Substance Disorders Flashcards Preview

Mental Health > Substance Disorders > Flashcards

Flashcards in Substance Disorders Deck (26):
1

Symptoms of alcohol withdrawal

CNS feature - Anxiety, Tremor, Sweating, agitation, and distractibility
Nausea
Vomiting
Tonic clonic seizure
Headache
Severe withdrawal - DT - hyperactivity, fluctuating confusion, paranoid ideation and visual hallucination.

2

Coarse of alcohol withdrawal

Symptoms start within 6 to 24 HR of last drink
Can seizure or delirium
Duration 72hr to several weeks

3

Ix for alcohol withdrawal

LFT - GGT
FBC - MCV
Creatinine
Electrolytes

4

Mx for alcohol withdrawal - short term

Supportive care - education, reassurance, monitoring and low stimulus environment.
Alcohol withdrawal chart - CIWA-AR or AWS
Med - Benzodiazepine Iv or Oral, 20mg PO PRN 2hourly until symptoms resolve (max of 100mg
- Thiamine PO, IM, IV 100-300mg for 3-5 days

5

Mx of Alcohol withdrawal Long term

Diazepam for 2-7 days if symptoms return
Thiamine 300mg orally for several weeks.
ATODS

6

Areas looked at in the CIWA-AR and scoring system

Nausea and vomiting
Tremor
Paroxysmal sweats
Anxiety
Agitation
Tactile disturbances
Visual disturbances
Headaches, fullness in head
Orientation and clouding of sensorium
Total out of 67 with 20 Severe.

7

Alcohol intoxication

Depressed conscious level - stupor to coma
Ataxia
Respiratory depression
Risk of inhalation of vomit and asphyxiation
Death if BAC above 0.4g

8

Condition due to alcohol abuse

Alcoholic liver disease - fatty liver, alcoholic hepatitis or cirrhosis.
- Fatty liver - a symptomatic to abdo pain and vomiting
- Alcoholic hepatitis - jaundice, fever, R sided abdo pain, sometimes as cites
- Cirrhosis - non specific GI symptoms and as cite, encephalopathy or varicella haemorrhages
Alcoholic pancreatitis - acute: epigastric pain, nausea, vomiting and hypotension to renal failure. Chronic: chronic upper abdominal pain and wt loss, exocrine deficiency eg steatorhoea, Diabetes.
Gastritis and peptic ulcer
GI cancers
CVS - Cardiomyopathy, arrhythmia, HTN,
Resp - aspiration pneumonia and lobar pneumonia
Musculoskeletal - acute myopathy, acute rhabdomyolysis, Osteoporosis, GOUT.
Endo - pseudo Cushing, Gonadal atrophy - sexual issues
Haem- Macrocytosis (folate deficiency), thrombocytopenia (marrow toxicity and hypersplenism)
Brain - Wernicke-Korsakoff syndrome - Thiamine deficiency. Short term memory defective but preserved immediate recal and remote memory. Frontal lobe syndrome, Cerebellar atrophy - ataxia and gait,
Stroke - Haemorrhage or thrombotic
Peripheral neuropathy - Numbness, dysaesthesiae and paraesthesiae in a glove and stocking distribution or weakness of proximal or distal muscle groups,
Trauma
Fetal alcohol syndrome - Characteristic faces - depressed nasal bridge, thinning upper lip and low set ear. Intellectual and cardiac defects.

9

Wernicke's

Ataxia affecting gait
Vestibular dysfunction
Confusion
Ocular motility abnormalities - horizontal nystagmus, lateral orbital palsy and gaze palsy
Sluggish reaction to light and anisocoria
Tx
IV thiamine
Cx
Korsakoff's - amnestied syndrome - impaired mental syndrome esp recent memory, and anterograde amnesia in an alert and responsive patient. May have confabulation

10

Cerebellar examination

Gait- walk, heel-toe walking, Romberg's test
Speech - "West register street", "British Constitution", Ataxic dysarthria or staccato speech.
Nystagmus - Horzontial jerking to the side of lesion
Coordination- Hand - finger to nose, rebound, Pronator drift. Legs: Heel-shin, foot tapping, toe-finger.
Truncal Ataxia
Knee reflexes.

11

Symptoms and signs of Opiod overdose

Decreased pain perception, sedation, decreased sex drive, nausea/vomiting, decreased GI motility (constipation and anorexia), and respiratory depression
typical syndrome includes shallow respirations, miosis, bradycardia, hypothermia, decreased level of consciousness

12

Tx of Opioid overdose

ABCs
ƒ IV glucose
ƒ naloxone hydrochloride (Narcan®): 0.4 mg up to 2 mg IV for diagnosis
ƒ treatment: intubation and mechanical ventilation, ± naloxone drip, until patient alert
without naloxone (up to >48 h with long-acting opioids)
• caution with longer half-life; may need to observe for toxic reaction for at least 24 h

13

Withdrawal of opioids

symptoms: depression, insomnia, drug-craving, myalgias, nausea, chills, autonomic instability (lacrimation, rhinorrhea, piloerection)
• onset: 6-12 h; duration: 5-10 d
• complications: loss of tolerance (overdose on relapse), miscarriage, premature labour
• management: long-acting oral opioids (methadone, buprenorphine), α-adrenergic agonists
(clonidine)

14

Tx of opioid use disorder

Methadone
Buprenorphine

15

Scoring system for cirrohosis

Child pugh score
Based on
Albumin
Bilirubin
INR
Ascites
Encephalopathy

16

Treatment of hepatic encephalopathy

Treat underlying cause
Lactulose
Antibiotic - rifaximin

17

Intoxication of depressants

Euphoria, slurred speech, disinhibition, confusion, poor coordination, coma (severe)

18

Intoxication of stimulants

Euphoria, mania, psychomotor agitation, anxiety, psychosis (especially paranoia), insomnia, cardiovascular complications (stroke, MI, arrhythmias), seizure

19

Intoxication of hallucinogens

Distortion of sensory stimuli and enhancement of feelings, psychosis (++ visual hallucinations), delirium, anxiety (panic), poor coordination

20

Withdrawal of depressants

Anxiety, anhedonia, tremor, seizures, insomnia, psychosis, delirium, death

21

Withdrawal of stimulants

‘Crash’, craving, dysphoria , suicidality

22

Withdrawal of hallucinogens

Usually absent

23

Pharmacologic therapy for quitting smoking

Nicotine replacement therapy
Antidepressants - bupropion
Varenicline (Champix) - nicotinic receptor agonist

24

Types of NRT

Nicotine Gum
Nicotine patch
Nicotine inhaler
Nicotine nasal spray

25

Bupropion

nhibits re-uptake of dopamine and/or norepinephrine
Side effects: insomnia, dry mouth
Contraindication - Seizure disorder
Eating disorder
MAOI use in past 14 d Simultaneous use of bupropion (Wellbutrin®) for depression

26

Varenicline

Partial nicotinic receptor agonist, and partial nicotinic receptor competitive antagonist
• Side effects: N/V, constipation, headache, dream disorder, insomnia, increased risk of psychosis, depression, suicidal ideation