Substance Abuse (Alcohol and Drug)

Question 1

state the spectrum of substnace use (4 stages)

Answer 1

recreational use-> acute intoxication-> harmful use-> Dependence syndrome

Question 2

define acute intoxication

Answer 2

transietn condition follwoing use of alcohol or drugs

-closely related to dose and following which recovery is usually complete

Question 3

define harmful substance use

-what does diagnosis of this need

*-what does not qualify for diagnosis

Answer 3

pattern of substnace use that causes damage to physical health, mental health or social circumstances

diagnosis requires damage to physical or mental health of use

*-social disapproval or adverse social consequences for example:
-ingestion of excessive amounts
-idosyncratic relations
-Iv adminsiosntr
-chronic use (considered misuse not harmful use)

Question 4

define dependence syndrome

-what is a central characteristic

Answer 4

cluster of physiological behvaiourla and cognitive phenoma where a substance takes on much higher priority for a given individual than other behaviours that once had greater value

-strong, sometimes overpowering, desire to take psychoactive drugs, alcohol or tobacco

Question 5

what is needed for a dependence syndroem diagnosis 6

Answer 5

3 or more of:
-strong desire or sense of compulsion
-diificulteis controlling substance taking behaviour
-physiological withdrawal state
-build up of tolerance
-neglect of alternative pleasures or interests
-persistent use of substance despite clear evidence of overtly harmful consequences

Question 6

define a withdrawal state 4

Answer 6

group of syx of variabl clustering, severity and duration depending on substance

occurs on withdrawal or reduction of use

occurs after repeated use of a substance

indicates dependence

Question 7

examples of withdrawal state syx from benzos

Answer 7

anxeity

agitation

irritability

diaphoresis

confusion

nauseas

Question 8

examples of withdrawal state syx from opioids

Answer 8

rhinitis

lacrimation

yawning

dilated pupils

diaphoresis

insomia

Question 9

how is delirium tremens characteristed 6

Answer 9

Hx of alochol

confusion-nocturnal worsening

hallucinations

illusisons( insects)

anxiety

fear

autonomic increase

Question 10

define alcohol withdrawal syndrome

Answer 10

set of physical and psycholgoical syx occur following a reduction in alcohol intake after period of excessive use

Question 11

when do alcohol withdrawal syndrome syx start

Answer 11

begin 6-8hrs afeer abrupt reduction in alcohol intake

can peak at 10-30hrs since last drink

can last 3-7days

Question 12

mild to moderate syx of alcohol withdrawal syndrome 7

Answer 12

N+V

diarrhoea

tremoors- hands arms lefs

hyperacitivty,anxietym, agitatio

muslce pain

sweating

insomnia

Question 13

severe syx of alcohol withdrawal syndrome 3

Answer 13

seizures

delirium tremenes

wernicks encephalopathy

Question 14

management of alcohol withdrawal syndrome seizures 1

Answer 14

lorazepam IV

Question 15

management of delirium trememns 2

Answer 15

chloridazepoxide (2-3 doses)

if no response

lorazepam

Question 16

define Wernicke encephalopathy

Answer 16

acute neuropsychatric disorder resulting fom thiamine deficiency which develops rapidly or sub-acutely over a number of days

Question 17

syx of delrium termenrs 6

Answer 17

24-72hrs after alchhol cessation

syx
-severe tremor
-delusions
-tachycarida
-pyrexia
-visual and auditory hallucaitons
-confusion

Question 18

inital managemnt of Wernicke encephalopathy 2

Answer 18

prophllyactilcaly give pabrinex
-after which give thiamine

-even of clinical suspsicion is low

Question 19

signs of Wernicke encephalopathy4

Answer 19

ataxia

opthalmoplegia

loss of memory

confusion

Question 20

signs of patient with a high risk of developing Wernicke encephalopathy 4

Answer 20

hypotension

hypothermia

malnourished

hyperglycaemia

Question 21

managemnt of alcohol withdrawal

Answer 21

benzos -chlordiazepoxide

Question 22

why is chlordiazepoxide used first line for alcohol withdrawal syndrome

Answer 22

more gradual onset

long half life

less risk of rebound syx

Question 23

when is diazepam used for alcohol withdrawal syndrome

Answer 23

in A&E
or if patient is unlieklyu to be admitted to hospital

Question 24

define korsakoof syndroem

Answer 24

memory disorder results from vit B1 deficiency

associated with alcholhil

Question 25

syx of korsakoff syndrome 3

Answer 25

problems learning new info inability to rememebr recent events long term memory gaps

Question 26

what pathway in the brain is implicit in drug use

Answer 26

mesolimbic dopamine rewarrd pathway

Question 27

aetiology of addiction

Answer 27

social learning model -observing others and copying disease model -altered brain structure and functioning genetic vulnerability children of alcoholic 4x likely to themselves

Question 28

assessment of substance use disorders

Answer 28

use problems phsycial adaptaion behvaioural dependence medical harm cognitive impairment motivation to change

Question 29

psychosocial interventions in additviosn 8

Answer 29

motivational enhancement interviweing brief interventions relapse prevention (CBT) 12 step programmes (AA,NA,CA) peer support contingency management therapeutic community/ residential rehab

Question 30

describe motivational interviewing 4

Answer 30

facilitatinf and engaging intrisinc motivation to change collaborative goal-orientated client centres

Question 31

describe the FRAMES model

Answer 31

F- Feedback of risks R- Responsibility Highlighted A - Advice to abstain or cut down M- Menu of alternative options and activities offered E- Empathic Interviewing S- Self efficacy enhanced

Question 32

main cause of drug related deaths in Scotland

Answer 32

>80% assoc w opiods >50% assoc w benzos

Question 33

most abused type of opiods

Answer 33

Most abused substances are μ receptor agonists

Question 34

effects of μ opiods 5

Answer 34

mediate analgesia respiratory depresion europhia drowsiness consitpation

Question 35

managment of opiod addicts 2

Answer 35

either detox or maintenance presciption lofexidine or buprenorphine for detox -high relapse rates methadone and buprenoprhine for maintenance

Question 36

issues with maintenance prescription for opiods addicts 4

Answer 36

respiraitory depresion in overdose rapid loss of tolerance high risk of OD if misse doses o& reinstated at usual dose need for re-titration after 3 days

Question 37

syx of opiod overdose 3

Answer 37

respiratiory depresion pinpoint pupils decreased level of conscious es

Question 38

treatment of opioid overdose

Answer 38

naloxone -usualy IM competitiev opiod antagonis -reverses depression of CNS and respiratory syx

Question 39

MOA of benzos

Answer 39

enhance GABA at GABA (A) receptors

Question 40

effects of benzos 4

Answer 40

sedative hypnotic anxiolytic muscle relaxant effects

Question 41

overdose of benzo syx (5) and managemnt 2

Answer 41

sedation drowsiness slurred pseech coma respiraoty depression Mx-supportive, flumanzenil(watch use as can cause seizures)

Question 42

define ketamine bladder

Answer 42

affects of ket on bladder erosion of urothelium -inflam leads to revasculaition 30% of regular ket users decreased bladder compliance and volume detrusor overacititvu painful haemturiatin can cause bilateral hydronephrosis and renal papillary necorisi on stopping use: -1/3 recover a third no change a third deteriroitate