Drug And Alcohol

Question 1

What is harmful use of a substance?

Answer 1

Pattern of use causing physical or mental health damage, often with social consequences

Question 2

4 criteria for ICD10 definition of harmful use?

Answer 2

Clear evidence of substance use leading to physical or psychological harm
Nature of harm should be clearly identifiable and specified
Pattern of use persisted for at least 1m month or repeatedly within 12m
Disorder meets no other criteria for mental or behavioural disorders apart from acute intoxication

Question 3

What is dependence syndrome of a substance?

Answer 3

A cluster of behavioural, psychological and physical symptoms in which the use of a substance takes on a much higher priority for an individual than any other previously highly held beliefs

Question 4

How many criteria and for how long must be present for diagnosis of dependence syndrome?

Answer 4

At least 3 for at least 1m or repeatedly over 12m

Question 5

What are the 6 ICD10 criteria for dependence?

Answer 5

Strong desire or compulsion to take substance
Impaired capacity to control onset, amount or termination of use e.g. Increasing amount
Physiological withdrawal if stopped
Tolerance
Preoccupation with substance e.g. Giving up other pleasures
Persistent use despite clear evidence of harmful consequences

Question 6

What is buprenorphine?

Answer 6

A partial competitive opioid agonist

Question 7

2 opioid antagonists used in substance misuse management?

Answer 7

Naloxone

Naltrexone

Question 8

What is methadone?

Answer 8

A full non-competitive opioid agonist

Question 9

What is bupropion?

Answer 9

A substance used to help quit smoking

Question 10

What is the half life of methadone?

Answer 10

Between 24-36 and 48-72 hours

Question 11

Why is the pharmacological profile of methadone relevant and useful in substance use?

Answer 11

Longer half life than heroin so less euphoria and less risk of withdrawal

Question 12

Side effects of high methadone use?

Answer 12

Similar to heroin - respiratory depression, constipation, reduced salivation (poor dental hygiene)

Question 13

How is methadone taken?

Answer 13

Liquid form PO

Question 14

What is subutex?

Answer 14

Buprenorphine

Question 15

What is the trade name for buprenorphine?

Answer 15

Subutex

Question 16

What does the pharmacological profile of buprenorphine mean in terms of its use? Cautions of use?

Answer 16

Partial agonist and highly competitive at opioid receptor
So competes with heroin/methadone causing acute withdrawal before takes time to kick in - can be dangerous so must be completely cold turkey before starting

Question 17

How do naltrexone and naloxone work?

Answer 17

Opioid receptor antagonism - short term prevention of acute overdose or after abstinence to reduce reinforcing effects of taking more heroin

Question 18

What is lofexidine used for? Major side effect?

Answer 18

Adjunct used to detox from opioids as it reduces withdrawal side effects
Major SE is hypotension

Question 19

What medications are used in acute alcohol withdrawal to reduce symptoms and seizures risk?

Answer 19

Benzos - chlordiazepoxide, diazepam

Question 20

What is disulfiram and what is it used for?

Answer 20

Aldehyde dehydrogenase inhibitor
Used once a patient is abstinent from alcohol to stop them from drinking again, as it causes acetaldehyde build up if they do and nasty hangover effects

Question 21

Medication used to put abstinent people off drinking again by inhibiting aldehyde dehydrogenase?

Answer 21

Disulfiram

Question 22

What is acamprosate useful for?

Answer 22

Reducing cravings for alcohol and urge to drink, use in abstinence

Question 23

What medication can be given for alcohol abstinence to reduce cravings and urge to drink?

Answer 23

Acamprosate

Question 24

What is varenicline?

Answer 24

Medication used to help quit smoking

Question 25

Questionnaires used to assess opioid withdrawal?

Answer 25

Objective Opioid Withdrawal Scale OOWS | Subjective Opiate Withdrawal Scale SOWS

Question 26

How do you calculate a unit of alcohol?

Answer 26

Percentage by volume X volume (mls) | All divided by 1000

Question 27

What is the AUDIT rating scale used for?

Answer 27

Assessment of alcohol dependence/harmful use

Question 28

What does AUDIT stand for?

Answer 28

Alcohol Use Disorders Identification Test

Question 29

What cut off score on the AUDIT Scale is recommended for hazardous/harmful alcohol use and possible dependence?

Answer 29

8 or more

Question 30

What is the SADQ-C?

Answer 30

Severity of Alcohol Dependence Questionnaire

Question 31

What is the SADQ-C used for?

Answer 31

To assess the severity of established alcohol dependence

Question 32

What questionare is used to assess severity of established alcohol dependence?

Answer 32

SADQ-C

Question 33

What questionare is used to assess for presence of harmful or hazardous use of alcohol or possible dependence?

Answer 33

AUDIT-C

Question 34

What liver marker is raised in acute intoxication or hangover from alcohol?

Answer 34

Gamma GT

Question 35

What liver and other markers change in chronic alcohol use?

Answer 35

ALT/AST Raised mcv anaemia Low magnesium Clotting abnormalities

Question 36

In a patient with chronic heavy alcohol use and dependence, when will symptoms of withdrawal occur following stopping? What are the mild initial symptoms?

Answer 36

Around 12 hours | Tremor, sweating, tachycardia, nausea, insomnia, nightmares, anxiety, depression

Question 37

When do symptoms of alcohol withdrawal reach their worst? What are these?

Answer 37

48-72 hours | Severe agitation, confusion, delirium/hallucinations, fever, seizures

Question 38

How many of the 10 criteria are required for ICD10 diagnosis of acute alcohol withdrawal?

Answer 38

3

Question 39

What are the 10 ICD10 criteria for acute alcohol withdrawal?

Answer 39

``` Tremor (tongue, eyelid, outstretched hand) Sweating Nausea and or vomiting Tachycardia, hypertension Psychomotor agitation Headache Insomnia Malaise and weakness Hallucinations/illusions - tactile, visual or auditory Seizures (grand mal) ```

Question 40

4 core features of delirium tremens?

Answer 40

Autonomic instability Fluctuating confusion Severe tremor Visual, auditory or tactile hallucinations

Question 41

Management of delirium tremens?

Answer 41

Chlordiazepoxide Diazepam IM/IV pabrinex 2 pairs TDS for 3-5 days Haloperidol for disturbed behaviour/may require benzos

Question 42

What is pabrinex? What specific B vits?

Answer 42

B vitamins - thiamine, riboflavin, pyridoxine, nicotinamide (B1, 2, 3 and 6) Vit C ascorbic acid Glucose

Question 43

What additional management is required for alcohol withdrawal seizures?

Answer 43

Increase benzodiazepine dose and initiate/continue anticonvulsants

Question 44

What syndrome is due to acute thiamine B1 deficiency?

Answer 44

Wernicke's encephalopathy

Question 45

Triad of Wernicke's encephalopathy?

Answer 45

Ataxia Confusion Ophthalmoplegia

Question 46

Alcohol withdrawal questionnaire?

Answer 46

Clinical Institute Withdrawal Assessment for Alcohol | CIWA-Ar

Question 47

What syndrome occurs from chronic untreated Wernicke's encephalopathy?

Answer 47

Korsakoff's psychosis

Question 48

What 3 factors suggest need to uptitrate methadone?

Answer 48

Withdrawal Sx Cravings Using on top

Question 49

How is subutex/buprenorphine taken? What does this mean?

Answer 49

Sublingual - faster absorption and avoids first pass metabolism

Question 50

What are NPSs?

Answer 50

Novel psychoactive substances e.g. Synthetic cannabinoids

Question 51

What is SPICE/black mamba?

Answer 51

An NPS/synthetic cannabinoid

Question 52

Antidote for NPS use?

Answer 52

There is none as you don't know what's in it

Question 53

Acute Sx and risks of NPS use?

Answer 53

Psychosis Respiratory depression Nausea, vomiting

Question 54

What constitutes rapid tranquillisation for acute agitation?

Answer 54

Haloperidol and lorazepam