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Substance Misuse Flashcards

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1
Q

How to assess alcoholism?

A

CAGE
Cut down - has anyone asked you
Annoyed - when people ask you to stop
Guilt
Eye opener - start mornings with a drink

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2
Q

Score on CAGE that is concerning

A

More than 2

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3
Q

What score do you use after CAGE to gauge severity of alcoholism?

A

AUDIT-C

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4
Q

What questions ask in AUDIT-C?

A

How often did you have a drink containing alcohol in the past year? - Never, monthly or less, 2-4 x a month, 2-3 x a week, 4+ x a week (+4)
How many drinks containing alcohol did you have on a typical day when you were drinking in the past year? - 1 or 2 drinks = 0, 3 or 4, 5 or 6, 7- 9, 10+ = 4 points
How often did you have six or more drinks on one occasion in the past year? - never, less than monthly, monthly, weekly, daily or almost (+4)

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5
Q

How long does it take to metabolise a unit of alcohol?

A

one hour

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6
Q

Classical drinking HbA1c?

A
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7
Q

Anaemia in alcoholism

A

B12/folate
Macrocytic
Fe deficient - iron absorption not done properly

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8
Q

What is concordant with alcohol misuse in females vs males off AUDIT c?

A

Females > 3
Males >4

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9
Q

Specific liver test for alcohol function

A

GGT

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10
Q

What does GGT test for?

A

Liver inflammation

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11
Q

What can you do in emergency situation for alcohol?

A

Blood alcohol level

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12
Q

What does a score over 5 from AUDIT C mean?

A

Alcohol misuse, possible liver damage

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13
Q

What do when alcoholics come in?

A

Refer to self help groups
Explore reasons behind it

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14
Q

What can you give to alcoholics in withdrawal adn DTS

A

Chlordiazapoxide
Banana bag - with vitamins to support them
Benzodiazapines
(Delirium tremens - IV fluids, antipsychotic meds, anticonvulsants, paracetemol)

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15
Q

What to tell people about stopping alcohol?

A

Do not stop cold turkey

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16
Q

What can immediate cessation of alcohol cause?

A

Alcohol withdrawal syndrome Wernickes/Brocas
Seizures

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17
Q

What classifies as heavy drinking?

A

Men >15 drinks per week
Women > 8 drinks per week

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18
Q

Alcohol affects on neurotransmitters

A

GABA increased
Glutamate decreased

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19
Q

What causes alcohol withdrawal syndrome?

A

Unnaturally low GABA levels
Glutamate spikes

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20
Q

Mild symptoms of withdrawal

A

Anxiety
Irritability
Headache
Shakiness
Sweating
Depression
Mood swings
Loss of appetite
Mild confusion
N+V

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21
Q

Moderate symptoms comon with alcohol withdrawal

A

12 - 24 hours after last drink
Confusion
Disorientation
Hallucinations
Seizures

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22
Q

Severe symptoms common with alcohol withdrawal and when occurs

A

High BP
Increase HR, RR, pulse
Extreme confusion and agitiation
Persistent hallucinations (visual, auditory, tactile)
Seizures
Tremors (DTS)
Fever

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23
Q

What is delirium tremens?

A

Psychotic condition involving tremors, hallucinations, anxiety, disorientation

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24
Q

Phases of alcohol withdrawal?

A

Stage 1 - 6-24 hours
Stage 2 - 24-48 hours
Stage 3 - 48-96 hours

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25
Stage 1 alcohol withdrawal
N+V Heachaes Insomnia Anxiety
26
Stage 2 alcohol withdrawal
24-48 hours Heightened HR, BP, elevate body temo, seizures, hallucinations
27
Stage 3 acohol withdrawal
48-96 hours Seizures and tremors Mood changes and agitation Severe adn allucinations
28
Stage 3 acohol withdrawal
48-96 hours Seizures and tremors Mood changes and agitation Severe adn allucinations
29
AUDIT vs AUDTI-C
AUDIT-C is 3 qs gives indication if need to ask 10 qs of AUDIT
30
Risk factors for delirium tremens
Cirrhosis Alcoholuc cardiomyopathy Alcoholic neuropathy Presence of co-occurring mental disorders
31
Questions to ask about delirium tremens
When did the person last have a drink? How much does the person typically drink per day? Since when does he or she drink? Has he or she ever had delirium tremens before, including a seizure? Has he or she tried to stop drinking before? If so, were there any withdrawal symptoms? Does the person have a mental or physical disorder? Are they getting treatment for it? Do they take illegal drugs or prescription medication?
32
What domains does the AUDIT test?
1. alcohol intake; 2. potential dependence on alcohol, and; 3. experience of alcohol-related harm.
32
What domains does the AUDIT test?
1. alcohol intake; 2. potential dependence on alcohol, and; 3. experience of alcohol-related harm.
33
How is the AUDIT scored?
Out of 40 10 questions each 0-4
34
What AUDIT score suggests a harmful or hazardous alcohol consumption?
8-14
35
What AUDIT score suggests a harmful or hazardous alcohol consumption?
8-14
36
What does a score of 15 or more on the audit suggest?
Likelihood of alcohol dependence - modersate-severe alcohol use disorder
37
What level of risk factor is alcohol in UK for death and disability?
Third after smoking and obesity
38
What can alcohol be a causal factor in?
Over 60 medical conditions including: -Liver disease -Mouth -Throat, stomach, liver and breast cancers, heart disease and depression
39
What is caused by drinking in pregnancy?
Foetal alcohol spectrum disorder
40
What to do if audit score 8-15
Hazardous drinking - brief inervention
41
What to do if audit score 16-19
Harmful drinking Extended brief interventionn Review and refer to speicalist if noimprovenent
42
What to do if audit score over 20
Probably alcohol dependencce Withdrawaal assessment/specialtist assessment
43
How sensitice is GGT to dirnking?
Low sensitivity and specificit y
44
What biomarker has the best sensitivity and sensitivity for alcohol use?
Carbohydrate deficient transferrin
45
Alchol withdrawal syndromes
Uncomplicated alcohol withdrawal syndrome Alcohol withdrawal syndrome with seizures Delirium tremens
45
Alchol withdrawal syndromes
Uncomplicated alcohol withdrawal syndrome Alcohol withdrawal syndrome with seizures Delirium tremens
46
When is carbohydrate deficient transferrin used?
Rarely in clincial practise In community to prove someone is no longer drinking over long period of time
47
When does uncomplicated alcohol withdrawal syndrome occur?
4-12 hours after last drink
48
What happens in uncomplicated alcohol withdrawal syndrome?
Coarse tremor Nausea and vomitting Sweating Insomnia Tachycardia Agitation Anxiety Hallucinations
49
What % of withdrawal syndromes are with seizure?
5-15%
50
Delirium tremens additional features
Clouding of consciousness Amnesia of recent events Psychomotor agitiation Disorientation Tactile/visual hallucinations Heavy sweating Paranoid Delusions Raised temperature Sudden cardiovascular collapse
51
Detailed assessment for people with harmful drinking and dependence
Quantitiy, frequency and pattern of consumption Severity of dependence Alochol related problems Use of other drugs Physical or mental health co-morbidity Risk to self or others Family hisotry Motivation or readiness to change Sociodemographic favtprs
52
Plannning treatment for alcohol addictionn
Make diagnosis - hazardous, harmful, dependent etc Assess stafe of change - pre-contemplatice Gial of intervation - continue current drinking pattern, change to a safer one, abstinence Family support Strategies
53
What is brief intervention used fir?
Hazardous and harmful drinkers Infographics eg compared to general pop, consequences of drinking at the level that they are
53
22What is brief intervention used fir?
Hazardous and harmful drinkers Infographics eg compared to general pop, consequences of drinking at the level that they are
54
Alcohol psych
Depression Insomnia Suicide Anxiety Personality change Pscyhotic changes Amnesia Hallcuinations Delirium tremens Morbid jealousy - obsession about partner cheating
55
Social disintegration
Financial difficulties, homelessness
56
Risk factors
FH addiction depression and anxiety
57
Types of harmful drinking
ICD-11 One episode eg binge drinking Repeated pattern of harmful use
58
Acute intpxication
Transient confition after intake psychoactive substance -> disturbance of consciousness, cognition, perception or behaviour
59
Dependence ICD-11
>2 of Control - lack of/powerless - onset, intensity, termination, frequency, context Precedence - over otjher aspects of healh Physiological Time - over 3 months
59
Dependence ICD-11
>2 of Control - lack of/powerless - onset, intensity, termination, frequency, context Precedence - over otjher aspects of healh Physiological Time - over 3 months
60
Alcohol MOA
Enhances GABA Downregulates NMDA and glutamate
61
why get withdrawal
decrease GABA over active CNS Increase glutamate - excitatory, sympathetic overdrive
62
What can cause fatality in withdrawal
Seizures
63
Symptoms of alcohol withdrawak
Sweating Tremor hands, tongue, eyelids Agitation/anxiety Tachy Fever Nausea, vommitting, diarrhoea HPTN Hallucination - tactile - spiders/bugs etc
64
Delirium tremens vs withdrawal
Hallucinations or psychosis - visual Significant tremor
65
What hallucinations in alchol withdrawal
Auditory and visual Often still remian orientated
66
What is severity of withdrawal determined by?
How much alcohol drinking not length
67
What is the problem with chlordiazapine with addicts?
Its a benzo eg can be addictive
68
When is AUDIT used to screen for alcohol?
On admission to mental health hospital
69
When is AUDIT used to screen for alcohol?
On admission to mental health hospital
70
Alcohol hisotry
A typical days drinking - max in one day, frequenct etc Presnce/severity of cdependence Alcohol related physical, pscyhological and social probkems incl forensic hisotry Risk Previous interventions for problem and outcome Patients expectations
71
What is the cycle of change
Prochaska and Diclemente Precontemplation, contemplation, prep, action, maintenance, termination OR relaspse -> contemplation again
72
Alcohol exam
Face Hands and body CNS CVS Abdo
73
Bloods in alcohol dependence
Raised LFTs High GGT, ALT, AST B12 and folate low FBC - low Hb, High MCV
74
Controlled drinking
Below 40, detect ealy No minimal No major medical complications No psych comorbidity No impulsicity Social stability Patients choice
75
Controlled drinking
Below 40, detect ealy No minimal
76
Pharmacotherapy options for alcohol addiciton - deterrent, anti craving, adjunctive
Deterrent - disulfiram - nasty sympotms after take Anti craving - acamprosate Adjunctive - antidepressants Others - naltrexone
77
What interviewing use with alcohol problems?
Motivational interviewing
78
Assisted alcohol withdrawal
>15 units a day or scroe over 20 on audit
79
Why is thiamine deficient in alcoholism
Helps break down carbs - alcohol is carbs, more thiamine needed Alcohol stops thiamine absorption Poor diet/malnourishment
80
How many people with wernickes go on to develop
80% 20% die
81
Treat wernickes
IV pabrinex for 5 days
82
What precedes korsakoffs
Wernickes
83
Symptoms of korsakoffs
Loss short term memory - anterograde Hallucinations Receptive aphasia Confabulation
84
Recovery from korsakoffs
25% recover 50% improve but dont fully recover
85
Cocaine symptoms
Wired, dilated pupils, tremor
86
Presentation of heroin
Lethargic, sleepy
87
Presentation of opiate misuse
Pinprick pupils Drowsy Reduced respiratory rate
88
Drugs that can be targets of drug seeking behaviour
Tramadol Cyclizine Gabapentin Pregabalin

Mental Health (57 decks)

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