Public health week 5 Flashcards

1
Q

Give 4 key features of drug addiction

A
craving
tolerance 
compulsive drug-seeking behaviour
physiological withdrawal state
little interest in other activities
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2
Q

What philosophy is used to guide management of drug users?

Give some core principles of it.

A

Harm reduction philosophy:

  • Accepts that drug use is part of our world
  • work to minimize its harmful effects
  • understands that some ways of using drugs are clearly safer than others
  • non-judgmental, non-coercive provision of services to drug users o assist them in reducing harm.
  • Ensures that drug users have a voice in the creation of programs and policies designed to serve them.
  • Affirms drugs users themselves as the primary agents of reducing the harms of their drug use, and seeks to empower users to support each other.
  • Recognizes that the realities of social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm.
  • Does not attempt to minimize or ignore the real and tragic harm and danger associated with drug use.
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3
Q

Physical effects of drug use

A
Complications of injecting (DVT, abscesses, SBE, blood-borne viruses)
Overdose (respiratory depression)
Poor pregnancy outcomes
Side effects of opiates (constipation)
Malnutrition
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4
Q

Social effects of drug use

A

Effects of poverty
Effects on families
Drive to criminality, Imprisonment
Social exclusion

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5
Q

Negative psychological effects of drug use

A

Fear of withdrawal
Craving
Guilt
Depression and anxiety

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6
Q

Heroin:

a) Administration
b) ‘Positive’ effects
c) Adverse effects

A

a) Routes of administration: (powder), smoking/chasing, snorting, oral , IV, subcutaneous, IM, rectal
b) Effects: euphoria, intense relaxation, miosis, drowsiness
c) Adverse effects: dependence and withdrawal symptoms, physical complications (nausea, itching, sweating, constipation), overdose, IVDU risks

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7
Q

Cocaine/crack

a) Admin
b) Mode of action
c) ‘Positive’ effects
d) Adverse effects

A

a) Routes of administration (coca leaves, powder, crack)
oral, snorting, smoking, iv

b) Mode of action:
- Blocks reuptake of mood enhancing neurotransmitters at the synapse (serotonin, dopamine)
- Intense pleasurable sensation
- Reinforcement leading to further use
- Depletion at secretory neurone
- Anxiety, panic, adrenaline secretion, ‘wired’

c) Effects:
- confidence, well-being, euphoria, impulsivity, increased energy, alertness
- impaired judgement, decreased need for sleep
may produce anxiety, HTN, arrhythmias, subsequent “crash”-dysphoria

chronic effects-depression, panic, paranoia, psychosis, damaged nasal septum, CVA, respiratory problems

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8
Q

Give 4 aims of treatment for drug users

A

To reduce harm to user, family and society
To improve health
To stabilise lifestyle and reduce the amount of illicit drug use
To reduce crime

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9
Q

Treatment approaches for drug users

A

Harm reduction (especially for non-opiate users)
Detoxification (lofexidine, buprenorphine)
Maintenance: methadone (full agonist), buprenorphine (partial agonist/antagonist)
Relapse prevention (naltrexone)
Psychological interventions
Alternative therapies
Referral for allied problems (Hep C, STDs etc)

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10
Q

a) Give 4 advantages of opiate maintenance treatment vs heroin use
b) Give 2 commonly used substitutes

A

a) Reduces mortality very significantly

Reduces drug-related morbidity

Reduces crime

Reduces risk taking behaviour and spread of blood borne viruses

b) Methadone and buprenorphine

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11
Q

What should be offered for a newly presenting drug user? (screening, tests, advice, signposting, etc.)

SEX-C SHIT

A

Sexual health screening
EXchange needles
Contraception
Signposting (additional help → counselling, stop-services)
Health check (full)
Immunisations (Hep B, C, A, et.c)
Treatment (detoxification, maintenance, relapse prevention, withdrawal relief, etc.)

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12
Q

Harm reduction: what can be offered to…

a) Prevent deaths
b) Prevent blood borne virus transmission
c) Who can you refer patients to?

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
- safer sex (condoms)
- provision of Hepatitis A and B vaccination
- Blood borne virus screening including Hep C
Referral where appropriate
- specialist drug services
- voluntary sector services
- infectious diseases services

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13
Q

Quick detox:

a) Who is it suitable for?
b) What is first line treatment for opiate replacement?

A

a) Young user, Less time addicted, Often not injecting, Lower level of drug use
b) Buprenorphine

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14
Q

Cocaine use

a) Is there a substitute?
b) What might a ‘brief intervention’ involve?
c) Should also follow rules of harm reduction (prevent deaths and disease, refer where appropriate)

A

a) No

b) explanation of effects, explanation of risks, advice on controlled use, setting limits, cognitive based approaches

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15
Q

What drug is commonly used in opiate relapse prevention?

How does it work?

A

Naltrexone

Antagonist at opioid receptor

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16
Q

Alcohol limits

a) What is hazardous drinking?
b) Weekly unit limits in normal circumstances and pregnancy
c) Calculating units of alcohol
d) Grams and ml of ethanol in 1 unit
e) How many units in a 500ml bottle of 40% whiskey?
f) Define binge drinking (for men and women)

A

a) Drinking levels that increasing risk of harm
b) 14. Pregnancy: first trimester abstinence, then 2U/week
c) ABV x ml/1000
d) 8g, 10ml
e) 40 x 0.5 = 20 units
f) Men = 8 unit session, Women = 6 units

17
Q

Alcohol dependence

- 2 screening tools. Score thresholds for each

A

CAGE (1/4) and AUDIT (8/40 = hazardous; 15/40 = refer for specialist help)

18
Q

Problem drinking: risk factors

A

Drinking within the family
Childhood problem behaviour relating to impulse control
Early use of alcohol nicotine and drugs
Poor coping responses to life events
Depression as a cause of problem drinking

19
Q

Signs of alcohol dependence

ALCOHOL

A

A - Amount of alcohol needed increases
L - Lost memory of night out
C - Continuing to drink even though aware of risk
O - Out of control drinking
H - Harm from continued use (e.g. work/relationships)
O - Overwhelming desire to drink
L - Little interest in other activities

Physiological withdrawal when intake is reduced.

20
Q

Physical effects of alcohol:

a) Liver (4)
b) Other GI (2)
c) Malignancy (7)
d) CV (4)
e) Neuro (4)
f) Miscellaneous

A

a) Fatty liver, cirrhosis, acute hepatitis, liver cancer
b) Peptic ulcers, pancreatitis, malabsorption, vitamin deficiencies (B1)
c) Head and neck, oesophageal, stomach, liver, pancreas, colorectal, breast
d) AF, HTN, CCF, cardiomyopathy
e) Acute intoxication with LOC, withdrawal, seizures, subdural haemorrhage, peripheral neuropathy, Wernicke-Korsakoff syndrome, cerebellar degeneration.
f) Accidents, violence, gout, birth defects (FAS, etc.), loss of libido

21
Q

Psychiatric effects of alcohol

A

Alcohol dependence syndrome
Suicidal ideation
Depression
Anxiety

22
Q

Effects of alcohol in pregnancy

A

Birth defects, FAS, LBW, miscarriage

23
Q

Public health measures to reduce alcohol consumption

  • MPOWER
  • Other measures
A
Monitor use and prevention policies
Protect people from tobacco
Offer help to reduce drinking
Warn about the dangers of drinking
Enforce bans on advertising, promotion and sponsorship
Raise taxes
  • Minimum price on alcohol, screening in primary care (CAGE, AUDIT),
24
Q

Alcohol dependence

CANT STOP

A

Compulsion to drink alcohol with stereotyped drinking pattern
Aware of physical/psychological harm but continues to drink
Neglect of other activities e.g. self-care, social, occupational
Tolerance to alcohol
Stopping drinking leads to withdrawal symptoms
Time pre-occupied with alcohol increases
Out of control use of alcohol
Persistent, futile attempts to cut down

25
Q

Define:

a) Tolerance
b) Dependence
c) Addiction
d) Withdrawal

A

a) Increasing amounts of substance needed to achieve the same effect
b) Physiological withdrawal state when stopping use
c) Keep using the drug and can’t stop
d) A set of symptoms that occur upon cessation of use

26
Q

What is binge drinking? (for men and for women)

A

Men > 8 units on their heaviest weekly drinking day

Women > 6 units

27
Q

Brief intervention for mild dependence:

4 components

A

Advice on the dangers of excessive or binge drinking.
Provision of advice leaflets and details on availability of any local organisations.
Trying to find out what factors make the patient drink and how they could be avoided.
Agreeing with the patient objectives that can be accomplished. This can include controlled drinking - e.g, weaker drinks, spacing drinks, alternating alcoholic with non-alcoholic drinks, eating with drinks

28
Q

Indications for inpatient alcohol detoxification

A

Patients at risk of suicide.
Those without social support.
Patients who have a history of severe withdrawal reactions.

29
Q

Alcohol detox: 4 measures

A

Daily supervision to detect complications early - eg, DTs, continuous vomiting, deterioration in mental state.
Multivitamin preparations to prevent Wernicke’s encephalopathy.
Benzodiazepines to prevent withdrawal symptoms (usually chlordiazepoxide).
Continuing support - primary healthcare team, community alcohol team, residential rehabilitation programmes, voluntary organisations, referral to the specialist mental health team, disulfira

30
Q

Treatments for relapse prevention in alcohol dependence:

a) main one - MoA?
b) Alternative (also used in opiate relapse prevention)

A

a) Acamprosate - blocks gamma-aminobutyric acid (GABA) and reduces N-methyl-D-aspartate (NMDA) receptor glutamate-related excitation. Reduces cravings.
b) Naltrexone - opioid antagonist (reduces pleasurable effects of alcohol)

31
Q

Alcohol withdrawal:

a) Common initial symptoms
b) Later more severe symptoms (3 stages)

A

a) Insomnia and fatigue. Tremor. Mild anxiety/feeling nervous. Mild restlessness/agitation. Nausea and vomiting. Headache. Excessive sweating. Palpitations. Anorexia. Depression. Craving for alcohol
b) Alcoholic hallucinosis, seizures, DTs