substance misuse Flashcards
(40 cards)
1
Q
what is substance misuse
A
use of psychoactive substances in a way that is harmful or hazardous to health - including alcohol and drugs
2
Q
what are the symptoms of substance dependency
A
- developing a tolerance for the drug
- going through withdrawal symptoms without it
- struggling to cut it back on it
3
Q
what does alcohol misuse include
A
- excessive and harmful drinking
- alcohol dependence
4
Q
whart is classsed and excessive and harmful drinking
A
- women = consumption >14 units/ week and < 35 units/ week
- men = consumption > 14 units/ week and < 50 units per week
5
Q
what alcohol related problems can excessive drinking cause
A
- psychological eg depression
- physical illness eg acute pancreatitis, hypertension, cirrhosis, heart disease, cancer
- accidents
6
Q
what is alcohol dependence
A
characterised by craving, tolerance, a preoccupation with alcohol and continues drinking in spite of harmful consequences
7
Q
what is alcohol dependence associated with
A
- increased criminal activity
- domestic violence
- increase rate of mental and physical health disorders
8
Q
what are signs and symptoms of alcohol misuse
A
- ataxia
- nystagmus
- drowsiness
- hypotension
- acidosis
- aspiration of vomit
- hypoglycemia
9
Q
how is alcohol misuse managed
A
- supportively
- maintain clear airway
- reduce risk of aspiration of gastric contents
- BM measure and glucose given if indicated
10
Q
what is drug misuse
A
dependence on or regular excessive consumption of psychoactive subtsnaces
11
Q
what drugs are missused
A
- illegal
- legal highs = New Psychoactive Substances
- over the counter meds
- prescription meds
12
Q
what do illegal drugs include
A
- stimulants = cocaine, ecstasy. amphetamines
- cannabis
- heroin
13
Q
what are the signs and symptoms of cocaine overdose
A
- simulation of CNS
- agitation
- dilated pupils
- tachycardia
- hypertension
- hallucination
- hyperthermia
- hypertonia and hyperreflexias
- cardiac = chest pain, MI, arrhythmias
14
Q
what is the treatment for cocaine overdose
A
- IV diazepam for agitation (or secondary is propofol but = resp depression)
- cooling measures for hyperthermia
- hypertension and cardiac effect treatment = GTN, aspirin, morphine
15
Q
what are the signs and symptoms of an ecstasy overdose
A
- ventricular arrhythmias
- hypertension
- hyperthermia
- delirium
- coma
- convulsions
- rhabdomyolysis
- respiratory distress syndrome
- hyperreflexia
- intracerebral haemorrhage
16
Q
what is the treatment for ecstasy overdose
A
- IV administration of diazepam
- haloperidol can be used if not responsive to diazepam
- supportive
- ECG monitoring
17
Q
what are the signs and symptoms of amphetamine overdose
A
- tachycardia
- hypertension
- mydriasis
- wakefulness and excessive activity
- paranoia
- hallucination’s
- convulsions
- hyperthermia
- coma
18
Q
what is the treatment for amphetamine overdose
A
- IV diazepam to control agitation
- haloperidol of unresponsive to diazepam
- supportive
- cooling measures
- cardiac monitoring
19
Q
signs and symptoms of cannabis overdose
A
- tachycardia
- hypertension
- miosis
- drowsiness
- hallucinations
- tremors/ seizures
- impaired motor function
- slurred speech
20
Q
treatment for cannabis overdose
A
- IV diazepam for agitation
- haloperidol if unresponsive to diazepam
- supportive
- cardiac monitoring
21
Q
heroin overdose
A
- opiate
- soluble in fat so reaches higher levels in the system more rapidly than other opiates
22
Q
what are the signs and symptoms of heroin
A
- bradycardia
- hypotension
- respiratory depression
- miosis
- decreased level of consciousness
23
Q
what is the treatment for heroin overdose
A
- supportive (airway management)
- naloxone repeated IV or IO every 5 mins until opioid reversal to restore breathing
- pts can become combative post naloxone
24
Q
what are legal highs
A
- type of drug that contain various chemicals
- ingredients may be illegal and legal
- similar effects to illegal drugs
25
examples of legal high drugs
- synthetic stimulants
- synthetic cannabinoids
- synthetic hallucinogens
26
what are the signs and symptoms for synthetic hallucinogens
- mood swings due to it altering the brains serotonin levels
- changes in sexual behaviours
- hallucinations
- changed sense of time
- difficulty sleeping
- panic or paranoia
- irrational behaviour
- cardiac arrest
- seizures
- coma
27
what is the treatment or synthetic hallucinogen overdose
- remove pt from distractive or dangerous environment due to sensory overloads
- support
- low dose of a benzodiazepine to control anxiety
28
what is an acute overdose in a paracetamol overdose
excessive amounts of paracetamol ingested over a period of less than 1 hours (self harm)
29
what is a staggered overdose in a paracetamol overdose
excessive amounts of paracetamol ingested over longer than 1 hour (self harm)
30
what is therapeutic excess in paracetamol overdose
excessive paracetamol taken with intent to treat pain or fever and without self harm intent
31
what is the toxic ingested dose of paracetamol in adults and children over 6
75 mg/kg or more of paracetamol in 1 hour or less
32
what is the toxic ingested dose of paracetamol in children under the age of 6
150 mg/kg or more of paracetamol in 1 hour or less
33
why is the toxic dose of paracetamol higher in children
- children have a higher/ larger liver size compared to their body
- this means that their metabolism is faster
- higher rates of metabolism mean that they are able to take a higher dose of paracetamol and break it down
34
calculating paracetamol overdose on obese pts
to avoid underestimating if pts wight over 110kg use a body weight of 110kg rather than their own weight to work the total dose of paracetamol
35
what is the treatment for paracetamol overdose
- activated charcoal if ingested within 1 hour
- supportive airway
- supplemental o2
- dextrose-free IV for hypotension
36
what is the standard 21 hour regimen for paracetamol overdose
- 3 consecutive IV infusions of N-acetylcysteine over 21 hrs
- 1st over 1hr
- 2nd over 4 hrs
- 3rd over 16 hrs
37
what is another paracetamol overdose regimen
12 hour acetylcysteine infusion (Scottish and Newcastle acetylcysteine protocol)
38
when to give acetylcysteine
- within 8 hrs of ingestion
- if acute and >150mg/kg or clinical features of liver injury start with no delay
- if asymptomatic and <150mg/kg wait for bloods
39
when to give acetylcysteine in asymptomatic paracetamol overdose
- serum paracetamol concentrations on or above treatment line for nomogram
- or suspicion of liver injury (elevated alanine aminotransferase)
40
what are the most common opioid prescription medication overdoses
- morphine
- meperidine
- codeine
- fentanyl
- methadone
- hydrocodone
- oxycodone
- nalbuphine
- pentazocine
(treat same as heroin overdose)
