Substance Misuse Flashcards Preview

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Flashcards in Substance Misuse Deck (61)
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1

What is harmful use?

A pattern of use likely to cause physical or psychological damage

2

What is dependency?

A cluster of physiological, behavioural and cognitive symptoms in which use of a substance takes on a much higher priority than other behaviours that once had grater value

3

What is withdrawal?

A transient state occurring while readjusting to lower levels of the drug in the body

4

What is the classical conditioning theory of dependence?

Cravings become conditioned to cues
So that a cue itself can trigger a craving and thus cause drug seeking behaviour

5

What is the operant conditioning theory of dependence?

Behaviours rewarded are repeated: positive reinforcement
Behaviours are repeated if they relieve unpleasant experiences: negative reinforcement

6

What are features of dependence?

Tolerance
Compulsion
Withdrawal
Problems controlling use
Continued use despite harm
Salience
Reinstatement following abstinence
Narrowing of the repertoire

7

What is tolerance?

Larger doses required to gain the same effect experienced previously

8

What is compulsion?

Strong desire to use the substance

9

What is salience?

Obtaining and using the substance becomes so important that other interests are neglected

10

What is narrowing the repertoire?

Loss of variation in use of the substance?

11

What is the social learning theory of dependence?

AKA vicarious learning

We learn by copying behaviours of others
Substance misuse can result from peer pressure

12

What is the neurobiological model for addiction?

All drugs if abuse affect the dopaminergic reward pathway in the brain:
Ventral tegmental area -> prefrontal cortex and lambic system
Prefrontal cortex has a role in motivation + planning
Dopamine release in nucleus accumbens= sensation of pleasure

13

How do cocaine and amphetamines give pleasure?

Block dopamine reuptake
= increased synaptic dopamine levels

14

Aetiology of alcohol misuse

Some genetic susceptibility: supported by adoption studies
Occupation: stressful work + socially sanctioned drinking
Social background: difficult childhood, poor educational achievement
Psychiatric illness: assoc with personality disorders, mania, depression, and anxiety disorders

15

1 unit of alcohol:

1/2 pint normal beer
Small 125ml glass wine
One measure (25ml) spirit
One measure (50ml) fortified win

Units= vol in ml x % alcohol /1000

16

What are safe levels of alcohol consumption?

Women: 2-3/day, 14/week
Men: 3-4/day, 21/week

17

What are harmful levels of alcohol consumption?

Women: >6 /day, >35 /wk
Men: >8 /day, >50 / wk

18

Delerium tremens

48hrs into abstinence, lasts 3-4 days
Symptoms:
Confusion, hallucinations, affective changes, gross tremor, autonomic disturbance, delusions
Mortality rate 5% (30% with sepsis)
Management: reducing benzodiazepine regime and parenteral thiamine, management of potentially fatal dehydration and electrolyte disturbance

19

What is Wernicke's encephalopathy

Due to acute thiamine (vit B1) deficiency
Confusion, ataxia, opthalmoplegia
Medical emergency!
Treat with parenteral thiamine

20

What is korsakoff's syndrome?

Cause by untreated Wernicke's encephalopathy
Irreversible antegrade amnesia
Can register new events but cannot recall them
Patients may confabulated to fill in gaps in memory

21

What is intoxication?

Transient state of emotional and behavioural change following drug use, dose dependent and time limited

22

How would you investigate a patient with apparent alcohol misuse?

FBC: macrocytic anaemia (incr MCV) due to B12 deficiency
LFTs: gammaGT rises with recent heavy alcohol use, raised transaminases indicate hepatocellular damage
UDS: if suspect drug misuse too
Hepatitis screen: if suspect IV drug use

23

What can a UDS: urine drug screen detect?

Amphetamine: 2 days
Heroin: 2 days
Cocaine: 5-7 days
Methadone: 7 days
Cannabis: up to 1 month

24

How do you assess a patients' motivation to change?

The stages of change model:
Pre-contemplation, Contemplation, Preparation, Action, Maintenance, Relapse
Identify support needed, set realistic goals e.g.
Short term: reduce consumption
Medium term: undergo detoxification
Long term: attend college

25

How is detoxification managed?

Planned = following period of preparation
Unplanned = e.g. after emergency hospital admission
Long-acting benzos: prevent withdrawal symptoms incl seizures + DT
Gradually withdrawn and stopped
Thiamine: parenteral prophylaxis

26

What methods are used to support relapse prevention?

Psychological: CBT + group therapy
Medical:
Acamprosate, anti craving drug thought to act in midbrain
Disulfiram, mimics flush reaction to alcohol making consumption highly unpleasant

27

How does heroin give pleasure?

A mu opiate agonist it stimulates brain and spinal cord receptors usually acted on by endogenous endorphins

28

How is heroin taken?

Initially often smoked
IV injection: antecubital fossa -> feet, backs of hands, groin
Veins become damaged
Subcutaneous 'skin popping' or IM

29

What are local complications of IVDU?

Abscess
Cellulitis
DVT: femoral injection damages valves slowing venous return
Emboli: can cause gangrene and consequently amputation

30

What are systemic complications of IVDU?

Septicaemia: direct injection of bacteria or from abscess/cellulitis
Infective endocarditis: tricuspid valve
Blood borne infections: hepB, hepC, HIV
Increased risk of OD less dose titration than in smoking