spinal cord & then positive feedback loops to the brain.
Choose a newer synthetic opioid over morphine if creatinine clearance low.

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14
Q

Which other opioids could you consider in palliative care management of a patient with poor renal function other than morphine?

A

Oxycodone & Hydromorphone both have renal clearance but have less toxic metabolites than morphine = generally better tolerated.
- Much more potent than morphine, tend to be restricted to palliative/pain specialists
Methadone = all excreted by the liver (hepatically) but needs close monitoring
Fentanyl – not renally excreted but difficult to get hold of outside hospital (Not PBS)

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15
Q

What is the usual half life of most opioids? How can this be managed?

A
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16
Q

Give 3 examples of Oral SR opioids and 2 examples of Transdermal SR Opioids?

A
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17
Q

What are SR Oral Opioids usually indicated for?

A
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18
Q

List 3 advantages of SR opioid formulations?

A
  1. Convenience
  2. Improved compliance
  3. Less fluctuations in plasma levels
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19
Q

List 4 Disadvantages of SR Opioids?

A

Eg. Damage to slow release capsule = all of the dose at once = risk of toxicity

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20
Q

Give 3 specific examples of side effects of opioid medications?

A
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21
Q

Give 2 examples of where medication side effects may benefit a patient in palliative care.

A

But be careful prescribing off-licence (eg. Mirtazapine for sleep/appetite) – need to be able to defend your prescribing choice.

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22
Q

How do the models of care differ in chronic pain management vs. palliative care in terms of polypharmacy?

A

This is obviously a different approach in chronic pain management.

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23
Q

List 6 different types of pain.

A

Emotional experience of the pain is such an important factor in the pain.
Eg. Where is your pain? My pain is everywhere doctor = often indicates suffering emotionally (somatic complaints)

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24
Q

What is the safest first approach to prescribing opiates in an opiate naive patient?

A

Safest first approach to prescribing opiates in an opiate naïve patient is an immediate release so that if there are problems they can ‘wash out’ quickly.

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25
Q

What are the current screening recommendations for skin cancer?

A
  • A ‘skin check’ can be defined as a comprehensive assessment and examination of an asymptomatic patient for any evidence of skin cancer.
  • Current Australian guidelines advise against general population screening for skin cancer, citing the lack of evidence for the feasibility of organised screening and the effectiveness of screening in reducing mortality. Patient self examination with opportunistic screening is the current standard.
  • Cancer Council Australia argues against patients having regular or annual skin checks on three grounds: nonmelanoma skin cancer has a low mortality, melanoma frequency does not justify a mass population screening program on economic grounds, and the instrument that would be used for mass screening (GP assessment) is not sufficiently accurate.
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26
Q

Assessment of skin cancer risk:
- High risk? (7)
- Medium risk? (7)
- Low risk? (5)
- How often should each be checked?

A
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27
Q

What are the top 10 benign lesions of the skin?

A

The top 10 benign lesions are:
1. Solar keratosis
2. Diffuse superficial actini
3. Porokeratosis
4. Seborrhoeic keratosis (and the benign lichenoid keratosis variant)
5. Benign melanocytic naevus (junctional, compound or intradermal)
6. Chondrodermatitis nodularis helices chronicus
7. Blue naevus
8. Benign fibrous papule
9. Sebaceous hyperplasia
10. Capillary haemangioma
11. Dermatofibroma

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28
Q

What are the current screening recommendations for colorectal cancer?

A

The recommended strategy for population screening in Australia remains the immunochemical faecal occult blood test, commencing at age 50 years in asymptomatic individuals with no family history of colorectal cancer. This test is to be performed every two years to age 74 years. Individuals with a family history of colorectal cancer will need appropriate risk stratification. Aspirin should now be considered for all patients aged 50–70 years in the prevention of colorectal cancer.

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29
Q

Which tools are used to screen for colorectal cancer?

A
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30
Q

Colorectal Cancer Risk - Category 1
- Who?
- What should be done?
- How often?

A
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31
Q

Colorectal Cancer Risk - Category 2
- Who?
- What should be done?
- How often?

A
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32
Q

Colorectal Cancer Risk - Category 3
- Who?
- What should be done?
- How often?

A
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33
Q

Colorectal Cancer - Risk stratification based on family history?

A
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34
Q

Colorectal Cancer - Current screening guidelines based on family history?

A
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35
Q

What are the follow up recommendations for colorectal cancer screening following polypectomy?

A

Patients who have adenomatous polyps removed at colonoscopy are then classified as having aboveaverage risk for the development of metachronous adenomatous polyps and CRC.

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36
Q

What are the current screening recommendations for lung cancer?

A

Neither low-dose CT scanning nor chest X-ray are currently recommended for population-based screening for lung cancer in Australia.
- See Position Statement: Lung Cancer Screening using Low-Dose Computed Tomography

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37
Q

What are the current screening recommendations for breast cancer?

A

Mammographic screening for women at average or slightly above average risk is currently recommended for women aged 50–74 years, and is available but not routinely recommended for women at average risk aged 40–49 years due to a much smaller benefit than for older women. Routine mammographic screening is not recommended for women aged <40 years as there is no evidence of effectiveness and screening results in many false positive mammograms.

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38
Q

Breast Cancer Risk - Average or only slightly higher risk
- Who?
- What should be done?
- How often?

A
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39
Q

Breast Cancer Risk - Moderately increased risk
- Who?
- What should be done?
- How often?

A

How often:
- At least every two years from 50-74 years of age
- Annual mammograms from 40 may be recommended if the woman has a first degree relative <50yrs diagnosed with breast cancer.

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40
Q

Breast Cancer Risk - Potentially high risk
- Who?
- What should be done?
- How often?

A

How often:
- At least every two years from 50-74 years of age
- Annual mammograms from 40 may be recommended if the woman has a first degree relative <50yrs diagnosed with breast cancer.

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41
Q

What are the current screening recommendations for cervical cancer?

A

Women and people with a cervix aged 25 to 74 years of age are invited to have a Cervical Screening Test every 5 years through their healthcare provider.

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42
Q

Cervical Cancer Risk - Average risk
- Who?
- What should be done?
- How often?

A
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43
Q

Cervical Cancer Risk - Increased risk
- Who?
- What should be done?
- How often?

A
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44
Q

Tests for detecting cervical cancer?

A
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45
Q

What are the current screening recommendations for prostate cancer? What are the tests for prostate cancer?

A

Screening of asymptomatic (low-risk) men for prostate cancer by prostate specific antigen (PSA)
testing is not recommended because the benefits have not clearly been shown to outweigh the
harms. Therefore, GPs have no obligation to offer prostate cancer screening to asymptomatic men.

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46
Q

Describe the Aetiology of Colorectal Cancer - Colorectal carcinogenesis pathways (molecular pathology)
- Chromosomal instability pathway in colon cancer?
- Microsatellite instability pathway in colon cancer?
- Hypermethylation phenotype pathway in colon cancer?
- COX-2 Overexpresion?

A
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47
Q

What are the 2 main aetiological pathways for carcinogenesis in colorectal cancer? Explain them.

A

Top: Chromosomal instability pathway (adenoma-carcinoma sequence)
- Loss of the tumor suppressor gene, APC, results in hyperproliferative epithelium due to a loss of cellular adhesion and increased cellular proliferation. A mutation in KRAS results in unregulated cellular signaling and cellular proliferation, leading to the formation of an adenoma. Loss of the tumor suppressor genes TP53 and DCC results in the malignant transformation of an adenoma to carcinoma. The chromosomal instability pathway is responsible for carcinomas in FAP (loss of APC) as well as in most cases of sporadic colorectal carcinoma.
Bottom: Microsatellite instability pathway
- Acquired or inherited mutations in the mismatch repair genes (esp. MLH1 and MSH2) result in abnormal proliferation and the formation of adenoma and carcinoma. The microsatellite instability pathway is responsible for carcinomas in Lynch syndrome (HNPCC) and a few cases of sporadic colorectal carcinoma.

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48
Q

List 6 Risk Factors for Colorectal cancer:
- Which hereditary syndromes? (5)
- Which associated conditions? (4)
- 2 lifestyle?
- 3 diet?

A
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49
Q

3 Protective factors for colorectal cancer?

A
  1. Long-term use of aspirin and other NSAIDs
  2. Physical activity
  3. Diet rich in fiber and vegetables and lower in meat
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50
Q

List 5 Constitutional Symptoms of Colorectal cancer?
Clinical Features of Right vs. Left-Sided Colorectal cancer?

A

**Constitutional symptoms: **
1. Weight loss
2. Fever
3. Night sweats
4. Fatigue
5. Abdominal discomfort (symptoms similar to diverticulitis, especially in carcinoma of the rectosigmoid or descending colon)

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51
Q

Definition and clinical features of a rectal carcinoma?

A
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52
Q

4 Red Flags for Colorectal Cancer?

A
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53
Q

Clinical features of Metastatic Colorectal Cancer? Where is the most common site of metastasis?

A
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54
Q

Which investigations should be ordered in a patient with suspected colorectal cancer?
- Indications and findings for a DRE?
- Indications and findings for Flexible sigmoidoscopy +/- anoscopy?

A

All patients with suspected CRC should undergo a complete colonoscopy with biopsy of suspicious lesions. Once the diagnosis is confirmed, additional tests to stage the cancer are required to guide management.

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55
Q

What are the indications, typical findings, and considerations for Complete colonoscopy in patients with suspected colorectal cancer?

A
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56
Q

List 4 Laboratory studies you would consider in a patient with suspected colorectal cancer?

A
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57
Q
A
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58
Q

Complications of Colorectal Cancer: Peritoneal carcinomatosis
- Definition?
- Epidemiology?
- Aetiology?
- Clinical features?
- Diagnostics?
- Treatment?
- Complications?
- Prognosis?

A
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59
Q

What are the follow-up recommendations for patients with a history of colorectal cancer?

A
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60
Q

What are 6 Hormonal risk factors for breast cancer?

A
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61
Q

What are 5 Individual risk factors for breast cancer?

A
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62
Q

Which gene mutations are associated with breast cancer?

A
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63
Q

What are 3 Genetic conditions that have an increased risk of breast cancer?

A

For the characteristics of Li-Fraumeni syndrome, think BLAST53: Breast cancer/Brain tumors, Leukemia/Lymphoma, Adrenocortical carcinoma, Sarcoma, and Tp53.

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64
Q

What are the 3 main types of breast cancer? 5 less common types?

A
  1. Ductal carcinoma in situ (DCIS) - eg. Comedocarcinoma
  2. Invasive ductal carcinoma (IDC) - eg. Medullary breast cancer
  3. Invasive lobular carcinoma (ILC) -
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65
Q

What are 4 Characteristics of Ductal carcinoma in situ (DCIS)? What is a Comedocarcinoma?

A
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66
Q

Invasive ductal carcinoma (IDC)
- 2 Characteristics?
- Localisation?
- Medullary breast cancer characteristics?
- Medullary breast cancer differential diagnosis?

A
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67
Q

Invasive lobular carcinoma (ILC)
- Characteristics? (2)
- Localisation?

A
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68
Q

What are the clinical features of breast cancer:
- in the Early stages? (3)
- in Locally advanced disease?
- Progressive disease? (3)

A

Early Stages
In early stages, affected individuals may notice a palpable mass with the following characteristics:
* Typically single, nontender, and firm
* Poorly defined margins
* Most commonly located in the upper outer quadrant (∼ 55%)

Progressive disease
1. Ulcerations
2. Edema of the arm
3. Paget disease of the nipple

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69
Q

What are the signs of metastatic disease in breast cancer?
- Lymphatic spread?
- Hematogenous spread?

A

Lymphatic spread
1. Lymphadenopathy
2. Nontender, firm, enlarged lymph nodes (> 1 cm in size), that are fixed to the skin or surrounding tissue
3. Most commonly the axillary nodes and, in later stages, the supraclavicular and/or infraclavicular nodes

70
Q

Paget disease of the breast
- Definition?
- Pathogenesis?
- Clinical features?
- Diagnostics?
- Differential diagnosis?
- Treatment?

A
71
Q

Inflammatory breast cancer (IBC)
- Definition?
- Clinical features?
- Diagnostics?

A
72
Q

Inflammatory breast cancer (IBC)
- Differential diagnosis?
- Treatment?
- Prognosis?

A

Inflammatory breast cancer is always classified as T4 because it involves the skin.

73
Q

Occult Breast Cancer
- Definition?
- Clinical features?
- Diagnostics?
- Treatment?

A
74
Q

Describe an approach/algorithm to suspected breast cancer?

A
75
Q
A
76
Q

What are the 6 principle clinical presentations of cervical cancer?

A
77
Q

List 7 Complications of Cervical Cancer.

A
78
Q

What are the 7 principle clinical presentations of prostate cancer?

A
79
Q

Describe the role of the human papilloma virus in cervical cancer?

A
80
Q
A
81
Q

How does H.pylori cause gastric adenocarcinoma?

A

Even though some sources still refer to H. pylori infection as a risk factor for only the intestinal type of gastric cancer, it has been proven to be associated with both intestinal and diffuse types.
It is believed that H. pylori contributes to gastric cancer development by direct action of its virulence factors and indirectly by initiation and maintenance of a chronic inflammation in the gastric mucosa.

82
Q

What is the link between H. pylori and gastric malt lymphoma?

A

H. pylori alone is not likely responsible for gastric cancer. Rather, it may provide a suitable environment, including chronic gastritis and intestinal metaplasia, for neoplastic change.

83
Q

What cancers are the Epstein-Barr virus associated with? (3)
- Role in Hodgkins?

A
  • EBV is linked to Hodgkin lymphoma , Burkitt lymphoma (a rare type of non-Hodgkin lymphoma) and nasopharyngeal cancers.
  • EBV could either play a direct or indirect role in the pathogenesis of Hodgkin’s disease, possibly by triggering the pathogenic mechanism(s), or it could reflect the presence of an inherited or acquired depression of immunoregulation that is a prelude both to the malignancy and to the reactivation of EBV.
  • Immunosuppressed patients show rises in all herpesvirus antibodies, rather than a selective rise in EBV antibodies, which suggests that depression of immunoregulation, rather than a specific disease phenomenon, might be responsible for these raised values.
84
Q

List 9 Principles of Palliative and Hospice Care?

A
85
Q
A
86
Q

What is the definition of Addiction?

A

Addiction is defined as not having control over doing, taking or using something to the point where it could be harmful to you.

87
Q

How does the DSM-5 classify substance-related disorders according to the underlying substance?
- List 12 Substances people may have an addiction/substance-related disorder to.
- How are gambling disorders classified?

A
88
Q

What is the definition of a Substance use disorder?

A

A chronic condition in which an uncontrolled pattern of substance use leads to significant physical, psychological, and social impairment or distress, with continued use despite substance-related problems.

89
Q

Substance use disorder - Epidemiology
- Which sex is more affected?
- Which 2 drugs are most commonly involved?

A
  • Sex: ♂ > ♀
  • Alcohol and nicotine use are most common.
90
Q

List and Describe 4 Characteristics of Substance use disorder?

A
  1. Impaired control
  2. Social impairment
  3. Risky use
  4. Pharmacologic indicators
91
Q

List and define the 3 Substance-induced disorders?

A
92
Q

Define Drug-seeking behavior and give 7 examples of it?

A
93
Q
A
94
Q

List 5 Signs/Symptoms of Alcohol Withdrawal?

A
  1. Autonomic symptoms (e.g., palpitations, sweating, ↑ blood pressure)
  2. Anxiety, insomnia
  3. Nausea, vomiting
  4. Alcohol withdrawal seizures
  5. Alcohol withdrawal delirium
95
Q
A
96
Q

List 4 Signs/Symptoms of Opioid Withdrawal?

A
  1. Flu-like symptoms (e.g., chills, myalgia, piloerection)
  2. Gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea)
  3. Sympathetic hyperactivity (e.g., mydriasis, tachycardia)
  4. CNS stimulation (e.g., insomnia, anxiety, agitation)
97
Q
A
98
Q

List 2 Signs/Symptoms of Barbiturates withdrawal?

A
  1. Delirium
  2. Severe hypotension, possibly cardiovascular collapse
99
Q
A
100
Q

List 4 Signs/Symptoms of Benzodiazepine Withdrawal?

A
  1. Autonomic symptoms (e.g., sweating, hypertension)
  2. Gastrointestinal symptoms (e.g., nausea, vomiting)
  3. Neurological symptoms (e.g., seizures, tremors)
  4. Psychiatric symptoms (e.g., depressive moods, insomnia)
101
Q
A
102
Q
A
103
Q

List 8 Signs/Symptoms of Amphetamines and Cocaine Withdrawal?

A

Physiologic crash after use due to receptor downregulation characterized by:
1. Dysphoria
2. Anhedonia
3. Anxiety
4. ↓ Energy
5. Depression with suicidal thoughts
6. ↑ Appetite
7. Sleep disturbance
8. Agitation

104
Q
A
105
Q
A
106
Q

List 4 Signs/Symptoms of Caffeine withdrawal?

A
  1. Depressed mood, irritability
  2. Drowsiness, fatigue
  3. Difficulty concentrating
  4. Flu-like symptoms, muscle pain
107
Q
A
108
Q

List 5 Signs/Symptoms of Nicotine withdrawal?

A
  1. Frustration, anger
  2. Restlessness, anxiety, insomnia
  3. Dysphoria, depressed mood
  4. Impaired concentration
  5. ↑ Appetite, weight gain
109
Q
A
110
Q

List the Withdrawal Signs/Symptoms of the following drugs:
- Cannibinoids = 3
- Lysergic acid diethylamide (LSD) = 0
- MDMA = 3
- Phencyclidine (PCP) = 4

A
111
Q
A
112
Q

List 5 Signs & Symptoms of Gamma-hydroxybutyric acid (GHB) withdrawal?

A
  1. Diaphoresis, agitation
  2. CNS stimulation (e.g., irritability, insomnia, psychosis)
  3. Autonomic instability: tachycardia, hypertension
  4. Tremor, ↑ muscle tone
  5. Death
113
Q
A
114
Q

What is Urine Drug Testing? Give an example of when it might be ordered?

A
  • Immunoassay testing is the most frequently used method for urine drug testing.
  • Mass spectrometry/gas chromatography is used to confirm immunoassay results.
  • Example situations for the use of a urine drug test include workup of altered mental status and monitoring during SUD treatment or chronic opioid therapy.
115
Q

Which substances are detectable on Urine drug test (immunoassay)? = 5
Which substances are NOT detectable on Urine drug test (immunoassay)? = 6

A
116
Q

List 5 Substances that can cause cross-reactivity and yield false positive results on a Urine drug screen (immunoassay)?

A
117
Q

When might you consider a Blood/serum drug test?
What are 2 types of laboratory methods used in a Blood/serum drug test?

A
118
Q

Discuss the Mechanism of Action and Epidemiology of Caffeine substance use disorder?

A
119
Q

List 10 Clinical features of Caffeine intoxication?

A
120
Q

List 5 Clinical features of withdrawal of caffeine?

A
121
Q

What is the Treatment for Caffeine Overdose?
What is the Treatment for Caffeine Withdrawal?

A

Overdose: supportive therapy (e.g., beta-blockers for tachyarrhythmia)
Withdrawal: Symptoms typically manifest within 24 hours after the last intake and resolve spontaneously within 10 days.

122
Q

Cannibas Substance Use Disorder
- List some street names?
- Forms of preparation?
- Mechanism of Action?

A
123
Q

List 10 Clinical features of Cannabis Intoxication?

A
124
Q

List 5 Clinical features of cannabis withdrawal?

A
125
Q

What is the treatment for cannabis intoxication?
What is the treatment for cannabis withdrawal?

A

Intoxication: symptomatic treatment
Withdrawal: psychosocial support and interventions

126
Q

List 5 Complications of Cannabis Use?

A

Long-term effects include pulmonary problems (e.g., wheezing, shortness of breath), immunosuppression, and sex hormone imbalance.

127
Q

List 10 Clinical features of Cannabis substance use disorder?

A
128
Q

Phencyclidine use disorder
- Street names?
- Mechanism of action?
- Related drugs?

A
129
Q

List 3 Clinical features
of Phencyclidine use disorder?

A
  1. Signs of injury, e.g., due to fights, accidents
  2. Memory and speech deficits
  3. Cognitive impairment
130
Q

List 10 Clinical features
Phencyclidine Intoxication?

A
131
Q

Treatment for Phencyclidine Intoxication? (4)

A
  1. Reduction of environmental stimuli
  2. Gastric lavage to increase drug elimination
  3. Supportive care
  4. Sedation with benzodiazepines (for severe agitation) or haloperidol (if psychotic symptoms are present)
132
Q

Complications of phencyclidine use?

A
  1. Trauma (commonly accompanied by intracranial hemorrhage)
  2. Seizures
  3. Rhabdomyolysis
  4. Reabsorption of the drug in the gastrointestinal tract may lead recurrence of symptoms.
133
Q

Tryptamine derivatives - eg. LSD
- MOA?
- Specific clinical features of intoxication? (4)
- Treament of intoxication? (4)

A
134
Q

Phenethylamine derivatives - eg. MDMA
- Street names?
- MOA?
- Specific clinical features of intoxication? (9)
- Clinical features of withdrawal? (5)

A
  • Substances: MDMA, mescaline
  • MDMA: ecstasy, XTC
  • Mescaline: mesc, buttons
  • Mechanism of action: 5HT2A-serotonin-receptor and D2-receptor agonists and serotonin and dopamine reuptake inhibitors: increases serotonin and dopamine concentrations in the synaptic cleft → hallucinations.
  • MDMA increases secretion of antidiuretic hormone → thirst → increased water intake without electrolyte repletion → hyponatremia
135
Q

Inhalant-related substance use disorders
- Substances?
- Street names?
- Epidemiology?
- MOA?

A
136
Q

Clinical features of inhalant intoxication - eg. NO, glue etc.? (9)
Clinical features of withdrawal? (1)

A
137
Q

Inhalant-related substance use disorders
- Treatment? (3)
- Complications? (6)

A
138
Q

**Stimulant-related use disorders **
- Which substances?
- Definition?
- 10 Clinical features of intoxication?

A

Definition: stimulant-related disorders encompass conditions caused by cocaine, amphetamines, amphetamine substituted substances, and synthetic cathinones.

139
Q

**Stimulant-related use disorders **
- Clinical features of stimulant withdrawal? (5)
- Diagnosis?

A
140
Q

Cocaine Substance Use Disorder
- Substances?
- Street names?
- Forms of preparation?
- MOA?

A
141
Q

10 Clinical features of cocaine intoxication?

A
142
Q

Treatment for:
- Cocaine intoxication?
- Cocaine withdrawal?
- Cocaine use disorder?

A
143
Q

List and describe 2 major complications of cocaine substance use disorder?

A
144
Q

Amphetamines
- Substances?
- Street names?
- MOA?

A
145
Q

List 10 clinical features of amphetamine intoxication?

A
146
Q

List 5 Clinical features of amphetamine withdrawal?

A
147
Q

List 5 Clinical features of amphetamine withdrawal?

A
148
Q

Treatment for:
- Amphetamine acute toxicity?
- Amphetamine use disorder?
- Amphetamine withdrawal?

What are 2 complications of amphetamine use?

A
149
Q

Tobacco-related disorders
- Substance?
- MOA?
- Epidemiology?
- Clinical features of tobacco intoxication? (5)
- Clinical features of tobacco withdrawal? (5)

A
  • Substance: nicotine from the tobacco plant (consumed in cigarettes, cigars, pipes, e-cigarettes)
  • Mechanism of action: stimulates nicotinic receptors in autonomic ganglia → sympathetic and parasympathetic stimulation
  • Epidemiology: Approx. 13% of adults in the US smoke cigarettes, Most prevalent cause of preventable morbidity and mortality in the US.
150
Q

4 Treatments for Tobacco use disorder?
5 Complications of tobacco use disorder?

A
151
Q

Gambling Disorder
- Definition?
- Epidemiology?
- Etiology?
- Diagnostic criteria?

A
  • Definition: Gambling disorder is a disorder in which the affected individual feels the compulsion to gamble despite negative consequences and/or multiple attempts to stop. Also, the gambling behavior cannot be better explained by a manic episode.
  • Epidemiology: Sex: ♂ > ♀, No specific age group
  • Etiology: combination of factors (genetic, environmental, neurochemical abnormalities)
152
Q

Treamtent and Complications of Gambling disorder?

A
153
Q

** Gamma-hydroxybutyric acid (GHB)**
- Substances?
- Street names?
- MOA?
- Clinical features of intoxication?
- Clinical features of withdrawal?

A

Substances: gamma-hydroxybutyric acid (GHB)
Street names: liquid ecstasy (unrelated to MDMA), liquid X, invigorate
Mechanism of action: direct agonist of GABA receptors (similar to benzodiazepines)

154
Q

Gamma-hydroxybutyric acid (GHB)
- Diagnosis?
- Treament?

A
155
Q

What is Alcohol withdrawal syndrome?
List 5 Clinical features of Alcohol withdrawal syndrome (uncomplicated)? When do these occur?

A

A transient excitatory state caused by a sudden cessation of or reduction in alcohol consumption after a prolonged period of heavy drinking

156
Q

When might Alcohol withdrawal seizures occur?

A
157
Q

What is Alcohol-induced psychotic disorder (alcoholic hallucinosis)?
- Onset?
- Clinical features?
- Duration?

A
158
Q

Alcohol withdrawal delirium (delirium tremens)
- Definition?
- Onset?
- Clinical features?
- Duration?

A
159
Q

How is Alcohol Withdrawal Syndrome classified?
What is a useful tool to assess alcohol withdrawal severity that can help guide management and prevent complications in patients diagnosed with AWS?

A
  1. Classification by syndrome
  2. Classification by severity - Clinical Institute Withdrawal Assessment for Alcohol
160
Q

Describe an approach to diagnosing Alcohol withdrawal syndrome?
List 8 invesigations would consider ordering

A
161
Q

Describe an approach to the management of Alcohol Withdrawal Syndrome?

A
162
Q

What are the first line and second line drugs for treatment of Alcohol Withdrawal Syndrome?

A
163
Q

Describe the supportive care involved in the treatment of Alcohol Withdrawal Syndrome?

A
164
Q

Describe the Pathophysiology of Opioid withdrawal?

A
165
Q

Clinical features of Opioid withdrawal?

A
166
Q

Diagnosis of Opioid withdrawal?

A
167
Q

Describe an approach to the management of opioid withdrawal?

A
168
Q

Neonatal abstinence syndrome
- What is it?
- Clinical features?

A

Neonatal abstinence syndrome is caused by maternal drug use during pregnancy (typically opioids) that subsequently leads to a withdrawal reaction in the infant.

169
Q

Neonatal abstinence syndrome - Treatment
- Supportive?
- Pharmacological?

A
170
Q

List 3 pharmacological measures for smoking cessation?

A
171
Q

What is the recommended daily/weekly intake of alcohol?

A

According to the National Health and Medical Research Council (NHMRC) guidelines, average daily consumption of alcohol in excess of 2 standard drinks is a health risk for men and women. In addition, they state that on any given day consumption should not exceed 4 standard drinks, a lower maximum alcohol consumption than previously. A standard drink contains 10 g of alcohol, the amount in 285 mL of full-strength beer, 100 mL of wine, 60 mL of fortified wine and 30 mL of spirits. Significant dependence associated with a withdrawal syndrome on cessation is more likely in those whose regular consumption is >8 standard drinks per day, and is increased if they also use other sedatives.

172
Q

What are the benefits of smoking cessation?

A

YR3 - R1: General Medicine (8 decks)

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