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AKT > Smoking, Alcohol, and Substance Misuse > Flashcards

Smoking, Alcohol, and Substance Misuse Flashcards

1
Q

What advice are pregnant women given throughout pregnancy regarding alcohol?

A

Not to drink alcohol

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2
Q

What does NICE recommend regarding pregnant women and alcohol in pregnancy?

A

To ask about alcohol use throughout pregnancy and record answers

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3
Q

What can alcohol in pregnancy cause?

A

Foetal Alcohol Spectrum Disorder

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4
Q

If a child/young person has probably prenatal alcohol exposure with significant effects, what should be done?

A

Referral for assessment by specialist

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5
Q

What are the 3 key facial features of FASD?

A
  1. Short palpebral fissures
  2. Smooth philtrum
  3. Thin upper lip
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6
Q

What do all children/young people with confirmed FASD need to help address their needs?

A

A management plan following neurodevelopmental assessment

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7
Q

If a patient over 14 presents with confirmed/suspected severe mental health issues, what should always be asked and documented in social history?

A

Use of alcohol and drugs

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8
Q

What should happen if a patient over 14 with coexisting severe MH issues and substance misuse if they miss any appointment?

A

The patient should be followed-up

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9
Q

What is problem alcohol use defined as?

A

Exceeding low-risk drinking guidelines

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10
Q

What are the low risk drinking guidelines as per chief medical officer?

A
  • Safest to drink no more than 14 units per week for both men and women
  • If drinking as much as 14 units, should be spread across 3 days or more, evenly
  • It is safest to avoid drinking alcohol in pregnancy
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11
Q

What is the definition of hazardous or increasing risk drinking?

A

Drinking more than 14 units per week, and 35 units of alcohol per week for women, or 50 units per week for men.

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12
Q

What are the 2 categories of alcohol-use disorder?

A
  1. Harmful/higher risk drinking
  2. Alcohol dependance
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13
Q

What is the definition of harmful/higher-risk drinking?

A

A pattern of alcohol consumption causing health problems directly related to alcohol

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14
Q

What acute problems can be caused by harmful drinking?

A
  • Psychological issues
  • Alcohol-related accidents
  • Acute pacreatitis
  • Withdrawal
  • Seizures
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15
Q

What chronic problems can be caused by harmful drinking?

A

-Hypertension
-Cirrhosis
-Heart Disease
-Some types of cancer

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16
Q

What types of cancer can be associated with harmful drinking?

A

Mouth
Throat
Liver
Bowel
Breast

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17
Q

What are the characteristics of alcohol dependance?

A

-Craving
-Tolerance
-Preoccupation with alcohol
-Continued drinking despite harmful consequences

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18
Q

How does the DSM-5 categorise the severity of AUD?

A

-Mild - 2-3 symptoms
-Moderate - 4-5 symptoms
-Severe - 6 symptoms or more

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19
Q

How many symptoms does the DSM-5 define AUD as having?

A

11

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20
Q

What are the 11 symptoms that DSM-5 define AUD as displaying over a 12 month period?

A
  1. Taking alcohol in larger amounts or longer than intended
  2. Persistent desire to or unsuccessful attempts to cut down
  3. Great deal of time dedicated to obtaining/using/recovering from alcohol
  4. Craving alcohol
  5. Alcohol use resulting in failure to fulfill obligations
  6. Continued use despite social or personal problems caused by alcohol
  7. Giving up important activities/roles due to alcohol
  8. Using alcohol when physically hazardous
  9. Ongoing alcohol use despite knowledge of ongoing consequences
  10. Tolerance
  11. Withdrawal
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21
Q

What is alcohol tolerance defined as?

A

Either:
-need for markedly increased amounts of alcohol to achieve desired effect
-markedly diminished effect with same amount of alcohol

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22
Q

What is alcohol withdrawal defined as?

A

Characteristic withdrawal syndrome for alcohol or use of alcohol or other substances to relieve or avoid withdrawal symptoms

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23
Q

What is one unit of alcohol defined as?

A

10ml or 8g of pure ethanol

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24
Q

What are the rough equivalents to one unit of alcohol?

A

A small measure of spirits (40%)
A standard measure of fortified wine (20%)
Half pint of lower-strength beer/lager/cider (3-4%)

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25
Q

What % of the adult population of England regularly drinks at levels which increase risk of ill health?

A

21%

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26
Q

What % of the adult population of England and Scotland regularly drinks at levels which increase risk of ill health?

A

24%

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27
Q

What is the recorded rough proportion of men to women who drink at higher risk levels?

A

Roughly double number of men to women

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28
Q

What is the lifetime prevalence of AUD in most western countries?

A

7-10%

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29
Q

What has happened to alcohol consumption since COVID-19 pandemic?

A

Lighter drinkers have decreased use, while heavier drinkers have increased consumption

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30
Q

What is the leading risk-factor for disability-adjusted life years for people ages 15-49?

A

Alcohol

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31
Q

How much does alcohol cost society in lost productivity?

A

£7 billion plus £3.5 billion to NHS

32
Q

Which region of England has highest rates of alcohol related deaths?

A

The North East

33
Q

How much more common are alcohol-specific deaths in men than women?

A

Double

34
Q

What are the most common short term harm complications that occur due to alcohol?

A

-Death/illness from accidents/Injury
-Drowning
-Alcohol poisoning
-Self harm

35
Q

What are the characteristics of alcoholic cardiomyopathy?

A

-Cardiomegaly
-Disruption of myofibrillary architecture
-Reduced contractility
-Reduced EF
-Increased stroke and HTN risk

36
Q

What are the 3 most common liver issues associated with alcohol?

A

Steatosis
Hepatitis (acute and chronic)
Cirrhosis

37
Q

Why are women at higher risk of alcohol related liver disease?

A

Lower ability to metabolise alcohol

38
Q

What causes increased risk of death due to cirrhosis?

A

Bleeding oesophageal varices
Infection
Renal failure
Hepatic Failure

39
Q

What percentage of acute pancreatitis are caused by alcohol?

A

40-45%

40
Q

What are the characteristics of chronic pancreatitis?

A

Reduced pancreatic exocrine function
Malabsorption
Diabetes
Pancreatic calcifications

41
Q

What is Wernicke-Korsakoff syndrome?

A

AUD associated with thiamine deficiency, which if severe can cause Wernicke’s encephalopathy

42
Q

What can alcohol exposure in pregnancy cause, short term?

A

Miscarriage
Stillbirth
Pre-term delivery

43
Q

How many units of alcohol daily throughout pregnancy is associated with most severe FASD?

A

5 units

44
Q

As well as the characteristic facial features, what are the features of FASD?

A

Growth deficiency
CNS abnormalities
Deficient brain growth, abnormal morphogenesis, or abnormal neurophysiology

45
Q

What are the social complications of alcohol misuse?

A

family conflict
domestic violence
abuse

46
Q

When is relapse most common after treating AUD?

A

The first 12 months after starting treatment

47
Q

AUD may progress from impulsivity to ___________?

A

Compulsivity

48
Q

When should alcohol screening be carried out?

A

Routinely e.g. when registering new patients, managing chronic disease, antenatal appointments, and treating minor injuries

49
Q

What incidental findings may raise suspicion for problem drinking?

A

-Abnormal bloods e.g. GGT or MCV
-Physical sings e.g. dilated facial capillaries, tremor in hands, bloodshot eyes
-Symptoms/conditions likely to be comorbid to alcohol

50
Q

What barriers may there be to open discussion about alcohol with a patient?

A

Stigma and discrimination often associated with alcohol

51
Q

What is the name of the questionnaire used routinely to assess the nature and severity of alcohol misuse?

A

AUDIT score - Alcohol Use Disorders Identification Test

52
Q

What is the shortened version of the AUDIT questionnaire called to use in time limited setting?

A

AUDIT PC

53
Q

What is the AUDIT PC questionnaire?

A

Quick 5 point screening test to indicate increasing or higher risk drinking

54
Q

If AUDIT questionnaire comes back positive for likely alcohol dependence, how can severity be further assessed?

A

SADQ (Severity of Alcohol Dependence Questionnaire) or LDQ (Leeds Dependence Questionnaire) tools

55
Q

What are the common mild/moderate symptoms of alcohol withdrawal?

A

-Anxiety
-Nausea and vomiting
-Insomnia
-Autonomic dysfunction (tremor, tachycardia, sweating, palpitations)

56
Q

When do symptoms of withdrawal typically start?

A

6-12 hours after the last alcoholic drink

57
Q

How long can mild/moderate withdrawal symptoms last?

A

3-7 days

58
Q

What are the common severe symptoms of alcohol withdrawal?

A

-Delirium tremens
-Seizures

59
Q

What are the features of delirium tremens?

A

Rapid onset:
-profound confusion/delirium
-visual/auditory/tactile hallucinations
-coarse tremor
-features of clinical instability/deterioration

60
Q

A patient attends your surgery trying to quit drinking. They are new to the area, with no nearby family or friends, and medical history including hypertension, prostate cancer in remission, and COPD.

Where would symptomatic withdrawal be best managed in this patient?

A

In hospital as the patient is poorly supported and has multiple comorbidities.

Low threshold for admission should also be had for patients who are frail, have cognitive impairment, or learning difficulties

61
Q

What are the features of Wernicke’s encephalopathy?

A

-Ataxia
-Ophthalmoplegia
-Nystagmus
-Acute confusional state
-Hypotension
-Hypothermia

62
Q

A patient known to turning point for alcohol misuse attends for a minor ailment, but appears acutely confused and with abnormal gait and eye movements.

What is this condition likely to be, and what should be done?

A

Wernicke’s encephalopathy - it is a medical emergency and needs hospital admission for parenteral thiamine.

63
Q

Where should a patient with alcohol misuse and coexisting psychotic disorder be referred to?

A

Secondary care mental health services

64
Q

A patient attends clinic with the aim to cut down their high level of drinking.

What is the best advice that you can provide?

A

-Avoid sudden reduction in alcohol intake
-Provide information on local alcohol support services

65
Q

Does the DVLA need to know if a person is alcohol dependant?

A

Yes - an alcohol dependant patient should be advised they are legally required to inform the DVLA

66
Q

What are the indications for oral thiamine in harmful or dependant drinkers?

A

-Risk of or actual Malnourishment
-Decompensated liver
-Acute withdrawal
-Before and during planned assisted alcohol withdrawal

67
Q

What resources can be given to patients seeking help for alcohol misuse?

A

-Information on community support networks and self help groups
-Signpost to sources of additional information

68
Q

What community support networks and self help groups exist for alcohol misuse?

A

-Alcoholics anonymous
-SMART recovery

69
Q

What additional resources exist for patients with alcohol misuse to educate and support?

A

-Action of addiction
-Al-Anon Family Groups UK & Eire
-Alcohol Change UK

70
Q

In addition to the patient with alcohol misuse, who may need support?

A

Family/carers

71
Q

What practical strategies can help reduce alcohol consumption?

A

-Recognise and avoid high risk situations for drinking
-Recognise personal cues for drinking
-Alternating alcoholic and non-alcoholic drinks
-Alternative stress-relief activities
-Switching beverage to lower alcohol content
-Keeping drinking diary

72
Q

If a patient’s alcohol misuse affects their relationship, what may be helpful?

A

Behavioural couples therapy if the partner is willing

73
Q

What are the contraindications or cautions for thiamine therapy?

A

There are none.

74
Q

What dose of thiamine is prescribed for alcohol withdrawal?

A

50-100mg for mild deficiency, 200-300mg in divided doses for severe deficiency

75
Q

What is the indication for acamprosate?

A

Maintenance of abstinence in alcohol-dependant patients

76
Q

Can acamprosate be used if a patient continues to drink alcohol?

A

No - it should be stopped if drinking persists for 4-6 weeks after starting the drug

AKT (22 decks)

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