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61 Cards in this Set
- Front
- Back
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Who are the heaviest drinkers? |
young males |
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Male to female ratios are? |
2:1 alcoholic disorders 4:! substance misuse disorders |
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What are the main theories of dependenace? |
Classical pavlovian conditioning operant (skinnerian) conditioning Social learning therapy (vicarious learning) |
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Drugs of abuse affect what pathway? |
the dopaminergic reward systems ventral tegmental area to prefrontal cortex(motivation and planning) and limbic system cocaine and amphetamine block dopamine reuptake |
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What is ethanol metabolised to? |
acetaldehyde then to aldehyde dehydrogenase |
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what is 1 unit in beer, wine, spirits, sheery/port |
half a pint of beer (3.5-4%) small glass of wine 125ml 25ml spirits standard measure of sherry/port (50mls) |
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How to calculate units? |
units = (volume mls x % alcohol)/1000 |
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Safe units a week for women and men? |
14 21 |
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What counts as binge drinking? |
>6 units a day women >8 units a day men |
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What is the onset of delirium tremens? |
48 hours |
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Symptoms of delirium tremens
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Conduction, hallucinations (esp visualanimal/people), affectiveve changes, gross tremor (hands), autonomicdisturbance (sweating, tachy, hypertension,dilated pupils, fecer), delusions |
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Rx DT? |
Reducing benzodiazepine regime andparaenteral thiamine. Manage fatal dehydration and electryolyte abnormalities |
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Liver complications |
Alcoholic Hepatitis – malaise,herpatomegaly and ascites Liver cirrhosis |
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GI complications? |
Pancreatitis Oesophageal varices Gastritis Peptic ulcers |
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Neuro complications? |
peripheral neuropathy, seizures, dementia |
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Cancer complications? |
bowel breast oesophageal and liver
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Cardiovascular complications? |
HTN and cardiomegaly |
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What psychological complications canpresent? |
Depression , anxiety, self harm, suicide,amnesia, cognitive impairment, alcoholic hallucinosis,morbid jealousy
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What can cognitive impairment result from? |
Korsakoff;s or alcohol dementia |
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What is wenicker’sand how does it present? |
Acute thiamine B1 deficiency. Confusion + ataxia + opthaloplegia |
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Rx Wernicke’s? |
Parenteral thiamine if untreated becomes Korsakoff’s |
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What is korsaoff’s |
Irreversible anterograde amnesia. Can register,cant recall. Will confabulate |
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Why do an FBC in investigatins? |
Alchol = macrocytic anaemia due to b12 defciency |
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Why so LFTs? |
yGT increases with recent boozeraised transaminases = hepatocellular damage |
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What does the stages of change model consist of? |
pre-contempltion contemplation preperation Action Mainenance Relapse |
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Detoxification treatment? |
Long-acting benzos (chloradiazepoxide) - reduce gradually and prevent withdrawal symptoms thiamine (B1) is presribed as prophylaxis against Wernicke's (IM or IV, porrly absorbed in the gut) |
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Name 2 medical interventions to prevent relapse? |
Acamprosate - anti-craving drug Disulfiram (Antabuse) - mimics flush reaction |
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When can a urine drug screen detect the following drugs? Amphetamine, Herorin, Cocaine, Methadone, Cnnabis |
Amphetamine - 2 days Heroin - 2 days Cocaine - 5-7 days Methadone - 7 days Cannabis - month |
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Where does heroin act? |
mu agonist , stimulating brain and spinal cord receptors normally acted upon by endogenous endorphins (bodys natural painkillers) |
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Local complications of IVDU? |
Abscess Cellulitis DVT - damage valves Emboli |
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Systemic complications of IVDU? |
Septicaemia infective endocarditis Blood-borne infections Increased risk of overdose |
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What is a classic sign of opiate addiction? |
Pin point pupils |
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What is the antidote for opiate over |
Naloxone |
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When does withdrawal from heroin begin and peak? |
6 hours 36-48 hours |
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Effects of withdrawal? |
dysphoria, nausea, insomnia and agitation feverish |
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Symptoms of neonatal abstinence syndrome? |
start within hours...last several weeks high-pitched cry restlessness tremor hypertonia, convulsions loose stools, vomiting sweats, fever tachypnoea |
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Methadone MoA? |
fulll agonist at opiate receptors with a longer half life than heroin ( so withdrawal is longer but milder) |
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Buprenorphine MoA? |
partial agonist at the mu receptor, blocking the euphoric effects of feroin whilst preventing withdrawal symptoms |
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name an opiate antagonist that blocks the opiate receptors and thus the euphoric effects of opiates - can be used as a relaps preventing agent |
naltrexone |
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Effects of cannabis? |
relaxation, euphoria, paranoia, anxiety, pani nausea and vomiting cooardination is affected injected conjunctivae, tachycardia, fry mouth restlessness, irrativility |
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SEs of stimulants? |
cardiac arrhythmias hypertension stroke |
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benzo overdose can be treated with what? |
Flumazenil |
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Examples of opiates? |
Heroin Dihydrocodeine morphine Pethidine Codeine |
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Effects of opiates? |
Euphoria Sedation Analgesia Pinpoint pupils Respiratory Depression Bradycardia Death |
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Opiate withdrawal? |
runs..diarrhoea, vomiting, lacrimation, rinorrhoea Dysphoria Nausea Cramps, Aches Fever, sweats insomnia + agitation yawning pilo-erection dilated pupils |
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Opiate intoxication? |
relaxation, Euphoria Paranoia Anxiety Hunger Perceptual changes |
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Examples of stimulants? |
Cocaine, crack, amphetamine, |
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Effects of stimulatns? |
Energy Euphoria Diminished need for sleep ANorexia |
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Withdrawal for stimulants? |
Crash Depression Lethargy |
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Examples of hallucinogents? |
LSD Magic mushrooms Ketamine |
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Effects of hallucinogents? |
Visual distortions Hallucinations Synaesthesia |
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Ectasy effects and withdrawal? |
stimulant effects with empathic feelings lethargy |
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Examples of sedatives? |
benzodiazepines Barbiturates |
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Effects of Sedatives? |
Sedation Slurred speech, ataxia Stupor, coma |
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SEs sedatives? |
SImilar to alcohol withdrawal including fits |
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Solvents effects? |
Disinibition Euphoria Hallucinations Dizziness, vomiting Coma |
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In a history of substance misuse what four major areas should you cover? |
current use - TRAP (type, route, ammount, pattern) current use - dependencey and effect on life past use furture use |
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What questions shoudl you ask about current use- dependency and effect on life? |
Tolerance Withdrawal strong desire/compulsion to use Difficulties controlling use narrowing of repertoire - stertyped pattern of use Effect on life - positive Salience continues use despite harm |
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Things to ask about with past use? |
first try it has your use changed since then have you tried to stop or get help what else have you tried how old were you |
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Future use? |
Do you think its a problem any worries if you keep drinking? |
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What are the CAGE screening questions? |
Have you felt that you should cut down on your drinking? Have people annoyed you by criticising your drinking? Have you felt guilty about your drinking? Have you ever had an eye opener, early morning drink? |
