Substances

Question 1

Age related changes that can affect alcohol

Answer 1

-less body water (where alcohol goes)and less lean body mass - so higher concentrations

Liver metabolism of alcohol does not seem to be altered

Question 2

Key features of harm reduction as per alcohol guidelines

Answer 2

-humanism
-pragmatism
-individualism
-autonomy
-incrementalism

Question 3

Harm reduction approaches to alcohol use in elder

Answer 3

-sipped not gulped
-diluted with non alcohol
-alternated with caffeine free and non alcohol drinks
-drink in full stomach
-don’t drink kn risky situations or performing risky activities
-lower total intake
-drink less if Comorbidities
-for chronic heavy drinkers, thiamine 50 mg daily

Question 4

Assessment for AUd should include what

Answer 4

-standardized assessment
-assessment of meds and other substances
-eval of physical, mental and cognitive capacity
-nutrition
-chronic pain
-social conditions
-overall functioning
-collateral

Question 5

As per alch guidelines, who should receive inpatient care

Answer 5

-poor general health
-acutely suicidal
-have dementia
-medically unstable
-need constant one on one monitoring

Question 6

Wernickes korsakoff syndrome

Answer 6

Ophthalmologist, ataxia, confusion

Question 7

THC binds to what, what effect on body

Answer 7

CB1 in brain producing a high and sense of euphoria
Vasoconstriction of vessels, may increase risk of CVevents
Chronic bronchitis and respiratory symptoms
Osteoporosis
Cognitive and motor functions

Question 8

THC use linked to long term negative psychiatric effects

Answer 8

DePression
Anxiety
Worsening ptsd
Panic attacks
Suicidal ideation/attempts/completion rates

Question 9

Cannabis indicated for what

Answer 9

-chronic neuropathic pain*
-n/v due to chemo*
-seizures
-spasticity in MS*
-stimulate appetite in cancer and hiv patients

*substantive evidence for

Question 10

Side effects of cannabis

Answer 10

-dizziness, drowsiness,
-driving impairment
Headaches
Short term mem impairment
Increased anxiety, paranoia, euphoria, depression
Beonchospams
Palpitations, arrhymthmiass, postural hypotension
Dry mouth, nausea vomitting

Question 11

Harm reduction approach for cannabis

Answer 11

Avoid THC over 10 %
Low starting dose and gradually increased over time
Educate patients on different modes of use
Avoid illegal synthetic

Question 12

Long term effects of cannabis use

Answer 12

-cognitive impairment
Reso problems
Precancerous epithelial changes
Exacerbation if mental health conditions (especially when THC high)

Question 13

Cannabis withdrawal symptoms

Answer 13

-fluctuation behaviour and mood
Weakness,sweating, restlessness, dysphoria, sleeping problems, decreased appetite
Nervousness, aggregation, irritability

Question 14

Most efficacious treatment to date for cannabis

Answer 14

MET/CBT/CM

Question 15

Interventions to help decrease benzo use

Answer 15

Medication reviews
Prescribing feedback
Case conferences
Pharmacist chart audits
Educational sessions

Question 16

Reasons why dsm criteria for addictions don’t apply in elderly

Answer 16

Memory impairment (not able to report)
Changes in activities and role obligations
Attributing manifestations to other known health issues

Question 17

RFs for benzo withdrawal

Answer 17

Greater daily doses
Short acting agent use
Chronic sustained use

Lower edu
Depression/anxiety
Certain personality traits

Question 18

RF for opioid use disorders

Answer 18

Male
Exposure to illicit opioid earlier in life
Social isolation/loneliness
Psychiatric disorders prior to OUD
Having pain

Question 19

Things that help in the long term management of chronic non cancer pain

Answer 19

Patient education
Self management strategies
Movement based interventions
Mind body therapies
Alternative therapies
Psychosocial support

Question 20

Harm reduction for opioid use disorders

Answer 20

-lowest effective dose
-Least potent immediate release
-Duration less than 3 days and rarely more than 7
-if no SUD or past psych hx
-discontinue if function does not improve
-store them safely
-return unused meds to pharm

Question 21

Strategies that reduce the risk of opioid overdose

Answer 21

Lowest effective dose/tapering should be considered
Taper at 5% every 2-8 weeks
Dispense Naloxone kits
Educate patients on adverse events
Give info on supervised consumption sites

Question 22

Indications for stopping opioid agonist treatment

Answer 22

Patient preference
Adverse events
Safety around work or sport
Dangerous use of other drugs or meds
Lack of benefit

Question 23

As per guidelines, what are some signs that someone with pain has an OUD

Answer 23

Higher doses than usual
Run out early
Underlying risk factors (anxiety, depression)
Poor or deteriorating function and mood
Significant withdrawal
Resistance to tapering
Family members express concern

Question 24

Conditions that increase risk of opioid overdose

Answer 24

Benzo use
Renal failure
Sleep apnea

Question 25

Which psychosocial intervention has Most evidence for OUD

Answer 25

Contingency management

Question 26

3 strategies you could use to deprescdibe benzos in someone who is addicted

Answer 26

-slow taper
-simplify regimen if possible to a single pill if multiple benzos on there
-(scheduled visits? Ways to minimize withdrawal? Referal to addictions service)