Drug and Alcohol Problems Flashcards
defined as ‘any unwanted
effect of treatment from the medical use of drugs that
occurs at a usual therapeutic dose
adverse drug effect
______ are the most common and involve
augmented pharmacology; that is, they are caused by
unwanted, albeit predictable, effects of the drug
Type A reactions
Examples of Type A reaction
• _____ due to verapamil
• blurred vision and urinary outflow problems due
to ________
• hyperuricaemia due to______
constipation
tricyclic antidepressants
thiazide diuretics
Type A reactions are ______dependent
dose-
_____reactions are by definition bizarre. The
reactions are unpredictable from known properties of the drug
Type B
Examples of Type B
Examples include hepatotoxicity and blood
dyscrasias.
1 drug that causes side effects:
Antidepressants (number 1 cause): tricyclics,
MAOIs, SSRIs
_____ is the largest single, preventable
cause of death and disease in Australia.
Tobacco smoking
Signs of
major dependence are smoking within______
30 minutes of
waking and ≥ 20 cigarettes a day
What symptoms after stopping smoking?
The initial symptoms are restlessness, cravings,
hunger, irritability, poor concentration, headache
and frustration
Withdrawal
After about _____ days most of these effects subside but it takes about ____ for a smoker to feel relatively comfortable
with not smoking any more
10
three months
DSM criteria for nicotine withdrawal
1 Irritability, frustration or anger 2 Anxiety 3 Difficulty concentrating 4 Increased appetite 5 Restlessness 6 Depressed mood 7 Insomnia
______ which should
be used in conjunction with an educational support
program, has been proved to be effective and
is available as chewing gum, inhaler, oral spray,
lozenges, sublingual tablets or transdermal patches
(the preferred method).
Nicotine replacement therapy (NRT),
Ideally the nicotine should
not be used longer than _____months.
3
NRT should be directed at smokers who are
_______ There is little evidence that drug
treatment will benefit individuals with low levels
of nicotine dependence who smoke fewer than
10 cigarettes a day
motivated to quit.
All forms of NRT are effective: a pooled analysis
of all NRT trials showed an absolute increase in
cessation at 1 year of ______compared to placebo
7%
How to use the Nicotine gum
Low dependence (less than 10 cigarettes per
day, not needing to smoke within 30 minutes
of waking):______
use non-pharmacological methods
rather than replacement
How to use the Nicotine gum
Moderate dependence (10–20 cigarettes per day, smoking within 30 minutes of waking): \_\_\_\_\_\_
2 mg,
chew 8–12 pieces daily
How to use the Nicotine gum
High dependence (>20 per day, waking at night to smoke or first thing after waking):\_\_\_\_\_\_\_
4 mg
initially, 6–10 pieces chewed daily changing to
2 mg after 4–8 weeks
Useful points in using Nicotine gum:
• Chew each piece slowly for about______
• Ensure all the nicotine is utilised.
• Chew at least 6 pieces per day, replacing at regular
intervals (not more than 1 piece per hour).
• Use for ______ weaning off before the end of
this period
30 minutes.
3 months,
This is available as 16-hour or 24-hour nicotine
patches in three different strengths. The patients
should stop smoking immediately on use
Transdermal nicotine
Useful points in using Transdermal nicotine
low to moderate dependence (10–20 cigarettes/
day): ______
14 mg/24 hour or 10 mg/16 hour patch,
daily; aim to cease within 12 weeks
Useful points in using Transdermal nicotine
high dependence (>20/day): ______
21 mg/24 hour or 15
mg/16 hour patch; change to 14 mg or 10 mg patch
after 4–6 weeks; aim to cease within 12 weeks
Useful points in using Transdermal nicotine
Rotate sites with a_____for reuse of a
specific site.
7-day gap
Nicotine inhaler
Uses cartridges in a mouthpiece resembling smoking.
_________
• 6–12/day for 12 weeks then taper
____________
These are available in 2 mg and 4 mg strengths, the
strength used according to the level of dependence
Nicotine lozenges and sublingual tablets
Controlled trials have shown enhanced outcomes
when nicotine patches are combined with ______. Consider it for highly addicted smokers
gum or
inhaler.
This oral agent has a similar effectiveness to NRT.
Adverse effects include insomnia and dry
mouth (both common), with serious effects, such
as allergic reactions and increased seizure risk
Bupropion (Zyban)
Commence with 0.5 mg (o) daily for 3 days
titrating slowing to 1 mg bd by day 7 until the
end of the 12-week course
It is an effective agent but there are several side
effects, especially nausea
Varenicline tartrate (Champix)
__________ is one of the most
common and socially destructive problems in the world.
Excessive drinking of alcohol
At least 20–40% of acute general and psychiatric
hospital admissions have ________
an alcohol-related
illness
Problem drinkers represent about
_______of the population
15–20%
_____________occurs at >6
standard drinks (SDs) a day (average) for men and
>4 SDs for women
High-risk and harmful drinking
The main causes of alcohol-related deaths are
1
2
3
road
trauma, cancer and alcoholic liver disease
What questionaire is used?
1 Have you ever felt you should CUT down on your
drinking?
2 Have people ANNOYED you by criticising your
drinking?
3 Have you ever felt bad or GUILTY about your
drinking?
4 Have you ever had a drink first thing in the
morning to steady your nerves or get rid of a
hangover? (an EYE-OPENER)
CAGE questionnaire
The following blood tests may be helpful in the
identification of excessive chronic alcohol intake:
1
2
3
• blood alcohol
• serum GGT: elevated in chronic drinkers (returns
to normal with cessation of intake)
• MCV: >96 fL
