substance dependence

Question 1

what is the definition of substance dependence

Answer 1

a cluster of cognitive behavioral and physiological phenomena that develop after repeated substance use.

Question 2

what is 1 unit of alcohol

Answer 2

10ml of pure alcohol

or

1l of 1% alcohol

Question 3

what is the nhs guidance on the amount of units a week

Answer 3

no more than 14

Question 4

what is 14 units in glasses of wine

Answer 4

7 standard glasses of wine

Question 5

when is the best time to identify alcohol misuse

Answer 5

drug history

Question 6

what are the mild symptoms of alcohol withdrawal

Answer 6

anxiety

nausea

tremor

tachycardia / palpitations

insomnia

sweating

Question 7

what are the severe symptoms of alcohol withdrawal

Answer 7

delerium

depressions

fever / hypothermia

seizures

hyper/hypotension

Question 8

what is the timeframe in which a patient that hasn’t had alcohol may experience severe symptoms

Answer 8

12-18 hours

Question 9

What symptom of alcohol withdrawal is considered a medical emergency

Answer 9

delirium

Question 10

what is delirium characterized by

Answer 10

agitation
confusion
fear
paranoia
disturbed sleep

Question 11

What is the first line for delirium

Answer 11

benzodiazepine oral

Question 12

what else can we give for delirium

Answer 12

IV benzo
Iv haloperidol
Iv pabrinex
Iv fluids

Question 13

what is wernicke’s encephalopathy

Answer 13

due to thiamine deficiency which is caused by the abuse of alcohol.

Question 14

what are the symptoms of wernicke’s encephalopathy

Answer 14

severe cognitive impairment

delirium

ataxia

Question 15

what syndrome can occur if wernicke’s encephalopathy is not treated

Answer 15

korsakoffs (memory disorder)

Question 16

how do we treat wernickes encephalopathy

Answer 16

oral thiamine

iv pabrinex if patient has altered mental status

Question 17

what is pabrinex

Answer 17

vit b and ascorbic acid and comes in two vials

Question 18

what is chlordiazepoxide used for

Answer 18

drug assisted detox of alcohol

Question 19

how is the starting dose of chlordiazepoxide determined

Answer 19

CIWA score - starting dose estimated from current level of alcohol consumption

Question 20

what are the two dosing regiments for chlordiazepoxide

Answer 20

fixed - they only get it at certain times

variable - they get it whenever but is only used in specialist settings.

Question 21

what is acamprosate

Answer 21

NMDA antagonist

Question 22

what is acamprosate used for

Answer 22

prevents relapse once abstinence happens

Question 23

how long should acamprosate be used for

Answer 23

6 months - 1 year

Question 24

what are the contraindications of acamprosate

Answer 24

pregnancy
breastfeeding
creatinine > 120mcmol/l

Question 25

what are the side effects of acamprosate

Answer 25

gi sex dysfunc skin reaction

Question 26

how long should we monitor acamprosate

Answer 26

6 months

Question 27

when should we stop acamprosate

Answer 27

stop drinking persists 4-6 weeks after initiation

Question 29

what is disulfiram used for

Answer 29

produces unpleasant physical symptoms when a patient drinks alcohol 👁️👄👁️

Question 30

when is disulfiram used

Answer 30

used in hospital or specialist use

Question 31

how often we monitor disulfiram (3 steps)

Answer 31

2 weeks for first 2 months then month for 4 months then 6 montly if use continues

Question 32

what are the contraindication

Answer 32

Alcohol consumed in 24 hours Cardiac disease Severe mental illness Liver impair Pregnant and breastfeeding

Question 33

what are the main interactions of disulfiram

Answer 33

amitriptyline benzodiazepines drugs metabolised by liver

Question 34

what is the interaction between disulfiram and amitriptyline

Answer 34

can increase the intensity of the disulfiram reaction

Question 35

what is the interaction between disulfiram and benzos

Answer 35

disulfiram inhibits their metabolism and can increase the sedative effects

Question 36

what is the interaction between disulfiram and drugs metabolized by liver

Answer 36

can affect the effect and increase the side effects

Question 37

what are the symptoms of opioid intox

Answer 37

constricted pupils itching scratching sedation somnolence lower bp

Question 38

what are the symptoms of acute withdrawal of opioids

Answer 38

abdominal cramps nausea vomitting diarrhea tremor anxiety hypertension

Question 39

how do we help treat opioid dependence

Answer 39

give them a prescription which they are replaced on rather than using the opiate / opioid this is to help stabilize and reduce risk

Question 40

METHADONE VS BUPRENORPHINE what has the lower risk of overdose in first weeks of treatment

Answer 40

buprenorphine

Question 41

METHADONE VS BUPRENORPHINE which is more effective in retaining people in treatment

Answer 41

METHADONE

Question 42

METHADONE VS BUPRENORPHINE which gives a clear head response

Answer 42

BUPRENORPHINE

Question 43

METHADONE VS BUPRENORPHINE which gives a clouding

Answer 43

METHADONE

Question 44

METHADONE VS BUPRENORPHINE which is more sutible for people who use large quantities of heroin

Answer 44

METHADONE

Question 45

METHADONE VS BUPRENORPHINE which is less affected by inhibiting liver enzymes

Answer 45

BUPRENORPHINE

Question 46

METHADONE MOA

Answer 46

long acting agonist

Question 47

METHADONE contraindications

Answer 47

non opioid dependent allergic <15 liver disease

Question 48

Methadone cautions

Answer 48

severe mental illness chronic pain head injury respiratory disease QT prolongation

Question 49

What do SSRI's do to methadone level

Answer 49

increase

Question 50

What do Anti-epileptic do to methadone and bup levels

Answer 50

decrease

Question 51

What does fluconazole do to methadone and bup levels

Answer 51

increase

Question 52

what does macrolides do to methadone and bup levels

Answer 52

increase

Question 53

Burpenorphine contraindications

Answer 53

severe respiratory disease allergy

Question 54

what are the buprenorphine cautions

Answer 54

qt prolong hep b recent head injury severe respiratory disease

Question 55

what are the side effects of buprenorphine

Answer 55

respiratory depression fatigue anxiety depression