Assessment and management of people with substance use disorder

Question 1

What scoring system is used to assess opioid withdrawal?

1 - CIWA score
2 - Wells score
3 - COWS score
4 - all of the above

Answer 1

3 - COWS score
- Clinical Opiate Withdrawal Scale

Question 2

What scoring system is used to assess problem alcohol drinking?

1 - CIWA score
2 - Wells score
3 - COWS score
4 - AUDIT-C score

Answer 2

4 - AUDIT-C score
- Alcohol Use Disorders Identification Test

Question 3

What is the recommended alcohol use that patients are advised to stay below?

1 - <6 units
2 - <12 units
3 - <14 units
4 - <20 units

Answer 3

3 - <14 units

• calculation for alcohol units =

% of alcohol x volume of alcohol / 1000

Question 4

Which 2 drugs are typically detectable in the blood for the shortest length of time?

1 - amphetamines
2 - benzodiazepines
3 - cocaine
4 - cannabis

Answer 4

1 - amphetamines
3 - cocaine

Question 5

Which of the following medications is the drug of choice for uncomplicated alcohol detoxication and delirium tremens?

1 - chlordiazepoxide
2 - diazepam
3 - atropine
4 - naloxone

Answer 5

1 - chlordiazepoxide

Question 6

Which of the following medications is the drug of choice for alcohol detoxication when there is a risk of seizures and in delirium tremens?

1 - chlordiazepoxide
2 - diazepam
3 - atropine
4 - naloxone

Answer 6

2 - diazepam

Question 7

Thiamine (B1) is used in alcoholics. Is thiamine effective in both Wernicke’s encephalopathy and Korsakoff’s?

Answer 7

• no
• just Wernicke’s encephalopathy which is caused by a sudden stop in glucose from alcohol
• no thiamine means glycogen cannot be mobilised causing neurological damage

Question 8

Typically, how quickly can alcohol withdrawal seizures occur?

1 - <12h
2 - 12-24h
3 - 12-48h
4 - >48h

Answer 8

3 - 12-48h

Question 9

Typically do patients who have seizures due to alcohol withdrawal have EEG abnormalities?

Answer 9

• no
• they can be normal

Question 10

Typically patients with alcohol withdrawal (12-48h) can have alcohol withdrawal seizures. What is a precipitating factor that can make the seizures worse?

1 - age
2 - gender
3 - hypoglycaemia
4 - liver cirrhosis

Answer 10

3 - hypoglycaemia

Question 11

Are Delirium tremens dangerous?

Answer 11

• yes
• medical emergency

Question 12

Delirium tremens is a medical emergency. Which of the following is NOT a stage of delirium tremens?

1 - prodrome
2 - acute on chronic
3 - later
4 - finally

Answer 12

2 - acute on chronic
- essentially the symptoms can develop and worsen over time

Question 13

Delirium tremens is a medical emergency. How long from the last drink is it before delirium tremens begins?

1 - 1-2 days
2 - 2-4 days
3 - 3-7 days
4 - 5-10 days

Answer 13

2 - 2-4 days
- typically lasts 3-7 days

Question 14

Which of the following is NOT a typical complication of delirium tremens?

1 - Wernicke’s encephalopathy
2 - amnesic (Korsakoff’s) syndrome
3 - dehydration
4 - hyperkalaemia
5 - cardiac failure
6 - intercurrent infection

Answer 14

4 - hyperkalaemia
- typically causes hypokalaemia

Question 15

All of the following can cause delirium tremens, but which is the most likely?

1 - alcohol withdrawal
2 - vitamin deficiency
3 - liver disease
4 - hypomagnesaemia

Answer 15

1 - alcohol withdrawal

Question 16

Which of the following drugs is used to treat alcohol dependence and as part of a relapse prevention strategy?

1 - adenosine
2 - haloperidol
3 - disulfiram
4 - lithium

Answer 16

3 - disulfiram

Question 17

Disulfiram is used to treat alcohol dependence. What is the mechanism of action of this drug?

1 - agonist of NMDA receptors and increases glutamate
2 - inhibits GABA A receptors
3 - inhibits aldehyde dehydrogenase
4 - all of the above

Answer 17

3 - inhibits aldehyde dehydrogenase

Question 18

Which are the 2 most commonly used drugs are used to treat patients who are opioid dependent?

1 - Methadone
2 - Buprenorphine
3 - Codeine
4 - Diclofenac

Answer 18

1 - Methadone
2 - Buprenorphine

• both long acting oral preparations
• essentially titrating the patient off drugs

Question 19

Which are the 2 most commonly used drugs are used to treat patients who are completely off opioids?

1 - Naltrexone
2 - Buprenorphine
3 - Lofexidine
4 - Diclofenac

Answer 19

1 - Naltrexone
3 - Lofexidine

Question 20

If a patient is addicted to opioids, the aim is for complete absence. However, this is generally not possible and a treatment pathway should be used. What should be the first aim of a treatment plan?

1 - stop the drug and monitor the patient
2 - motivate the patient towards change and involve them in treatment plan
3 - start on a lower dose of opioids and slowly withdraw the drug

Answer 20

2 - motivate the patient towards change and involve them in treatment plan
- important to consider the stages of change model

Question 21

If a patient is addicted to opioids, the aim is for complete absence. However, this is generally not possible and a treatment pathway should be used. The first step is to try and motivate the patient towards change and involve them in treatment plan. What should be the next phase?

1 - stop the drug and monitor the patient
2 - motivate the patient towards change and involve them in treatment plan
3 - start on a lower dose of opioids and slowly withdraw the drug
4 - minimise harm related to taking substances, improve mental and physical health, reduce criminal activity and blood born infections

Answer 21

4 - minimise harm related to taking substances, improve mental and physical health, reduce criminal activity and blood born infections

Question 22

If a patient is addicted to opioids, the aim is for complete absence. However, this is generally not possible and a treatment pathway should be used. What should be the final phase of any treatment plan?

1 - stop the drug and use naloxone (opiod antagonist) and monitor the patient
2 - motivate the patient towards change and involve them in treatment plan
3 - start on a lower dose of opioids and slowly withdraw the drug
4 - minimise harm related to taking substances, improve mental and physical health, reduce criminal activity and blood born infections

Answer 22

1 - stop the drug and use naloxone (opiod antagonist) and monitor the patient

• if the opiod cannot be stopped then it should be substited to a safer drug

Question 23

Deaths surrounding heroine and morphine have increased since 2011, which of the following is not a common factor that has been highlighted as a contributing factor towards this?

1 - age
2 - hepatitis
3 - lung disease
4 - metabolic syndrome

Answer 23

4 - metabolic syndrome

• research suggests patients have a lesses respiratory reserve and this is what they die from
• naloxone is given to patients to reduce the risk of death as an antidote to opioids