WK 7-ALCOHOL, TOBACCO AND CANNABIS Flashcards
(40 cards)
What are the drinking guidelines
- MEN and WOMEN no more than TWO standard drinks daily to decrease LIFETIME RISK of DEATH from DISEASE or INJURY due to alcohol (chronic harms)
- MEN and WOMEN no more than FOUR on any ONE OCCASION to decrease risk of INJURY or HARM from that occasion (acute harms)
- Under 18 NO ALCOHOL because of increased risk of dependence associated with age on onset
- NO ALCOHOL during pregnancy or breastfeeding
Why is smoking and consuming alcohol at the same time more detrimental for health (why is there an increase in head/neck cancer)
Alcohol can cross membranes (without breaking the membrane)→ can take molecules with it (like tobacco) → move tobacco molecules into the fat of the head/neck
What are some of the psychological effects of alcohol
- Insomnia
- Fatigue
- Anxiety/depression
- Suicidal ideation
- Exacerbation of mental health issues
What is the difference between intoxication and overdose?
Intoxication= immediate, short term effects
Overdose (poisoning)= long term effects including withdrawal and tolerance
What is foetal alcohol syndrome- what are some of the characteristics
When the foetal brain is exposed to alcohol during development it can cause structural malformations (disrupts connections between hemispheres)
Features; flat midface, short nose, thin upper lip, short palpebral fissures, indistinct philtrum, epicanthal folds, low nasal bridge, minor ear anomalies
What are 2 types of screening mechanisms used to screen for alcohol dependence
C.A.G.E and AUDIT (Audit C is the shorter version)
What are the 4 questions asked in a C.A.G.E screening
- Have you ever felt you should cut down on your drinking?
- Have people annoyed you by criticising your drinking?
- Have you ever felt bad or guilty about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?
What are the 3 questions asked in AUDIT-C- what score is a ‘positive’ result in women/men
1: How often did you have a drink containing alcohol in the past year?
Q2: How many drinks did you have on a typical day when you were drinking in the past year?
Q3:How often did you have six or more drinks on one occasion in the past year?
Men= 4+
Women= 3+
What are the national guidelines for treatment of alcohol problems
- Level A recommendations: ASK
- Screening with AUDIT for the general population should be widely implemented in GP and ED
- Screening with indirect biological markers (LFT-liver function test) should only be used as an adjunct to AUDIT – less sensitive and specific
Where should ‘brief interventions’ for alcohol use be used? What kind of people should they not be used on?
Brief interventions are useful in GP/ED settings and are effective in reducing alcohol use in people with risky drinking patterns but are not dependent–> they should not be used for people who are alcohol dependent
What acronym is used for ‘brief interventions’ of alcohol use
FLAGS F= feedback L= listening A= advice G= goals S= strategies
What are 3 examples of psychosocial interventions used in alcohol use
Motivational interviewing (first line or stand alone treatment), Behavioural self management (if low or no dependence) and Coping skills
What are the 3 drugs used to treat dependent drinkers
- Acamprosate
- Naltrexone
- Disulfiram
What is the MOA of acamprosate in the treatment of alcoholism- what is the precaution
Acamprosate blocks glutamate receptors and activates GABA receptors–> provides fewer side effects of alcohol
-need to have normal renal function
What is the MOA of naltrexone in the treatment of alcoholism- what is the precaution
Blocks opioid receptors-> taken once daily
-need normal liver function
What is the MOA of disulfiram in the treatment of alcoholism
Aversive agent-> blocks alcohol dehydrogenase increasing the ‘unwell’ feeling you get when drinking alcohol-> closely supervise
What is the major concern that can occur with alcoholism (disorder)
Wernickes Encephalopathy/Korsakoffs Psychosis
What is Wernickes Encephalopathy/Korsakoffs Psychosis- how does it occur, what are the symptoms, how can it progress?
Alcoholism can lead to thiamine deficiency which then leads to developement of WE/KP-> WE is the physiological component and causes nystygmus, ataxia and opthalmalgia-> KP is the psychological symptom and causes confabulation/memory loss
-> It is preventable but can be irrevesible and leave people in a constant state of confusion
How do you treat WE/KP
If there is nystgymus/thought that the patient may have WE/KP administer large doses of thiamine
What is the role of thiamine
Thiamine is required for myelin/fatty acids/steroids and glycolysis to work (the enzymes in this pathway require thiamine)-> without thiamine the brain will not function
What are the complications of alcohol withdrawal
seizures, vomiting, confusion, delirium tremors, extreme agitation, tachycardia, paranoia, hypertension, high temp-> can be fatal
What medication is given to alcoholics going through withdrawal-> why must administration be monitored
Benzodiazepines-> need to monitor patient and only give small doses and benzodiazepines are also highly addictive-> don’t want to replace one addiction with another
What is the CIWA- Alcohol-> what is it used for
Clinical Institute Withdrawal Assessment -> used to assess the physical and psychological symptoms of withdrawal and determine whether the patient may be in danger (ie. escalation of symptoms)
What patients should be asked about their smoking status and interest in quitting
Any patient over the age of 10 years old
