Alcohol + Substance Misuse Flashcards by Emmy Beever

List the different types of ‘disorders/states’ seen in substance misuse (6) (THAWDD)

Acute intoxication
Harmful use
Tolerance
Dependance syndrome
Withdrawal state
Drug-induced psychosis

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What are the core features of Dependance syndrome

Primacy (most important thing + relationships etc suffered)
Tolerance
Withdrawal
Rapid reinstated dependance after abstinence
Continued use despite -ve consequences
Loss of control
Narrowing of repertoire (range → one + same setting)

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What % of: drink daily?

a) 16-25yrs
b) 25-45yrs
c) 65+ yrs

What % of men + women are alcohol-dependant in UK?

a) 1%
b) 4%
c) 13%

Men: 9%
Women: 4%

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What proportion hosp admissions related to alcohol?
What proportion violent incidents in pub/club
What proportion RTAs from drinking?

2/3rd hosp admissions related to alc

1/5 violence in pubs/clubs
1/6 RTAs from drink driving

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What are the Bio (2) - Psycho (1) - Social (5) RFs for Alcohol Misuse Disorder?

Bio: 
Genetic role (alc metab)
1st degree = 7x risk (even if adopted)

Psycho:
Any mental illness
(Stress / Social Anxiety / Low-Self Esteem associated)

Social:
Men
Low socio-economic class
Loss of spouse
Social isolation
Certain professions

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List the neurological complications with alcohol misuse (7)

Cognitive/memory impairment
Cerebellar dysfunc
Reduced brain wt/vol
Wernicke-Korkasoff
Central pontine myelinolysis (quadriparesis)

Peripheral neuropathy/myopathy
Optic nn atrophy

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List the Resp (2) + CV (4) complications with alcohol misuse

Infection susceptibility
Aspiration susceptibility

Alcoholic cardiomyopathy
Arrhythmias (esp AF)
CVA (esp haemorrhagic)
HTN

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List the Hepatic complications of alcohol misuse (4)

Fatty liver changes in 90% (can occur after 1 binge - reversible w. abstinence)

Alcoholic hepatitis
Cirrhosis as end-stage (fast progress if female/HepBC)
Hepatocellular Carcinoma

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List the Renal (2), Pancreas (2) + Spleen (1) complications of alcohol misuse

Renal:
Cirrhosis → hepato-renal syndrome
HTN → CKD

Pancreas: Acute/Chronic Pancreatitis

Spleen: Splenomegaly from cirrhosis/portal HT

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What are the GI complications of alcohol misuse (3:3:3)

Oesophageal: M-W tears / Varices / Barretts

Gastric: Gastritis / Ulcers / Carcinoma

Intestinal: Malabsorp / Chronic diarrh / Colorectal cancer

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What are the reproductive complications of alcohol misuse (3F/2M)

Female: Sexual dysfunc / subfertility / pregnancy risks
Male: Erectile dysfunc / hypogonadism

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List some psychiatric complications of alcohol misuse (6)

Substance-induced psychosis (rare/reversible)
Alcohol-Related Brain Damage
Pathological jealousy (monosymp delusion)

Anxiety/Depression (self-medicate / depressant / withdrawal-anxiety)

Scz: associated incidence
Higher risk of: relapse / non-concordance / violence

Suicide: higher risk, esp if: social isolated / many failed abstinence attempts / psych co-morb

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What are the social complications of Alcohol Misuse (6)

Marital disharmony/divorce
Psychological harm to family
Physical harm /domestic violence

Risky sexual activity
Impact on employment
Financial/legal problems

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What are the RFs for more severe alcohol withdrawal (5)

Amount alc consumed**
Length time been heavy drinking**

Previous withdrawal
Advanced liver disease
Intercurrent medical illness

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In what timeframe does mild/uncomplicated AWS (alc withdrawal syndrome) occur?

4-12hrs after

Last 2-5d

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What are the symptoms of Mild/Uncomplication AWS (I CANT SIPP)

Intense alc craving

Coarse tremor
Anxiety
N+V
Tachycardia

Sweating
Insomnia
Psychomotor agitation
Poss transient hallucinations

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In what timeframe do alc withdrawal seizures occur?

What is their incidence?

6-48hrs after

5-15% get grand-mal seizures

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What are the RFs for withdrawal seizures in alc misuse? (4)(HHIP)

H/o head injury
Heavy/prolonged alc consumption
Idiopathic epilepsy
Previous withdrawal seizures

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In what timeframe do delirium tremens occur?

What incidence ?

1-7d after

5% AWS

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List a DDx for delirium tremens (3)

Head injury
Encephalopathy (Hepatic/Wernicke)
Alternative cause of delirium

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What are the Sx of delirium tremens (8)

In addition to Uncomplicated AWS Sx:

Disorientation
Altered consciousness
Amnesia
Hallucinations
Severe psychomotor agitation / tremor
Autonomic disturbance
Fever
Electrolyte imbalance

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What are the key components for alcohol detox Tx (3)

Symptomatic relief with BZDs (reducing regime w. chlordiazepoxide)
Nutritional/vitamine supplementation (thiamine + multivit)
Close monitoring of complications

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Describe the pathophysiology behind Wernicke’s encephalopathy

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Neurodegeneration from thiamine defc

Haemorrhages + secondary gliosis in grey matter (periventricular/periaqueductal)

List the causes of thiamine defc (4)

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Chronic alc misuse***
Anorexia nervosa
Post-GI surgery
Hyperemesis gravidarum

Why are alcoholics particularly prone to thiamine defc? (3)

1. Poor diet 2. Reduced GI absorption 3. Reduced hepatic storage capacity (co-existing disease)

What is the classic triad of Sx in Wernicke's encephalopathy (AAO) + any other associated Sx (3) (PRN)

Acute confusional state (80%) Ataxic gait Oculomotor (nystagmus/ophthalmoplegia) Peripheral neuropathy Resting tachycardia Nutritional defc stigmata

What is the prognosis like in Wernicke's encephalopathy (mortality / progression)

15% mortality if untreated | 80% progress to Korsakoff syndrome

How is Wernicke's encephalopathy managed? (2) | What should not be done / caution when treating?

IV High potency thiamine (VitB1) replacement (Pabrinex) Treat co-existing AWS NB do not rehydrate with glucose solution before thiamine as will exacerbate

What are some causes for Korsakoff syndrome (4)

Thiamine defc Head injury Encephalitis CO poisoning

What are the clinical features of Korsakoff syndrome (4)

``` Anterograde amnesia (marked) Retrograde amnesia (slight) Confabulation (false memories where amnesic) Apathy ```

Describe the bio-psycho-social management of Korsakoff syndrome

Bio: treat any Wernicke's / oral thiamine + multivit (2yrs) Psychosocial: e.g. OT input, carer support (for cognitive impairment)

What is the prognosis like in Korsakoff syndrome?

50% no recovery 25% signif recovery over time 25% complete recovery

List the main headings in taking an Alcohol History | ALC Stops The Pain

Screening (CAGE) Attempts stopping Lifetime pattern of alc consumption Current alc consumption Social/occupational probs Tolerance/Dependance/Withdrawl Physical/Mental health

What may be seen physically O/E in an alcoholic?

``` Poor general condition AWS symptoms Facial capillarisation Liver disease stigmata Peripheral neuropathy Cerebellar signs ```

What Ix can be done when assessing alcohol misuse? (3)

MCV - high specificity (stays high 3-6m post-abstinence) GGT - more specific < other LFTs Liver USS

What is the MOA of heroin?

Crosses BBB → mu agonist → inhibs GABA release → less inhib effect / increased release dopamine → continued activation of dopaminergic reward pathway

What are the harmful effects of heroin via all routes (4)

Constipation N+V Resp depression Loss of consciousness/aspiration risk

What are the harmful effects of heroin via IV route? (6)

``` Local abscess Cellulitis Osteomyelitis Bacterial endocarditis Septicaemia HIV/HepBC transmission ```

What are the acute (5) + chronic (2) harmful effects of MDMA use?

``` Hyperthermia Blurred vision Jaw clenching Nausea Comedown (fatigue/depression) 12-48hrs after ``` ``` Depression/Anxiety Tolerance develops (but not dependance) ```

What is the MOA of cocaine?

Blocks monoamine reuptake (Dopa/NA/5HT) | Increased dopamine in mesocorticolimbic

What are the acute (3) + chronic (4) harmful effects of Cocaine use?

Acute - CV: Panic attacks Tachycardia HTN / Generalised vasocon (MI/CVA) ``` Chronic: Septum/sinus necrosis CKD 2o to HTN Pregnancy risks (miscarry/abruption) Psych: panic disorder / GAD / psychosis ```

What are the withdrawal symptoms with Cocaine? (4)

Craving Fatigue / diff conc Anxiety / dysphoria Muscle aches / tremors

What is the MOA of cannabis?

THC activates CB1 (cannabinoid) receptors | → assoc w. memory/conc/time perception/exec func

What are the physical effects of cannabis (4)

Increased HR Increased appetite Dizziness Smoking-related pathology

What are the psychological effects of cannabis (3)

Can provoke panic attacks Can provoke psychotic Sx Chronic use → dysthymia, anxiety, avolition

What is the MOA of BZDs?

Potentiate effects of GABA

What are the acute effects of BZDs (7)

``` Intoxication Drowsiness Dizziness/blurred vision Impaired conc Impaired coord Hypotension (if IV) Resp dep (if IV) ```

What are the chronic effects of BZDs (MDT)

Memory/conc impaired Depression Tolerance/dependance if regular use for 3-6wks

What are the withdrawal Sx seen with BZDs (6)

Agitation Anxiety Insomnia Seizures Delirium Psychosis

Give some examples of harm reduction strategies in alc/drug misuse (3)

Don't share / use uncleaned injecting equipment Use other methods (i.e. not injecting) Substitute prescribing (methadone)

What are some +ve prognostic factors in giving up alc/illicit drug use (5)

Motivated to change Supportive fam/relationships In employment Drug/alc services Treatable co-morbid (e.g. dep/anx)

What are some -ve prognostic factors (6) in giving up alc/illicit drug use

Ambivalent to change Cognitive impairment Unstable accom/homeless Unemployed Repeated failures Primacy

What are the 4 principles of motivational interviewing

Focus - on habits want to change Engage - estab relationship Evoking - belief/motivation to change Planning - practical steps to change

Describe the Bio (3) - Psycho (6) - Social (3) management of Alcohol Misuse

Bio: Chlordiazepoxide / Disulfiram (deterrent) / Acomprosate Psycho: AA / Drug+Alc services Indiv Counselling / Motiv Interviewing CBT / Self-Help Social: Housing support Financial/employment support Social services / child care

What drugs are available for opiate dependance (3 + 2)

Detox - Sx relief of withdrawals: Lofexidine Loperamide / Metoclopramide (anti-emetics) Substitute - long-term as alternative: Methadone Buprenorphine

Alcohol + Substance Misuse Flashcards

(55 cards)