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Flashcards in Substance Misuse Deck (41)
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1
Q

what has WHO changed the word addiction to in the ICD-10?

A

Dependence

2
Q

What is the icd-10 criteria for dependence/addiction?

A
  • craving
  • tolerance
  • compulsive drug-seeking behaviour (pre-occupation)
  • physiological withdrawal state
  • loss of control of substance taking behaviour
  • continued use despite harmful effects
3
Q

What are some acute physical complications of dependent drug use?

A

Complications of injecting: DVT, Abscess/infection, Subacute bacterial endocarditis

Overdose (respiratory depression)

Poor pregnancy outcomes

Uses of opiates: constipation, low salivary flow, pinpoint pupils…

4
Q

What are some chronic physical complications of dependent drug use?

A

BBV transmission (HepC - 50%)

5
Q

Give some SEs of heroin

A

Constipation, low salivary flow, RESPIRATORY DEPRESSION

6
Q

Give some SEs of cocaine

A

local anaesthesia, vasoconstriction

7
Q

Give some social effects of dependent drug use?

A

Poverty, effects on families/relationships, crime, imprisonment, social exclusion, economic costs (E.g. NHS)

8
Q

What are some psychological effects of dependent drug use?

A
  • Fear of withdrawal
  • Craving
  • Guilt

(All temporarily alleviated by drug use)

9
Q

What are the routes of administration of heroin?

A

Oral, smoking/chasing the dragon, snorting, IV, sc, IM, rectal

10
Q

What are the effects of heroin?

A

Euphoria, itnense relaxation, miosis (constriction), drowsiness

11
Q

Give some signs/sx’s of heroin/opioid withdrawal?

A

Sx’s: anorexia, N+V, abdominal pain, hot/cold flushes, insomnia/disturbed sleep, cramps, intense craving, bone/joint/muscle pain

Signs: restless, yawning, perspiration (sweating), piloerection, dilated pupils, vomiting, diarrhoea, muscle twitching…

12
Q

What are the routes of admin of cocaine/crack

A

Oral, snorting, smoking, iv

13
Q

What is the mode of action of cocoaine/crack?

A

Blocks reuptake of mood enhancing neurotransmitters at the synapse (serotonin, dopamine)

14
Q

What are the effects of cocaine/crack?

A
  • Intense pleasurable sensation
    • Reinforcement leading to further use
    • Depletion at secretory neurone
    • Anxiety, panic, adrenaline secretion, ‘wired’

confidence, well-being, euphoria, impulsivity, increased energy, alertness

impaired judgment, decreased need for sleep

15
Q

What are some acute negative effects of cocaine/crack use?

A
  • decreased sleep
  • anxiety
  • HTN
  • Arrhythmia
  • subsequent crash / dysphoria
16
Q

What are some chronic effects of cocaine/crack use?

A

depression, panic, paranoia, psychosis, damaged nasal septum, CVA, respiratory problems

17
Q

What are the 7 features that define the a dependence syndrome?

A
  • Primacy of drug seeking behaviour (drug/need to obtain = most important thing; takes priority)
  • Narrowing of the drug-taking repertoire (e.g. seen in alcoholism - type of alcohol)
  • Increased tolerance to the effects of the drug (tolerance = more of the drug needs to be taken for the same effect)
  • Loss of control of consumption
  • Signs of withdrawal on attempted abstinence
  • Drug taking to avoid development of withdrawal sx’s
  • Continued drug use despite negative consequences
  • Rapid reinstatement of previous pattern of drug use after abstinence
18
Q

Define tolerance

A

More of the drug is needed to be taken to achieve the same effect

19
Q

What is the trade name for buprenorphine?

A

Subutex

20
Q

in the treatment of heroin, what is detoxification therapy? What about maintenance therapy?

A

detoxification therapy: coming off opioids all together (complete absteninence)

Maintenance therapy = aim to convert from street drug to prescribed drug. It is a medium-term thing (long-term plan of stopping altogether). more successful than detoxification

21
Q

What is the MAINTENANCE therapy for heroin dependence? (1st + 2nd line)

A

1st line: methadone (full opioid receptor agonist)

2nd line: buprenorphine (partial agonist/antagonist)

22
Q

What is the drugs of choice 1st + 2nd line for heroin DETOXIFICATION?

A

1st line: buprenorphine

2nd line: lofexidine

23
Q

What drug can be used to prevent heroin relapse?

A

Naltrexone

24
Q

Other than drugs what other thing are important in the treatment of heroin addiction?

A

HARM REDUCTION

  • Psychological interventions
  • Investigate for HIV, HepABC, Liver function, FBC
  • ECG (look for prolonged QT syndrome - as methadone prolongs it –> risk of sudden death syndrome)
  • Advise on sexual health…
  • referral for allied problems: sexual health and HIV
25
Q

Why shouldn’t metaclopromide be prescribed long-term (>5d)?

A
  • Extra-pyramidal SEs
  • Tardive dyskinesia: repetitive involuntary movements (stick out tongue, smacking of lips, grimacing)

(like antipsychotics)

26
Q

Give to neuroleptic complications of metaclopromide?

A
  • Extra-pyramidal SEs

- Tardive dyskinesia

27
Q

How does methadone affect the ECG?

A

Prolongs the QTc interval which can lead to sudden death –> therefore important to do ECG at initial assessment to

28
Q

Treatment of acute heroin withdrwal?

A

Symptomatic:

  • Nausea: metachlopromide (max 5 days), prochlorperazine
  • Diarrhoea: loperamide
  • stomach cramps: hyoscine butylbromide
  • general aches + pains: paracetamol, ibuprofen…
  • anxiety, agitation, sleeplessness: propranolol

Also: diazepam (sedation)

29
Q

What can a newly presenting drug user be offered? (NICE)

A

Health check
Screening for blood borne viruses and referral for positive result (Hep C, HIV treatable)
Contraception, smear
Sexual health advice
Check general immunisation status and Hep A/B
Signpost to additional help (counselling, benefits, housing)
Information on local drugs services including needle exchange

30
Q

What is the problem with treating stimulant addiction compared to heroin?

A

Unlike heroin, there are no substitutes

31
Q

Who might benefit from detoxification of heroin (over maintenance)?

A

Young user, less time addicted, often not injecting, lower level drug use

(however, maintenance is better)

32
Q

Who benefits from maintenance therapy (over detoxification)

A

Longer time addicted, usually injecting, high level of drug use

33
Q

How is maintenance therapy for heroin addiction carried out?

A

Titration from a low starting dose to a maintenance dose (i.e. pt fully comfortable for 24hrs + doesn’t need to use heroin)

34
Q

What is harm reduction?

A

Practices/policies that aim to reduce the harms assoc. w/ psychoactive substance use in people unable or unwilling to stop

35
Q

Give some examples of harm reduction guidelines for heroin

A

Action to prevent deaths (2nd highest cause of death in young males)

- not injecting or injecting more safely
  - not mixing respiratory depressants
- not using drugs alone
- reducing amount taken after intervals where tolerance is lost
- call an ambulance if necessary   

Action to prevent blood borne virus transmission

- not sharing needles etc (including needle exchange programmes)

- safer sex (condoms)
- Hep A/B vaccine
- Blood borne virus screening including Hepatitis C

Referral where appropriate

- specialist drug services
- voluntary sector services
- infectious diseases services
36
Q

What is the principles of treatment of crack cocaine addiction?

A
  1. Harm reduction: sex-c shit
    - advice on risky behaviour
    • safe sex advice
    • blood borne virus advice
    • Hep B/C testing & vaccination
    • contraceptive advice
  2. Brief intervention:
    - explanation of effects
    • explanation of risks
      • advice on controlled use
    • setting limits
    • cognitive based approaches
  3. Team working:
    - referral to sexual health/infectious diseases etc
    - referral to voluntary agency if appropriate
    - referral for specialist advice if necessary
37
Q

What drug can be used for relapse prevention in heroin users? What must be monitored?

A

Naltrexone

LFTs, urinalysis, supervised administration, warnings regarding concomitant heroin use

38
Q

give 4 problems associated with heroin user in hospital

A

May be very ill (NB: DVT, SBE, TB)

May be craving drugs especially opiates

May fear a negative response from staff

May already be prescribed maintenance medication – needs to be continued

May be untreated and will need to start treatment if they are to stay in hospital

Must have liaison between community and hospital prescriber on admission and discharge if doubt about dose or change of dose

39
Q

How would you manage an elective admission of an opioid dependent pt on maintenance treatment?

A

Continue maintenance medication whilst in hospital
Confirm maintenance dose on admission
If no evidence of dose, contact prescriber (GP or PCASS 0114-226-1844 or Wicker Pharmacy 0114-276-7676)
Inform prescriber or pharmacist that the patient has been admitted
If possible, check when last dose was taken
Inform anaesthetist of maintenance drug especially if buprenorphine
Do not add benzodiazepines but continue if confirmed long-term prescription
On discharge, inform prescriber in advance so regular prescription can be started

INFORM PRESCRIBER OF ANY DOSE CHANGES WHILST IN HOSPITAL

40
Q

How would you manage an elective admission of an opioid dependent pt NOT on maintenance treatment?

A
  • Take a full drug history
  • Confirm by urine testing
  • Opiate users: titrate onto methadone if signs of withdrawal develop
  • Benzodiazepines: observe and take expert advice if withdrawal symptoms develop
  • Other drug users: prescribing not normally necessary but remember HARM REDUCTION
  • Prior to discharge, make arrangements for follow-up prescribing by another agency so prescription does not lapse- PCASS 0114-305-4401, Wicker pharmacy 0114-276-7676) and prescribe one or two days’ TTOs if safe and necessary (warn re: dangers to non-tolerant individuals and children)
  • Take expert advice if in doubt
41
Q

How should you use analgesia in drug users?

A
  • Patients on methadone and other opioids still need analgesia as well as their maintenance medication
  • Treat the addiction with substitution treatment, treat pain separately
  • Follow the usual analgesic ladder- start with paracetamol/NSAIDs
  • If opiates indicated, give in at least the usual dose and frequency – may need more due to tolerance, keep maintenance medication constant

NB!! Patients on buprenorphine may need alternative analgesia, if problematic switch to methadone and use opiates