Addiction Flashcards

Question

What are stimulant drugs and give some examples and how they act?

Answer 1

Potentiate neurotransmission and increase cortical excitability --> increased alertness, endurance, reduced need for sleep + confidence Cocaine - AKA Charlie, coke, snow - ROA = intranasal, IV Crack cocaine - AKA rocks, base, freebase - ROA = concentrated smokeable form - Causes an immediate, extreme high but wears off quickly (5-10mins) - Highly addictive Amphetamine - AKA speed - ROA = IV, PO, intranasal - Withdrawal meds include dexamphetamine Khat - AKA Quat, chat - Mild stimulant, used in E. African communities - Causes psychosis Ecstasy - AKA MDMA, E (3,4-methylenedioxymethamphetamine) - Causes 5HT release and blocks reuptake - Hallucinogenic + stimulant properties - Initial 3h rush, bruxism, agitation received by dancing/movement - hangover at 24-48h (fatigue, anorexia, depressed mood)

Answer 2

Sx: - Increased alertness, endurance and confidence - Risky behaviour - Unpleasant 'crash period' - No dependence apart from amphetamines SEs: --> Cocaine: [acute] = arrhythmia, intense anxiety, HTN, impaired judgement [chronic] = septal necrosis, foetal damage, delusions and psychosis, panic and anxiety , no dependence but can become 'habit' --> Amphetamines: [acute] = tachycardia, arrhythmia, hyperpyrexia, irritability, post-use depression, quasi-psychotic state with visual, auditory and tactile hallucinations, v regular use associated with dependence --> Ecstasy: [acute] = increased sweating, nausea, vomiting, diminished potency despite increased libido, death associated with dehydration and hyperthermia

Answer 3

Occurs in 2 stages: [1] Crash phase - from 3h: depression, exhaustion, agitation and irritability [2] Withdrawal - lasting 1-10w: cravings, irritability, anergia, poor concentration, insomnia, slowed movements

Answer 4

Ix: - Full drug Hx and physical examination for signs of disease/chronic use - UDS (cocaine can last in urine for 5-7d) - Bloods - FBC for infection, BBV and HIV testing? Mx: - Health education (support, + family and social help, NA) - Harm reduction (needle exchanges, BBV testing) - Short term withdrawal symptom relief can be provided with BDZ as an inpatient

Answer 5

Uses of BDZ = sedation, hypnotic, anxiolytic, anticonvulsant, muscle relaxant (enhances GABA transmission) Should only be used for a short time (2-4w) Risks of BDZ use [short-term] = drowsiness, reduced concentration [long-term] = cognitive impairment, WORSENING OF anxiety and depression, DEPENDENCE, sleep disruption

Answer 6

i) Misuse - Similar to alcohol; calm and mild euphoria - Slurred speech, ataxia, stupor ii) OD - Respiratory depression, low GCS, low BP, mydriasis, hyporeflexia - Tx = IV flumazenil iii) Withdrawal - Similar to alcohol; ANXIETY, tremor, insomnia, palpitations + tachycardia/tachypnoea, delusions, depersonalisation, irritably, hyperreflexia, ataxia, sweating, mydriasis, depression and anterograde amnesia, tinnitus, seizures - Sudden withdrawal may present with a DT-like picture!!

Answer 7

Ix: - Full Hx and physical exam (neuro - reflexes, ataxia) - Hx --> use of BDZ, where from, how often/dose - Obs (HR, BP, RR) Mx: -> Address underlying need for BDZ (anxiety, sleep, depression) and the long term complications of use (cognitive impairment, anxiety, depression, insomnia) -> Check willingness to withdraw and whether this can be done in primary care -> Withdrawal Mx: 2 methods= [1] Slow dose reduction [2] Switch to equivalent dose of Diazepam and slow dose reduction (preferred: used in those on short-acting, potent BDZ such as lorazepam, and difficulty with physically tapering dose) --> Withdraw 1/8th daily dose reduction every 2w -> Advice: - If done properly, there will be few, if any, withdrawal SEs - Anxiety is the most common SE and is normal; treat with conservative mx such as relaxation/breathing techniques - May take 3m-1y or longer - Assess driving risk as can't drive on certain amounts of BDZ (DONT drive if feeling drowsy) - Offer CBT **EG 1/8th daily dose reduction every 2 weeks – e.g. diazepam 40 mg per day: • Reduce dose by 5 mg every 2 weeks until reaching 20 mg per day -> 8 weeks • Reduce dose by 2 mg every 2 weeks until reaching 10 mg per day -> 10 weeks • Reduce dose by 1 mg every 2 weeks until reaching 5 mg per day -> 10 weeks • Reduce dose by 0.5 mg every 2 weeks until completely stopped -> 20 weeks THEREFORE Estimated total withdrawal time = 30–60 weeks NOTE: short acting BDZ e.g. lorazepam, long-acting e.g. chlordiazepoxide, diazepam

Answer 8

14. 7% of UK smoke | - > A CO level of =/< 10ppm indicates abstinence from smoking (5-9ppm)

Answer 9

Mx: - > Very brief advice (given anytime and anywhere) - ask about current and past smoking behaviour - Provide written AND verbal information on RISKS (cancer, CLD i.e. bronchitis, COPD, hospital admissions) and BENEFITS of stopping (whatever time you stop its beneficial, cost saving, health) - Advise options for smoking cessation like behavioural support and medication: refer to local cessation service if they wish to stop - If they don't want to quit, enquire to a harm reduction policy i.e. use of NRT as most problems attributed to tobacco smoke, not nicotine and these NRTs provide nicotine slowly and less-addictively than smoking - > 1st line = ADVICE - Behavioural support and medication is best for stopping - Set a quit date and commit to it - First few days are most difficult, may experience withdrawal, but passes by 3-4d -> 2nd line = MEDS [] NRT varies on preference, but can't prescribe in combination with medications. Types = lozenges, mouth spray, patches - Start on agreed quit date - 24h patches useful is smoking shortly after waking, on combined NRT so the patch is for 'background craving' [] Varenicline - Partial nicotine receptor agonist - Dose = 1mg BD, titrated up from 500mcg OD over 1w - Started 7-14d before quit date, whilst still smoking - Contraindicated in those <18y and those with renal disease [] Buproprion - Weak but selective DA and NA reuptake inhibitor - 150mg BD, titrated up from 150mg OD over 1w - Max use for 7-9w, then discontinue Started 7-14d before quit date, whilst still smoking - Contraindicated in those <18y, eating disorders, BPAD, cirrhosis, CNS disorders and seizures DO NOT RECOMMEND E-CIGARETTES as unclear health impact - > Follow up - 2w if on NRT, 3-4w if on medications - Measure CO levels 4w after quitting - Check progress and withdrawal sx - If relapse/partial release then encourage and set new quit date

Addiction Flashcards

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