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Y5 Psych > Addiction > Flashcards

Addiction Flashcards

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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
Ix for ?alcohol dependence
CAGE / AUDIT / FAST questionnaire LFTs
26
Alcohol Hx questions
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
27
how do you calculate units of alcohol
[ABV x volume (mL)] / 1000
28
define alcohol dependence syndrome (Edwards and Gross 1976)
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
29
do alcoholics have 1 drink of choice or will they drink any alcohol
1 drink of choice usually
30
Mx of alcohol dependence - inc meds, therapy, laws
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
list 4 alcohol abstinence medications and their use
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
which drug is an anti alcohol craving drug
acamprostate
33
which drug increases hangover symptoms more quickly (aversive)
disulfram
34
which drug is contraindicated in alcohol dependence
nalmafene - only for binge drinking episodes, not constant drinking
35
Ix for alcohol withdrawal
basic obs abdo exam - organomegaly neuro exam - tremor / pupils bloods - FBC, LFTs, thiamine, clotting
36
Mx of alcohol withdrawal
chlordiazepoxide - reducing regime over 7-10 days thiamine / pabrinex do NOT give glucose prior to pabrinex as it can precipitate wernickes
37
what is alcohol withdrawal
when alcohol dependent stops drinking, is potentially lethal
38
risks of alcohol withdrawal
wirhdrawal seizures, Delirium tremens, wernickes, korsakoffs
39
symptoms of alcohol withdrawal
tremors sweating N&V anxiety HTN, tachycardia, dilated pupils psychomotor agitation psychotic Sx - delusions / hallucinations withdrawal seizures
40
what % people get withdrawal seizures in alcohol
20%
41
when do alcohol withdrawal seizures occur
24-48 hours after last drink
42
what type of seizures are alcohol withdrawal seizures
tonic clonic
43
when do symptoms occur in alcohol withdrawal
6-12 hours after drinking has stopped
44
when is pabrinex not used in alcohol withdrawal
significant hepatic impairment
45
when does delirium tremens occur
24-72 hours after alcohol has stopped
46
sx of DT
withdrawal + alterted mental status - hallucinations / confusion / delusions /severe agitation +/- seizures
47
risk factors of DT
previous DT previous alcohol withdrawal seizures infection / medical problems recent higher than normal alcohol abnormal LFTs older age
48
Mx of DT
admit to hospital benzos pabrinex treat hypoglycaemia AFTER magnesium to prevent arrhythmias
49
mortality of untreated DT
35%
50
mortality of early recognition and TX of DT
2-5%
51
why does wernickes / korsakoffs occur
thiamine deficiency --> oxidative damage / apoptosis of neurones / glial cells / astrocytes
52
why are alcoholics thamine deficient
poor diet stomach lining damage so poor absorption
53
which one of korsakoffs and wernickes is reversible
wernickes
54
sx of wernickes
confusion --> main one opthalmoplegia - nystagmus or CN6 palsy ataxia
55
what % of people have 3/3 wernickes sx
25%
56
korsakoff's psychosis sx
profound anterograde and retrograde amnesia confabulation frontal lobe dysfunction - child like personality psychotic sx
57
what is clucking
term used by opioid users to describe withdrawal sx as you get goosebumps
58
low BP, low O2 sats, pin point pupils, unresponsive to pain. Dx?
opioid overdose
59
Tx for opioid overdose
ABC approach w IV fluids IV naloxone every 1-2 mins depending on response. titrate dose up until response seen
60
risk factors of opiate overdose
opiate naive / reduced tolerance older hepatic / renal impairment lung disease - COPD prescribed / using other sedatives
61
clinical features of opiate OD
reduced GCS respiratory depression hypotension & tachycardia hypotonic / hyporeflexic coma pin point pupils
62
prophylaxis for opiate OD
give addicts / ppl with opiates prescribed an IM naloxone pen
63
2 types of opiate substitution therapy
methadone buprenorphine
64
features of methadone - half life / action - action - side effects
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
features of buprenorphine - action - half life - comparison to methadone SE
partial agonist, long half life, adminsitered once a day attentuates effects of opiates produces less sedation, less euphoria, positive reinforcement, less resp depression
66
what is buprenorphine + naloxone called
suboxone - no longer used
67
how is OST done in acute setting
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
is opiate withdrawl lethal
Not really, but can be due to vomitting leading to dehydration
69
withdrawal Sx onset for heroin
6hrs after last peaks 26-48 hours after
70
withdrawal sx onset for methadone
1-2 day half life starts 36 hours and peaks 3-5 days later
71
when does heroin withdrawal complete
5 days
72
features of opiate withdrawal
sweating, yawning, lacrimation, flu like sx tremor tachycardia, HTN GI upset piloerection or goosebumps --> hence clucking
73
scale for opiate withdrawal rating
COWS - clinical opiate withdrawal scale

Y5 Psych (10 decks)

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