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Addiciton Flashcards

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1
Q

Moderate dependence alcohol withdrawal management

A

20 mg chlordiazepoxide QDS
Day 2 - 15
3 - 10mg
4 + 5 - 5mg

Severe dependence = inpatient, up to 250mg a day

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2
Q

What to do when someone is withdrawing

A

Assess safety
Ensure daily support at home, if no relative at least twice daily visits by healthcare professional
Discuss [land with patient and relative
Tell them what symptoms would urgent reassessment
Carer - stop withdrawal drugs if drinking resumes
High dose vitamins - thiamine minmium 300mg/day
Leave written plan

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3
Q

What symptoms require urgent assessment in withdrawal

A

delirium, confusion, seizures, sev vomitting, high levels of distress

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4
Q

When is there high risk of complicated withdrawal requiring a hospital admission?

A

Severe dependence
Previous delrium tremens
Prev alcohol withdrawal sei\ures
Prev failed detox in community
Poor support at home
Cognitive impairment

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5
Q

Symptoms of wernicke encephalopthay

A

Acute confusional state,ocular signs and ataxic gait

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6
Q

What causes wernicke-korsakoffs syndrome

A

THiamine deficiency

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7
Q

Treatment for wernicke encephalopathy

A

High dose parental vit B1

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8
Q

Prognosis of wernicke encephalopathy

A

Untreated high % develop korsakoff psychosis an risk of death

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9
Q

Korsakoff syndrome symptoms

A

Memory loss
Anterograde and retrograde amnesia

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10
Q

Treatment for korsakoff syndrome

A

High dose oral thiamine for at least 2 years

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11
Q

Prognosis of korsakoff syndrome

A

20% complete recovery, 25% significatn recovery

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12
Q

Psychosical interventions aftercare of withdrawal

A

CBT/pronlem solving/social skills training
Relapse planning
Group support eg alcoholics anonymous
Residential rehabilitation

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13
Q

Psychosical interventions aftercare of withdrawal

A

CBT/pronlem solving/social skills training
Relapse planning
Group support eg alcoholics anonymous
Residential rehabilitation

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14
Q

Pharmacological interventions after recovery from alcogol addiction

A

Aversice drugs - disulfiram
Anticraving drugs - acamprosate, naltrexone

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14
Q

Pharmacological interventions after recovery from alcogol addiction

A

Aversice drugs - disulfiram
Anticraving drugs - acamprosate, naltrexone

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15
Q

Aversive drugs for recovered alcoholics

A

Disulfiram

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16
Q

Anti-craving drugs for recovered alcoholics

A

Acamprosate
Naltrexone

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17
Q

When is it especially important to ask about alcohol and drugs use>

A

Patient registration
Mental health presentations
Regular A+E attendance

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18
Q

Depressants

A

Barbituates
Benzodiazapines
Z-hypnotics
Opioids
Alcohol
Solvents
Ketamin
PCB

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19
Q

Hallucinogenic drugs

A

LSD
Mescalin
Fungi
Plants

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20
Q

What drugs are depressants, stimulants and hallucinogenics?

A

Ket
PCB

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21
Q

What drugs are stimulants and hallucinogens?

A

Ecstasy
PMMA
mCPP

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22
Q

Hallucinogens and depressant drugs?

A

Cannabis
Spice

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23
Q

Stimulant drugs

A

Khat
Cocaine
Amphetamine
Catinones

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24
Opioid substitution treatment
Methadone Buprenorphine
25
What do drug deaths often involve?
Opiate Another drug
26
How long do ypu have methadone for
Supervised consumption 3-6 months
27
How protect methadone use
Daily pick up Regular and spot urine testing
28
Overdose
The use of any drug such an amount that acute adverse physical or mental effects are produced
29
Withdrawal
Experience of a set of unpleasant symptoms following the abrupt cessation or reduction in dose of a psychoactive substance Consumed in high enough doses and long enough duration for person to be physically or mentally dependent on it Oppoaite to those produced by psychoactive substance itself
30
What is harmful use of anything?
Pattern of use caused damage t persons physical or mental health or resulted in behaviour leading to harm ot health of others >12 months (or 1 month if continious)
31
Time period harmful vs dependence
Addiction > 12 months (or 3 months if continious) >12 months or 1 month if continious for harmful use
32
Physiological symptoms of addiction
Tolerance, withdrawal, use to prevent/alleviate withdrawal
33
Where do opioids target?
Opioid receptors in th ebrain, spinal cord, peripheral neurons and digestive tract
34
Effect of opiates
Slow down body functioning and are strong painkillers Feeling of warmth, relaxation and detachment with lessening anxiety Start quickly, last several hours
35
Symptoms opiate withdrawal
Diaphoresis Mydriasis Goosebumps - cutis ansarina Muscle cramps abdo pain and cramps
36
History for heroin use
Substance Quantity, pattern, recent events Control (initiation/cessation) Impact on life Other info sources
37
Examination for drug use
Features of withdrawal/intoxication Needle marks
38
Features to consider when screening for drug addiction
Alcohol and other drugs Needle sharing and other risky behaviours Mental/physical/social health General examination BBV screening
39
What pharmacological treatments of opioid dependence linked to agonism?
Short acting (heroin assisted treatment) Long acting (methadone)
40
What drugs have partial agonism for opioid dependece treatment?
Long actihng - buprenorphine V long acting (extended release buprenorphine)
41
Antagonism drugs in treating opioid dependence?
Short acting (naloxone) Long acting (naltrexone) V long actnig (extended release naloxone)
42
Duration of heroin
3-6 hours
43
Peak effect of heroin
Peaks in minutes
44
Half life of heroin
15-30 minutes
45
Routes can take methadone
ral/IV/IM
46
Onset of methadone
30-60 mins
47
Duration of mehtadone
24-36 hours
48
Half life of methadone
20-37 hours
49
Buprenorphine route
Sub-lingual
50
Onset of buprenorphine
2-3 days
51
duration of buprenorphine
2-3 dyas
52
peak effects of buprenorphine
1-4 hours
53
Half life of buprenorphine
20-70 hours
54
What is cocaine?
Acid - cocaine hydrochloride - insufflated or injected
55
Effect of cocaine
Starts in mins 'Ful high at 15-30 mins Gradual come down
56
Crack effect
Few secodns - very short, rapid come down
57
How is cocaine and crack ingested
Cocaine - snorted (powder) Crack - smoked both can be injected
58
What is crack vs cocaine?
Cocaine - powder (acid) crack - crystalloid (alkaloid)
59
MOA of cocaine
Dopamine Serotonin Noradrenaline
60
How does MDMA target receptors and what does it therefore do?
Relatively higher affinity for serotonin transporters Thereby a mild hallucinogens Neurotoxic to serotonin axon terminals
61
What causes cravings?
Trigger - emotion, meet someone, money Physiological reaction Anticipation of high Mission to rise
62
How to do harm reduction for drug
BBV testing and treatment Safe injecting advice Safe environment Clean quipment and avoid home made pipes Mucous membrane care - vaseline Eat before using Stay hydrated Buy less - effect reduces after first hit
63
Education around taking drigs
Risks of specific combinations Not dangerous to stop suddenly Health risks
64
Health risks of taking drugs
Stroke MI Cognitive Impairment Parkinsons disease Seizures Psychotic illness Anxiety/depression
65
Purpose of motivational interviewing
Basisi of brief intervention or longer piece of work -Express empath y -Develop discrepancy -Roll with resistnace -Support self efficacy
66
Psychosocial interventions for drug taking
Psychoedu cation Practical strategies to reduce safely Harm reduction Mutual help groups Online self help Carer support Employment suppoirt Accom support Contingency manamgenet CBT family therapy
67
Effect of cocaine short term
Excited, confident and/or anxious, happy, panicky, risk taking Tachycardia, tachypnoea, HPTN, hyperthermia, nausea, sweating, shaking
67
Effect of cocaine short term
Excited, confident and/or anxious, happy, panicky, risk taking Tachycardia, tachypnoea, HPTN, hyperthermia, nausea, sweating, shaking
68
Continued use of cocaine effects
Decreased need for sleep, appetite suppression, paranoia, hallucinations, mood swings/depression
69
What is important in the limbic system of cocaine
Dopamine transporters highly concentrated in this system Nucleus accumbens thought particuarly important in cocaine high
70
What does opioid intoxication look like in behaviour?
Dysfunctional behaviour in at least one of: -Apathy and sedation -Disinhibition Psychomotor retardation Impaired attention Impaired judgement
71
Signs of opioid intoxication
Drowsiness Slurre speech Pupillary constriction Decerased LOC - stupor or coma
72
When does dilation occur in opioid intoxication?
Anoxia from severe overdose
73
What to cover in a drugs hisoty?
Age initiation Past and current drug use Types + quantities Frequency and routes of administration Symptoms withdrawal/other signs of dependence Periods of abstinence/relapse Funding/risky behaciours IMpact How funding
74
What to cover in a drugs hisoty?
Age initiation Past and current drug use Types + quantities Frequency and routes of administration Symptoms withdrawal/other signs of dependence Periods of abstinence/relapse Funding/risky behaciours IMpact How funding
75
AIm of treatment of drug addiction
Reducing illicit/non-prescribed drug use Reducing dangers associated with drug misuse Reducing episodes of drug misuse Reducing need for criminal activity to fund drug misuse Reduce diversion Stabilisation(where appropriate) onto substitute medication to alleviate withdrawal Sx Improve overall health , personal,social and family functioning Dealing with other problems relating to drug use
76
Treatment options recovery addiciton
Advice/info Harm reduction Self help eg AA, NA, SMART Precribing Goal directed counselling and psychological support Structured day programmes Detoz Rehabilitation Aftercare
77
Treatment options recovery addiciton
Advice/info Harm reduction Self help eg AA, NA, SMART Precribing Goal directed counselling and psychological support Structured day programmes Detoz Rehabilitation Aftercare
78
Aim of harm reduction
Stop drug using Reduce/stop injecting If injecting stop sharing equipment and avoid contaminated Sharing - clean equipment
79
Aim of harm reduction
Stop drug using Reduce/stop injecting If injecting stop sharing equipment and avoid contaminated Sharing - clean equipment
80
Strategies for harm reduction
Education - risks Needle exchange, condom provision Hep B immunisations BBV testing Substitute oral drugs
81
Strategies for harm reduction
Education - risks Needle exchange, condom provision Hep B immunisations BBV testing Substitute oral drugs
82
Strategies for harm reduction
Education - risks Needle exchange, condom provision Hep B immunisations BBV testing Substitute oral drugs
82
Strategies for harm reduction
Education - risks Needle exchange, condom provision Hep B immunisations BBV testing Substitute oral drugs
83
How to commence methadone?
Titrate against withdrawal symptoms Observe hourly/daily appointments Build up over 3 days Mixture used - not tablets In specialist treatment centres (drug services)
84
Functions of perscriptions for opioid users
Retention in treatment Reduce risks ass inject Reduce/prevent withdrawal symptoms Stabilise lifestyle Maintain contact with vulnerable Reduce criminal activity
84
Functions of perscriptions for opioid users
Retention in treatment Reduce risks ass inject Reduce/prevent withdrawal symptoms Stabilise lifestyle Maintain contact with vulnerable Reduce criminal activity
85
Treatment for stimulant dependence
Psychogical - CBT Benzodiazapines - short course Antidepressants - NTO anticraving or dopamine agonists Dexamphetamine - substitution in amphetamine dependence
86
Issues drug related to read around
Drugs and pregnancy Drugs and young people Drugs and the Prison Service (DTTO) Drugs and mental illness Children of drug using parents Drugs & driving Drug related deaths

Mental Health (57 decks)

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