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Y5 Psych > Addiction > Flashcards

Addiction Flashcards

1
Q

awful feeling, no sleep last night, visible sweating and a tremor.
PMH: panic disorder treated with benzodiazepines.
Non smoker, drinks alcohol. Takes xanax.
Dx?

A

benzodiazepine withdrawal

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2
Q

Ix for ?benzodiazepine withdrawal

A

UDS

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3
Q

Mx of ?benzodiazepine withdrawal

A

give a long acting benzo and taper it down

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4
Q

can benzo withdrawal be lethal?

A

YES

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5
Q

when can benzos be used

A

no other choice for severe anxiety
rapid tranq
medical reasons eg epilepsy

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6
Q

risk factors for benzo withdrawal

A

prolonged use
high doses
short acting benzos

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7
Q

MoA of benzos

A

target gaba a positive allosteric modulators –> bind so receptor has greater affinity for gaba –> increased flow of Cl- –> hyperpolarisation –> reduced excitability & less likely to fire

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8
Q

withdrawal features of benxos

A

anxiety
irritability
restlessness
tremor
sweating
insomnia
confusion
seizure / psychosis risk

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9
Q

toxicity of benzos

A

drowsy
ataxia
slurred speech
reduced conciousness

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10
Q

toxiticy of benzos

A

hypotension
bradycardia

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11
Q

antidote to benzos

A

flumazenil (antagonist)

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12
Q

how is benzo dependance managed

A

GP / addiction services
convert to diazepam equivalent dose daily (up to 40mg OD)
very slowly reduce the dose - no more than 10% every 2 weeks

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13
Q

what can be tested on UDS

A

amphetamines
barbiturates
benzos
cocaine
ectasy
meth
morphine
methadone
opiates
TCAs
cannabis

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14
Q

range of detection of cannabis in UDS

A

casual use - 1-14 days
heavy use up to 30 days

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15
Q

range of detection of other drugs in UDS

A

2-6 days ish

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16
Q

back injury with codeine 60mg every 4 hours, 4 times per day. comes in saying she lost prescription so needs another & has contacted OOHs to get more separately. admits to buying co-codamol too, and taking more than prescribed.
says she has withdrawal Sx when trying to cut down. Dx?

A

opioid dependance

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17
Q

red flags of opioid dependence Hx

A

lost prescription
going to different pharmacies to get max amount
buying meds off friends

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18
Q

define harmful use

A

a pattern of psychoactive sybstance use that is damaging to health
- physical or mental damage

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19
Q

define substance abuse / dependence

A

the continued misuse of any psychoactive substance that severely affects a person’s physical and mental health, social situation and responsibilities

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20
Q

what is a psychoactive substance

A

substance that has an effect of central nervous system

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21
Q

define the 6 criteria of ICD 10 dependence syndrome

A
  • strong desire / compulsion to take substance
  • difficulties controlling substance taking behaviour
  • physiological withdrawal state when they stop using substance
  • evidence of tolerance
  • progressive neglect of alternative pleasures or interests
  • persisting with substance use despite clear evidence of overtly harmful consequences
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22
Q

how many criteria are needed for a diagnosis of dependence with ICD 10 criteria

A

3+

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23
Q

stages of change model

A

pre contemplation
contemplation
preparation
action
maintenance
relapse OR abstinence

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24
Q

what method can you use to move someone from pre contemplation to contemplation

A

FRAMES
- feedback about risk / impairment
- responsibility for change is placed on pt
- advice given to pt
- menu of alternative self help / treatment
- empathic style used
- self efficacy / optimistic empowerment

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25
Q

Ix for ?alcohol dependence

A

CAGE / AUDIT / FAST questionnaire
LFTs

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26
Q

Alcohol Hx questions

A

what / how much / when / where drinking
alone or with friends
withdrawal - what / when / alcohol needed to overcome
triggers for drinking
binging / steady drinking
longest period of abstinence
any help sought for drinking / psych conditions
drugs / crimes
FH

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27
Q

how do you calculate units of alcohol

A

[ABV x volume (mL)] / 1000

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28
Q

define alcohol dependence syndrome (Edwards and Gross 1976)

A

narrowing of drinking repertoire
salience of drink-seeking behaviour
increased tolerance
repeated withdrawal syndrome
relief / avoidance of withdrawal Sx by further drinking
subjective awareness of compulsion to drink
reinstatement after abstinence

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29
Q

do alcoholics have 1 drink of choice or will they drink any alcohol

A

1 drink of choice usually

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30
Q

Mx of alcohol dependence
- inc meds, therapy, laws

A

motivational interviewing & discuss evidence for concern
initiate discussion of Mx for reduction of drinking
offer referral to specialist alcohol services
must notify DVLA by law
offer prophylactic oral thiamine to harmful / dependent drinkers if malnourished
use a daily drink diary
follow up

31
Q

list 4 alcohol abstinence medications and their use

A

acamprostate - reduced hyperglutamtergic state, increases abstinence. anti craving drug.
naltrexone - reduces relapse rates (licesned for opiates)
disulfram - inhibits liver enzymes that metabolise alcohol, so is an aversive if alcohol is drank. can be dangerous if alcohol is drank as increased acetyldehyde.
nalmafene - opioid antagonist. start when drinking to reduce consumption / stop binge drinking.

32
Q

which drug is an anti alcohol craving drug

A

acamprostate

33
Q

which drug increases hangover symptoms more quickly (aversive)

A

disulfram

34
Q

which drug is contraindicated in alcohol dependence

A

nalmafene - only for binge drinking episodes, not constant drinking

35
Q

Ix for alcohol withdrawal

A

basic obs
abdo exam - organomegaly
neuro exam - tremor / pupils
bloods - FBC, LFTs, thiamine, clotting

36
Q

Mx of alcohol withdrawal

A

chlordiazepoxide - reducing regime over 7-10 days
thiamine / pabrinex
do NOT give glucose prior to pabrinex as it can precipitate wernickes

37
Q

what is alcohol withdrawal

A

when alcohol dependent stops drinking, is potentially lethal

38
Q

risks of alcohol withdrawal

A

wirhdrawal seizures, Delirium tremens, wernickes, korsakoffs

39
Q

symptoms of alcohol withdrawal

A

tremors
sweating
N&V
anxiety
HTN, tachycardia, dilated pupils
psychomotor agitation
psychotic Sx - delusions / hallucinations
withdrawal seizures

40
Q

what % people get withdrawal seizures in alcohol

A

20%

41
Q

when do alcohol withdrawal seizures occur

A

24-48 hours after last drink

42
Q

what type of seizures are alcohol withdrawal seizures

A

tonic clonic

43
Q

when do symptoms occur in alcohol withdrawal

A

6-12 hours after drinking has stopped

44
Q

when is pabrinex not used in alcohol withdrawal

A

significant hepatic impairment

45
Q

when does delirium tremens occur

A

24-72 hours after alcohol has stopped

46
Q

sx of DT

A

withdrawal + alterted mental status - hallucinations / confusion / delusions /severe agitation
+/- seizures

47
Q

risk factors of DT

A

previous DT
previous alcohol withdrawal seizures
infection / medical problems
recent higher than normal alcohol
abnormal LFTs
older age

48
Q

Mx of DT

A

admit to hospital
benzos
pabrinex
treat hypoglycaemia AFTER
magnesium to prevent arrhythmias

49
Q

mortality of untreated DT

A

35%

50
Q

mortality of early recognition and TX of DT

A

2-5%

51
Q

why does wernickes / korsakoffs occur

A

thiamine deficiency –> oxidative damage / apoptosis of neurones / glial cells / astrocytes

52
Q

why are alcoholics thamine deficient

A

poor diet
stomach lining damage so poor absorption

53
Q

which one of korsakoffs and wernickes is reversible

A

wernickes

54
Q

sx of wernickes

A

confusion –> main one
opthalmoplegia - nystagmus or CN6 palsy
ataxia

55
Q

what % of people have 3/3 wernickes sx

A

25%

56
Q

korsakoff’s psychosis sx

A

profound anterograde and retrograde amnesia
confabulation
frontal lobe dysfunction - child like personality
psychotic sx

57
Q

what is clucking

A

term used by opioid users to describe withdrawal sx as you get goosebumps

58
Q

low BP, low O2 sats, pin point pupils, unresponsive to pain. Dx?

A

opioid overdose

59
Q

Tx for opioid overdose

A

ABC approach w IV fluids
IV naloxone every 1-2 mins depending on response. titrate dose up until response seen

60
Q

risk factors of opiate overdose

A

opiate naive / reduced tolerance
older
hepatic / renal impairment
lung disease - COPD
prescribed / using other sedatives

61
Q

clinical features of opiate OD

A

reduced GCS
respiratory depression
hypotension & tachycardia
hypotonic / hyporeflexic coma
pin point pupils

62
Q

prophylaxis for opiate OD

A

give addicts / ppl with opiates prescribed an IM naloxone pen

63
Q

2 types of opiate substitution therapy

A

methadone
buprenorphine

64
Q

features of methadone
- half life / action
- action
- side effects

A

long acting, half life 24 hours, used once a day
reduced slowly over weeks, less euphoria than heroin
side effects: letahrgy, resp depression, contipation, reduced saliva

65
Q

features of buprenorphine
- action
- half life
- comparison to methadone SE

A

partial agonist, long half life, adminsitered once a day
attentuates effects of opiates
produces less sedation, less euphoria, positive reinforcement, less resp depression

66
Q

what is buprenorphine + naloxone called

A

suboxone
- no longer used

67
Q

how is OST done in acute setting

A

confirm the substitute and dose with GP and then with the chemist
UDS - check for methadone
prescribe the dose if above are fine
call chemist when discharged to inform them

68
Q

is opiate withdrawl lethal

A

Not really, but can be due to vomitting leading to dehydration

69
Q

withdrawal Sx onset for heroin

A

6hrs after last
peaks 26-48 hours after

70
Q

withdrawal sx onset for methadone

A

1-2 day half life
starts 36 hours and peaks 3-5 days later

71
Q

when does heroin withdrawal complete

A

5 days

72
Q

features of opiate withdrawal

A

sweating, yawning, lacrimation, flu like sx
tremor
tachycardia, HTN
GI upset
piloerection or goosebumps –> hence clucking

73
Q

scale for opiate withdrawal rating

A

COWS - clinical opiate withdrawal scale

Y5 Psych (10 decks)

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