lecture 22 - the pharmacist in substance misuse Flashcards
(22 cards)
define tolerance, dependance and addiction
tolerance is reduced effect of the drug or requiring higher doses of the drug to get the same response level
dependance is a personchorncwcally sues a drug and the sudden discontinuation or rapid dose reduction causes withdrawal symptoms
Compulsion and repetitive use of a drug, often at potentially harmful doses
Tolerance and dependence may develop as a result
What are the ICD-10 / DSM-5 criteria for substance dependence?
Diagnosis of dependence requires three or more of the following within 12 months (if only 1 is applicable this is misuse). if less than 2 this is classed as drug misuse
strong desire to use the substance
difficulties in controlling the use of substance
neglect of other alternative interest due to substance use
tolerance
persistence with substance use despite evidence of harmful effects.
Name common pharmacological treatments for substance misuse.
Opioids: Methadone, Buprenorphine, Lofexidine, Naltrexone, Naloxone.
Benzodiazepine misuse: Diazepam.
Alcohol: Disulfiram, Acamprosate, Naltrexone, Nalmefene, Chlordiazepoxide, Diazepam, Thiamine, Vitamin B.
what is dual diagnosis?
dual diagnosis is coexistence of one or more mental disorder in individuals who also satisfy diagnostic criteria for substance use or vice vera
Name some common health comorbidities in substance misuse patients.
Mental health issues (Depression, Anxiety)
Poor diet & self-neglect
Dental health issues
Aging patient cohort
Social isolation & poverty
Discrimination & criminality
how can opioids be related to dental hygiene ?
Can get dry mouth which affects dental hygiene
Methadone is acidic which can rot the enamel –> do not brush teeth directly after taking it
what is the effect of alcohol misuse?
alcohol misuse can cause vitamin deficiency
malnutrition and malabsorption of vitamin B
can progress to Korsakofs Psychosis/ Wernickes Encephalopathy and cause aggression
What is Korsakoff’s Psychosis/Wernicke’s Encephalopathy, and how is it related to substance misuse?
Severe neurological disorder due to vitamin B deficiency from chronic alcohol misuse.
wernickes encephalopathy is an acute neurological condition characterised by a clinical triad of eye muscle weakness, repetitive movement of the eyes, ataxia, and confusion
Korsakoff’s psychosis is a memory disorder that involves the destruction of short-term memory
Can be reversible if caught early on
Symptoms: Memory loss, confusion, aggression, lack of coordination.
what are image enhancing drugs ?
image enhancing drugs include steroids or tanning agents. they can cause aggression, depression, diabetic complications, liver disorders and unknown long term effects
what are risks and common patterns associated with polysubstance use ?
Stimulant use followed by Benzes (or alcohol or opiates) to come down
Multiple effects = multiple dangers = unpredictable
What are common psychological and physical effects of substance misuse?
Opioids: Anxiety, depression, analgesic misuse.
Benzodiazepines: Memory loss, aggression, short-term anxiety relief.
Stimulants/Hallucinogens: Mania, depression, psychosis, nightmares.
Image-enhancing drugs: Liver disorders, diabetes, aggression.
Cannabinoids: Anxiety, paranoia, psychosis.
What are some general health risks associated with substance misuse?
Infections
Liver damage
Cardiomyopathy
Premature aging
Suicidality (increased risk of self-harm)
What alternative therapies can help treat substance misuse?
psychology
psychiatry
cognitive behavioural therapy
motivational interviewing
occupational therapy
acupunctur.
What are the drug interactions that pharmacists should be aware of in substance misuse treatment?
Methadone: QtC prolongation
CNS depressants & sedatives: Respiratory depression.
Antipsychotics & Hepatitis C treatment: Enzyme-inducing effects.
Metronidazole & Alcohol: Severe reaction
Which of the following DOES NOT usually trigger a reaction in disulfiram patients:
1. aftershaves and perfumes
2. deodorants
3. hairdye
4. alcohol within food dishes
5. high caffeine drinks
4 - food cooked with alcohol usually has all alcohol content boiled off
If there is alcohol content then there can be systemic absorption following contact
what are the aims of injecting equipment provision ?
provision of clean injection equipment
reducing injecting related harm
reducing BBV transmission
reduce viral pool
disposal of used apparatus
can provide harm messages
sign posting services
What injecting equipment can be supplied under IEP
Syringe/needle and barrel - injecting
Spoon - preparation of injection
Filter - removes particles
Alcohol wipe - cleaning injection site
Citric acid - preparation of injection
bin - disposal
Water for injection - Preparation of injection, Plastic ampoules are provided to minimise injuries
Foil - smoking the drug
What items cannot be supplied under IEP?
Tourniquet for raising veins as if the person faints when using it then they can cut of circulation and cause serious damage
What are emerging drug trends in substance misuse?
Synthetic opioids (e.g., fentanyls, nitazenes)
New benzodiazepines
Constant changes in illicit drug supply
True or false - buprenorphine is more likely to cause opioid fog than methadone
False - buprenorphine is less likely as it is a partial agonist
What basic advice can be shared about the use of needles when injecting?
Injection technique/direction
Injection sites (different injection sites have increased risk)
Never share or reuse needles
Longer needles are used for deeper sites
If a patient comes in for their supervised methadone and seem to be under the influence, what is the best thing to do/advise?
Ask them to come back later when they are sober
If it keeps happening, inform their worker
Ensure they understand why you are withholding the dose
