Substance abuse

Question 1

What are some of the risks for long term alcohol intake

Answer 1

Liver damage
increased risks of accidents
Weight gain
social and relationship problems
heart disease
strokes
insomnia
sexual problems

Question 2

What are some of the risk factors for alcohol problems

Answer 2

Genetics
Starting early
mental health

Question 3

What is wernickes korsakoff syndrome caused by

Answer 3

Thiamine deficiency

Question 4

What are the symptoms of wernickes korsakoff

Answer 4

confusion
disorientation
vomiting

Question 5

What is the treatment for wernickes korsakoff

Answer 5

Acute –> pabrinex
Maintenance –> oral thiamine 100mg TDS

Question 6

What are some signs someone is having alcohol withdrawal between 0-12 hours

Answer 6

seizures
sweating and tremor
increased respirations, HR, BP
hallucinations

Question 7

What are some signs someone is having alcohol withdrawal between 48-72 hours

Answer 7

Delerium
agitation
hallucinations
confusion
tachycardia

Question 8

What is the first line alcohol detoxification

Answer 8

Benzodiazapines
Chlordiazepoxide

Question 9

What are withdrawal symptoms measured by

Answer 9

Clinical institute withdrawal assessment for alcohol

Question 10

What benzodiazapines are considered in elderly and hepatic impairment

Answer 10

Lorazapam
Oxazepam

Question 11

Why are short acting benzodiazapines better in those with hepatic impairment

Answer 11

less risk of accumulation and further liver damage

Question 12

what causes withdrawal seizures

Answer 12

Brain usually releases glutamate in response to the alcohol releasing GABA
Alcohol stopped = decrease in GABA
Brain still releases glutamate = too much now

Question 13

What maintenance therapies are used for alcohol withdrawal

Answer 13

Disulfriam
Acamprosate
Naltrexone
Nalmefene

Question 14

What is the MOA of disulfiram

Answer 14

prevents conversion of acetaldehyde and dopamine

Question 15

What is MOA of acamprosate

Answer 15

Glutamate antagonist

Question 16

What is the MOA of naltrexone

Answer 16

Opioid antagonist
blocks opioid receptors that modulate release of dopamine

Question 17

What is MOA for nalmefene

Answer 17

opioid antagonist

Question 18

What tool do we use to screen for alcxohol levels

Answer 18

FAST
AUDIT-C

Question 19

What score indicates a positive FAST score

Answer 19

3 or more on the first question

Question 20

What indicates a positive score on AUDIT C

Answer 20

5+

Question 21

What benefits can we tell the patient about stopping alcohol

Answer 21

More energy
weight control
improved skin
better finances
better emotional control

Question 22

What practical advice can we give to reduce alcohol intake

Answer 22

smaller drink
reduced strength
start drinking later
stay hydrated

Question 23

Alcohol referral criteria

Answer 23

They want to talk
Alcohol dependence
Physical/mental harm

Question 24

What drugs reduce the reward and craving sensations?

Answer 24

Naltrexone
Acamprosate

Question 25

What are some of the opioid withdrawal symptoms

Answer 25

Nausea and vomiting Diarrhoea watering eyes dilated pupils

Question 26

What are the maintenance options for alcohol dependency

Answer 26

methadone --> full agonist Buprenorphine --> partial agonist

Question 27

What are some advantages of mathadone

Answer 27

Good evidence based treatment sedating cheap easy to supervise

Question 28

What are some advantages of buprenorphine

Answer 28

Safer in overdose less sedating easier to detox not as easy to use on top

Question 29

What are the disdvantages of methadone

Answer 29

Easy to overdose easier to get onto the streets longer detoxification doesnt stop cravings accumulate in fatty tissue

Question 30

Give disadvantages of bupronorphine

Answer 30

Difficult to supervise expensive not orally absorbed

Question 31

What is a standard maintenance dose of methadone

Answer 31

40-120mg/day

Question 32

What are some CNS effects associated with methadone

Answer 32

Pain relief euphoria respiratory depression drowsiness N&V --> CTZ trigger

Question 33

What could be prescribed alongside methadone

Answer 33

Constipation Prescribe laxatives

Question 34

What medication prolongs QT interval

Answer 34

Methadone

Question 35

When shouldnt a person be prescribed methadone

Answer 35

Increased QT interval Other medications that increase the QT interval Heart disease

Question 36

What other medications can cause QT interval prolongation

Answer 36

Lithium TCAs SSRIs macrolides

Question 37

When is naltrexone prescirbed

Answer 37

adjunctive prophylaxis treatment

Question 38

What is naltrexone dosing

Answer 38

Test: 7 days of 25mg then 50mg daily

Question 39

What are the signs of an opioid overdose

Answer 39

Pinpoint pupils pale skin blue lips respiratory depression N&V Loss of consciousness Low BP/HR

Question 40

What drug is used to reverse overdose

Answer 40

Naloxone

Question 41

What forms does naloxone come in

Answer 41

Injection Nasal spray

Question 42

What is needle syringe provision

Answer 42

Wound care advice hygiene safe disposal

Question 43

What are signs of cannabis CNS toxicity

Answer 43

Agitation tremor hallucinations convulsions

Question 44

What are some cardiac S/E associated with cannabis

Answer 44

Tachycardia hypertension palpitations

Question 45

What receptors are involved in cannabis

Answer 45

CB1 --> found in brain, control movement, appetite, pain CB2 --> Found in periphery, involved in immune function

Question 46

What are some positive recreational effects of canabis

Answer 46

Relaxed disinhibition euphoria

Question 47

What are some negative recreational effects of cannabis

Answer 47

Loss of coordinatrion Problems with memory distorted perception

Question 48

What happens if a susceptible person smokes cannabis

Answer 48

Exacerbate mental health problems Can cause anxiety and panic attacks Can induce psychosis

Question 49

How many times more likely are you to develop a mental illness if you smoke under 15

Answer 49

X4

Question 50

What mental illness can cannabis relapse

Answer 50

Schizophrenia

Question 51

What are some physical and mental symptoms associated with caffeine

Answer 51

Nervousness irritability anxiety insomnia headaches peptic ulcers

Question 52

What are the 4 caffeine induced disorders according tp DSM-IV

Answer 52

1) Caffeine intoxication 2) caffeine induced sleep disorder 3) caffeine induced anxiety disorder 4) Caffeine related disorder NOS

Question 53

What value indicates excess caffeine

Answer 53

>750mg/d

Question 54

What advice can we give to decrease caffeine amounts

Answer 54

Gradual reduction Caffeine free analgesia

Question 55

What tests can we do to determine drug use

Answer 55

Urine test

Question 56

What do you need to consider if a patient hasnt taken methadone ina while

Answer 56

loss of tolerance may be using drugs instead again prescirbe reduced dosage and titrate due to risk of overdose

Question 57

What chemical is released from smoking cannabis

Answer 57

Dopamine