Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MPharm Y3S2 > Mental Health Substance Abuse > Flashcards

Mental Health Substance Abuse Flashcards

(87 cards)

Start Studying
1
Q

What are the potential harms from using illicit drugs?

A

Psychological e.g stigma
Socio-economic effects on self/family/others
Addiction or diversion inc gateway to others
Physical consequences e.g sedation
Route of admin e.g blood born virus
Self neglect, poor dental hygiene, poor nutrition
Withdrawl symptoms
Poor pregnancy outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the potential risk factors for using illicit drugs?

A

Personal/ FH of substance misuse (inc alcohol)
Hx of pain issues
Easy access of medicines e.g working in healthcare
Time spent in secure environment e.g prison
Difficult life events
Chronic/severe mental/physical healthy problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the ‘dual diagnosis’ of substance abuse:

A

People with severe mental health problems- expect 25% misuse- find its 33-50% misuse
People with substance misuse problems- expect 25% have mental health problem- find its 50-75% problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe the relationship between Asian heritage and alcohol?

A

Decreased risk of alcohol problems due to about 50% having non-functional aldehyde dehydrogenase genes resulting in ‘asian flush’, N&V, (like what happens with disulfiram)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the prevalence of alcohol use in the UK:

A

In England around 603K dependant drinkers
Alcohol misuse is the biggest RF for death, ill health and disability among 15-49 year olds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the risks of long term alcohol intake?

A

Death= 20,000 premature deaths
Liver damage- 90%, 40% hepatitis
Accidents
Cancer- 3% of cancers are alcohol related
Gut- major bleeds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the genetic risk factors for getting an alcohol dependence?

A

FH: no single gene but up to 400 genes influence
50% of overall risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the other factors for getting an alcohol dependence?

A

Starting at an earlier age
Mental health problem
Sweet tasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the risks of chronic alcohol consumption in the CNS?

A

Cognitive impairment
Wernicke-Korsakoff syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe how chronic alcohol consumption can cause cognitive impairment?

A

Alcohol is neurotoxic, causes cognitive impairment:
alcohol dementia, neuropathy, cerebral atrophy (smaller/holes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe what Wernicke-Korsakoff is:

A

A neuropsychiatric disorder of acute onset caused by thiamine deficiency and includes confabulation (memory gone)
Wernicke’s Encaphalopathy is a neurodegerative brain disorder caused by severe lack of thiamine and presents as confusion, apathy, disorientation, vomiting and disturbed memory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can Wernicke-Korsakoff be treated with?

A

Pabrinex (thiamine supplementation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the acute treatment for Wernicke-Korsakoff?

A

One pair of ampoules IM or IV for 3-5 days- essential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the chronic treatment for Wernicke-Korsakoff?

A

100mg TDS is common but oral absorption is poor
Humans can only absorb up to 4mg an hour so OD dosing is pointless, has to be spread out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the first set of symptoms of alcohol withdrawl and when do these occur?

A

Onset 6-8 hours
Peak 10-30 hours
Subsides 40-50 hours
Generalised hyperactivity, tremor, sweating, nausea, retching, mood fluctuation, tachy, increased resp, HTN, pyrexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the second set of symptoms of alcohol withdrawl and when do these occur?

A

Onset 0-48 hours
Withdrawl seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the third set of symptoms of alcohol withdrawl and when do these occur?

A

Onset: 12 hours
Duration: 5-6 hours
Auditory and visual hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the last set of symptoms of alcohol withdrawl and when do these occur?

A

Onset 48-72 hours
Delirium temens: coarse temor, agitation, tachcardia, delusions, hallucinations- classically ‘lilliputian’= snakes, spiders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Name benzodiazepines used in alcohol detoxification:

A

Main- chlordiazepoxide
Lorazepam, oxazepam in hepatic impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the use of benzodiazepines in alcohol detoxification:

A

Chlordiazepoxide:
-long acting benzo, anticonvulsant, cross tolerant with alcohol
-no need to wait for withdrawl
-usual dose range 20-40mg QDS, then decrease over 9 days
When required ‘on demand’ doses should be prescribed
Withdrawl symptoms measured using CIWA (clinal institute withdrawl assessment for alcohol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Name special care groups when using benzodiazepines for alcohol detoxification:

A

Elderly and those with hepatic impairment may need to decrease dose as risk of accumulation (use short acting benzodiazepines)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Name different drugs used in the maintenance therapy of alcohol dependence:

A

Disulfiram (Antabuse)
Acamprosate (Compral)
Naltrexone
Nalmefene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the use of disulfiram for alcohol dependence:

A

A pro drug, activated in liver, prevents conversion of acetaldehyde to acetic acid and dopamine to NA
An adversive therapy
When a person consumes a small amount of alcohol, mild symptoms of acetaldehyde and dopamine excess is experienced; vasodilation, palpitations and headache
Combo with alcohol can be fatal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe the use of acamprosate for alcohol dependence:

A

Glutamate antagonist, better safety profile, decreased reward
Effectiveness overall is marginal but can help some people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Describe the use of naltrexone for alcohol dependence:
Licensed for alcohol misuse disorder, opioid antagonist Well tolerated and has a significant effect on drinking behaviour Blocks the opioid r that modulate release of dopamine in the brain reward system thus blocking the rewarding effects from heroin and alcohol
26
Describe the use of nalmefene for alcohol dependence:
Also an opioid antagonist It effectively decreases heavy drinking days by decreasing the reward Can be used on a 'when required' basis
27
When can nalmefene be used on a when required basis?
People who have failed to achieve abstinence and for whome a decrease strategy would be more suitable Those who can't achieve abstinence but require some form of intervention with psychosocial support
28
How many units are in: -pint lager -pint bitter -white wine (175ml) -single spirit -bottle of wine -bottle of lager
-pint lager= 3 -pint bitter= 2.3 -white wine (175ml)= 2.3 -single spirit= 1 -bottle of wine= 10 -bottle of lager= 1.7
29
What are the CMO's low risk drinking guidelines?
People are safest not to regularly drink more than 14 units a week Spread drinking over 3 days or more Have atleast 2 drink free days each week
30
What is IBA?
Alcohol Identificant and Brief Advice Simple brief advice, identify how much patient is drinking and what effects they have
31
What are the steps in IBA?
Gain permission to talk- do at beginning Screen for alcohol consumption levels (FAST) Complete a validated screening questionnaire: -AUDIT/C Give advice, refer, resources
32
Describe the FAST test:
Fast Alcohol Screening Test An overall total score of 3 or more on the first or all 4 questions is a FAST positive
33
Describe the AUDIT test:
If FAST positive, complete an AUDIT A total of 5+ score indicates a higher risk of drinking 12 is the highest score
34
Should you advise someone to stop drinking alcohol suddenly if they use it chronically?
No- can leads to seizures- death
35
Name full agonist opioids:
Codeine Diamorphine Morphine Dihydrocodeine Fentanyl Methadone Pethidine Oxycodone
36
Name partial agonist opioids:
Buprenorphine (SL only)
37
Name opioid antagonists:
Naloxone (Narcan- injection) Naltrexone (orally absorbed, decreased reward, opioid and alcohol)
38
What is the difference between an opiate and an opioid?
Opiate- natural opioids e.g heroin, morphine, codeine Opioid- all types inc natural and synthetic
39
Describe the stages of quitting opioids:
Drug use- detox (1-2 weeks)- early abstinence (4-7 years)- later abstinence
40
Describe the steps for the treatment for opioid dependence:
Assessment- confirm dependence (no one dies from withdrawl, but can with toxicity) Detoxification and induction onto maintenance Maintenance with opioid substance Gradual discontinuation with support, can be 1-3 months after or decades
41
What are the medications to withdraw from opioids?
Buprenorphine Methadone
42
Describe the withdrawl symptoms of opioids:
Runny nose Watery eyes Dilated pupils Yawning N&V Diarrhoea Restlessness
43
How does methadone work?
Full agonist Decrease peak levels from injecting Longer t1/2 than diamorphine so suppresses withdrawl
44
How does buprenorphine work?
Partial agonist, also decreases peak levels from injecting Longer t1/2 than methadone so suppresses withdrawl and craving
45
What are the advantages of methadone?
Established and familiar Good evidence based Sedating Cheap Easy to supervise Orally absorbed
46
What are the advantages of buprenorphine?
More difficult to use on top Safer in overdose Less stigmatised Easier to detox from Less sedating Better in pregnancy Initial titration rapid
47
What are the disadvantages of methadone?
Easy to overdose Can use on top Syrup rots teeth Stigmatised drug Can accumulate into fatty tissues Long detoxification Sedating Doesn't stop craving Toxic drug for naive adults (40mg) and children (10mg)
48
What are the disadvantages of buprenorphine?
Not orally absorbed Unpleasant taste More difficult to supervise Less evidence Can be injected-bad Expensive
49
What is the titration dosing of methadone?
20-30mg day 1, increase 5-10mg every few days up to max total 30mg above starting dose each week, then increase once or twice weekly (10-15mg) as needed Take about 5 days for blood levels to reach steady state
50
What is the maintenance dosing of methadone?
40-120mg daily dosing May spilt dosing in inpatients and prison
51
What are the CNS effects of methadone?
Euphoria Pleasant, warm feeling in stomach Pain relief Drowsiness N&V Resp depression Histaniergic effect
52
What are the other effects of methadone?
Decrease or absent menstrual cycle- still can become pregnant Sexual dysfunction Dry mouth/eyes Dental problems Constipation Constricted pupils QT prolongation ≥100mg
53
What should be the monitoring requirements for the SE of QT prolongation when taking methadone?
Other drugs can increase the risk too e.g SSRIs, lithium, TCA, macrolides If taking over 100mg a day offer ECG, measure every 6-12 months if normal
54
When is buprenorphine given?
First dose given when there are objective symptoms of withdrawl to decrease risk of precipitated withdrawl
55
What are the formulations of buprenorphine?
SL tabs with naloxone Buvidal (weekly and monthly injections) Sixmo (one off implant, rod, lasting 6/12)
56
Why is naloxone given with buprenorphine if naloxone isn't orally absorbed?
If it is injected then it will counteract the buprenorphine
57
Describe naltrexone:
Long lasting opioid antagonist Blocks euphoric effects, minimise +ve rewards Licensed as an adjunctive prophylactic treatment for detoxified formerly opioid dependent pts
58
What is the risk when taking naltrexone in patients?
Fatal overdoses if relapse while taking it due to resp depression
59
What is the dosing of naltrexone?
Test dose of 25mg at least 7 days after last dose of opioid, followed by 50mg/day Continue for at least 3 months If adherence problematic, larger doses may be given on alternative days (e.g 100mg mon, 100mg wed, 150mg fri)
60
Describe naloxone:
Opioid receptor antagonist Emergency antidote for overdoses Naloxone blocks opioid effect and can rapidly reverse breathing difficulties POM but drug services can supply without a prescription
61
Name different stimulants:
Amphetamines Caffeine Cocaine Tobacco
62
Name different sedatives:
Benzodiazepines Alcohol
63
Name different psychedelics:
Psilocybin (magic mushrooms) LSD
64
Name other types of misused drugs:
Cannabis Pregabalin/ gabapentin Nitrous oxide Ketamine MDMA (ecstasy)
65
Name the 3 major species of cannabis:
The plant is called hemp Dried flower buds smoked/resin Cannabis is the plant
66
Name and describe the different chemicals in cannabis:
THC (tetrahydrocannabinol) -over 120, different potencies, t1/2, r affinities CBD (cannabidiols) -over 100 identified Turpenes -aroma, some CNS effects
67
Name some synthetic cannabinoids:
Spice, black mamba
68
Describe some undesired effects of synthetic cannabinoids:
CNS toxicity: agitation, temor, confusion, hallucinations Cardiac: tachycardia, HTN, palpitations Others: renal damage, memory loss, bloodshot eyes
69
Name and describe the different cannabis receptors in humans:
CB1 (brain) CB2 (peripheral) Endocannabinoids include two distinct systems
70
Describe the psychopharmacology of cannabis:
CB1 controls appetite, movement, higher cognitive functions, decreases stress, decreases nausea, decreases pain sensation CB2 involved in immune function Phytocannabinoids occur in the cannabis plant Release may be stress induced
71
Describe the good evidence medical use of cannabis:
Derived medicinal products (DMP) Chronic and neuropathic pain Paediatric epilepsies- dravet syndrome Nausea in chemo- stops feeling, not being Spasticity and pain in MS
72
Describe the modest evidence medical use of cannabis:
Sleep disturbances PTSD PD Migraine Restless legs Anxiety
73
Describe the use of cannabidiol products which can be purchased in shops:
Obtained from cannabis/ industrial hemp Very low conc- may not have any action at all Products are unregulated so contents not reliable Oral bioavailability 4-6% CBD has no effects on the cannabinoid receptors
74
Describe the correlation between schizophrenia and cannabis:
Doesn't cause it, makes it worse if susceptible Smoking in a susceptible person: -exacerbation of mental health problems -anxiety and panic attacks -paranoia/psychosis Starting before 15 increases risk to develop psychotic illness 4 fold
75
What are the consequences of benzodiazepine use?
Recognised harms associated with long term (>3 months) Sudden cessation of longer term high doses (>50mg/day) can cause seizures Risk of overdose with other sedatives
76
What should be the requirements if a benzodiazepine is prescribed?
Clear treatment plan, discussed and agreed Have at least 2 +ve drug screens (make sure they're taking it) Have no -ve benzo screen in last 4 months Review reg
77
Describe the detoxification process of benzodiazepines:
Very gradually withdrawl (months if not years) Consider giving in divided doses and loading at night Consolidate multiple benzos to diazepam first (as long acting) If withdrawl symptoms, don't decrease further until symptoms improve Decrease by 1/8 of daily dose every 2-4* weeks, or longer
78
What are the lowering doses of the gabapentinoids?
Pregabalin: decrease daily dose at a max of 50-100mg/week Gabapentin: decrease daily dose at a max rate of 300mg every 4 days
79
Name the DSMIV caffeine induced disorders:
Caffeine intoxication Caffeine induced anxiety disorder Caffeine induced sleep disorder Caffeine related disorder not other wise specified
80
What is the amount of caffeine consumed considered moderate use?
Up to 500mg a day
81
What is caffeinism considered as:
600-750mg a day
82
What are toxic doses of caffeine?
More than 1000mg
83
What are the SEs of low- moderate doses of caffeine?
Passing more urine, tremor, anxiety, heart palpitations
84
What are the SEs of high doses of caffeine?
Insomnia, nervousness, tremor, dizziness, hallucinations, seizures, stomach pains, agitation
85
What are the methods of caffeine reduction?
Making sure know all caffeine sources in diet Gradual reduction e.g weaker drinks, less often Caffeine free analgesia for withdrawl headaches Doesn't need to be complete abstinence
86
Are antidepressants addictive?
No There is no craving, reward or tolerance But a person can get some withdrawl/discontinuation symptoms if stopped too quickly
87
Name other drugs with withdrawl symptoms:
ACEi Lithium PPIs

MPharm Y3S2 (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions