Block 33 Week 7

Question 1

what is binge drinking?

Answer 1

• Heavy dinking in a single session
• Twice the daily limit
• Above 4-6 units for women
• Above 6-8 units for men

Question 2

what is harmful use of alcohol?

Answer 2

• pattern of psychoactive substance use that damages health
• harmful patterns of use often criticized by others
  Harmful use should not be diagnosed if dependence syndrome, a psychotic disorder or another specific form of drug- or alcohol-related disorder is present.

Question 3

what is dependence syndrome?

Answer 3

• A cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviours that once had greater value.

Question 4

central characteristic of dependence syndrome?

Answer 4

desire (often strong, sometimes overpowering) to take alcohol.

Question 5

diagnostic guidelines for dependence syndrome?

Answer 5

• 3 of more of the following have been present together at some time during the past year:
• (a) a strong desire or sense of compulsion to take the substance;
• (b) difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use;
• (c) a physiological withdrawal state when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same substance with the intention of relieving or avoiding withdrawal symptoms;
• (d) evidence of tolerance, such that increased doses of the psychoactive substances are required in order to achieve effects originally produced by lower doses
• (e) progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects
• (f) persisting with substance use despite clear evidence of overtly harmful consequence.
• (g) Narrowing of the personal repertoire of patterns of drinking e.g. a tendency to drink alcoholic drinks in the same way regardless of social constraints that determine appropriate drinking behaviour.

Question 6

tolerance?

Answer 6

• either a need for markedly increased amounts of a substance to achieve intoxication or desired effect.
• Or marked diminished affect with continued use of same amount of a substance.

Question 7

withdrawal?

Answer 7

• Characteristic withdrawal syndrome for substance used or closely related or same substance taken to relieve or avoid withdrawal symptoms.
• A great deal of time is spent in activities necessary to obtain or use the substance or to recover from its effects.

Question 8

7 fold inc in risk of alcoholism in?

Answer 8

first degree relatives of alcoholics

Question 9

P300?

Answer 9

• abnormalities in P300 event-related potential associated with familial alcoholism > P300 predicts alcohol abuse

Question 10

FH in alcoholism?

Answer 10

• family history
• sons of alcoholics 4x more likely to be an alcoholic than sons of non-alcoholics regardless of drinking patterns of adoptive parents

Question 11

receptor involved in alcoholism?

Answer 11

D2 dopamine receptor

Question 12

variations in ? composition leads to?

Answer 12

• variations in allele compositions for alcohol dehydrogenase and aldehyde dehydrogenase may contribute to risk patterns of alcoholism among oriental populations

Question 13

reinforcement of alcohols effects via?

Answer 13

• Alcohol’s reinforcing effects are modulated by dopamine, serotonin, and GABA systems

Question 14

in alc dependence

dopamine

Answer 14

• alcohol stimulates DA release in nucleus accumbens
• increased DA may underlie ‘craving’

Question 15

5HT?

Answer 15

*alcohol potentiates effects of serotonin at 5-HT3 receptors
*some reports of 5-HT agonists in reducing alcohol craving

Question 16

psychodynamic theories of alcoholism?

Answer 16

• intoxication is a gain to the patient, with disinhibition allowing the expression of aggression
• maternal overprotection is described among some alcohol problems clinic attendees
• childhood sexual abuse is more commonly reported in women alcoholics than in the general population

Question 17

behavioural theory of alcoholism?

Answer 17

• models include drinking becoming a conditioned response to a wide range of circumstances
• modelling from parents, relatives, peers, etc. is clearly demonstrated
• The euphoriant effect - important reinforcer

Question 18

other behaviour factors linked to alcoholism?

Answer 18

• Stress and negative life events – bereavement; separation; impending court case

Question 19

type 1 alcoholic?

Answer 19

more dependent, anxious, rigid, less aggressive, more guilty, with either the mother or father an alcoholic

Question 20

type 2 alcoholic?

Answer 20

early onset, severe problems, socially detached, distractible, confident, and whose behaviour is linked to a similar pattern in the biological father - can be seen as alcoholism secondary to antisocial personality disorder

Question 21

epidemiology of alcohol disorders?

Answer 21

• rise in females; rise in adolescents
• 35 % of homeless have alcohol disorders

Question 22

?% of MCP abuse alcohol

Answer 22

4-6%

Question 23

age of onset for alcoholism?

Answer 23

• age of onset in late teens or 20s for males
• onset later in females, who are more likely to:
• drink alone
• delay seeking help
• have co-morbid depression
• have a stronger genetic predisposition
• develop physical complications, especially cirrhosis

Question 24

higher rates of alcoholism in:

Answer 24

• urban areas
• divorced/ separated
• those who manufacture, or sell alcohol
• commercial travellers, frequent overseas travellers
• entertainers, doctors, journalists
• North American, Afro-Caribbean, Irish

Question 25

lower rates of alcoholism in:

Answer 25

* ‘middle’ social groups * Jewish, Chinese

Question 26

hepatic alcohol related consequences?

Answer 26

* may be due to toxic effects of acetaldehyde / damage to immune system by alcohol * women are more susceptible than men

Question 27

fatty liver?

Answer 27

*may be present in 90 % of drinkers *reversible with abstinence

Question 28

alcoholic hep?

Answer 28

*abstinence aids resolution, but cirrhosis may follow

Question 29

cirrhosis?

Answer 29

*10 % of chronic alcoholics *vulnerability may be due to HLA-B8 antigen, found in 25 % of population

Question 30

HLA that has a protective effect on cirrhosis?

Answer 30

HLA-A28

Question 31

hepatic carcinoma?

Answer 31

*15 % of patients with cirrhosis go on to develop hepato-cellular carcinoma

Question 32

GI alcohol related consequences?

Answer 32

* Baretts Oesophagus * MW tears * oesophageal varices * Peptic ulceration – 20 % of alcoholics; bleeding may be exacerbated by Vitamin K deficiency secondary to cirrhosis * Pancreatitis – both acute and chronic * DM

Question 33

Haemtological alcohol related consequences?

Answer 33

* alcoholism is the commonest cause of macrocytosis * Thrombocytopenia and anaemia * Zieve’s syndrome is a rare form of alcoholic haemolysis

Question 34

neurological consequences of alcoholism?

Answer 34

* delirium tremens * Alcoholic Hallucinosis * Trauma, alcohol withdrawal, brain damage

Question 35

alcoholic hallucinosis?

Answer 35

* rare conditions in which auditory hallucinations occur alone in clear consciousness * usually clears in a few days, but may be followed by secondary delusional misinterpretation * up to 50 % go on to develop symptoms of schizophrenia

Question 36

what is the most common complication of neurological complication of alcoholism?

Answer 36

* Epilepsy of late onset (> 25 yrs) is the most common neurological complication

Question 37

peripheraly neuropathy from alcoholism?

Answer 37

most likely from b1 deficiency

Question 38

optic atrophy?

Answer 38

* loss of visual acuity * blindness associated with methanol poisoning, thiamine and B12 deficiency, and heavy tobacco smoking

Question 39

CV comps of alcoholism?

Answer 39

* increase in blood pressure * weakened contraction of myocardium, leading to heart failure * cardiac arrhythmia * cardiomyopathy

Question 40

comps of alcohol use in pregnancy

Answer 40

* stillbirth * neonatal mortality * low birth weight * later issues w distractibiltiy and attention

Question 41

FAS?

Answer 41

* microcephaly, mental retardation, low birth weight, cleft palate, ptosis, scoliosis, abnormal dermatoglyphics, congenital heart disease, congenital renal disease * may occur at alcohol intake of 4-5 units per day

Question 42

social effects of alcohol - inc rates of?

Answer 42

- physical / sexual abuse of partner - divorce - child abuse - later alcoholism in children

Question 43

social effects of alcohol - emp?

Answer 43

- 2 ½ times as many days off work - decreased productivity - increased accidents at work

Question 44

social effects of alc - accidents?

Answer 44

- 80 % of fatal car accidents involve alcohol - 40 % of casualty trauma involves alcohol

Question 45

psychiatric complications of alc?

Answer 45

* almost half of alcoholics meet criteria for another psychiatric disorder * affective disorders - depressive symptoms, contemplation of suicide * alcoholics have 7x the expected suicide rate

Question 46

anxiolytic effects of alcohol?

Answer 46

* Anxiety - the anxiolytic effects of alcohol wear off as tolerance develops

Question 47

schiz and alc?

Answer 47

* Schizophrenia - schizophrenic symptoms can occasionally be triggered by heavy drinking, which remit when the patient is detoxed

Question 48

morbid jealousy?

Answer 48

may be associated with an alcoholic paranoid state

Question 49

Delirium tremens?

Answer 49

- risk develops when intake is 12 units per day

Question 50

Triad of DT?

Answer 50

* clouding of consciousness and confusion, patient is disorientated * vivid hallucinations - usually visual (rats, insects, Lilliputian) or tactile * marked tremor

Question 51

 Marchiafava-Bignami disease presents w?

Answer 51

Ataxia, dysarthria, epilepsy, severe impairment of consciousness due to extensive demyelination of the corpus callosum, the optic tracts, and the cerebellar peduncles

Question 52

Central Pontine Myelinolysis consist of?

Answer 52

* consists of demyelination involving the pyramidal tracts within the pons

Question 53

Central Pontine Myelinolysis presents w rapid onset of?

Answer 53

* pseudobulbar palsy, quadriplegia, loss of pain sensation in the limbs and trunk, vomiting, confusion, and coma are common

Question 54

alc dementia

Answer 54

* mild cognitive deficits frequent, but reversible with abstinence * dementia rarely occurs before 40 years * associated with CT and MRI evidence of ‘atrophy’

Question 55

alcohols impact on actions?

Answer 55

* causes us to act on impulse * sexually acting out * displaying behaviours and saying things they wouldn't normally say * expressions of anger, happiness, violence

Question 56

alc impact on semi volunatry actions?

Answer 56

* dry mouth - stops body salivating * Red eyes; stop blinking and then eyes start to dry out

Question 57

alcohols impact on involuntary systems?

Answer 57

* Alcohol sedates this level so can cause nausea/ vomiting as food fails to be properly digested. * Libido affected & ability to perform the sexual act is lost. * The body can stop involuntary system actions in order to maintain vital functions-too much alcohol

Question 58

Alc and vital systems?

Answer 58

* In event of surge in alcohol the body creates a period of unconsciousness/ coma to protect vital functions. * Inexperienced drinkers pass out. * Acute alcohol poisoning is where the vitals start to shut down and can result in death.

Question 59

assessment of alcohol/ drug misuse?

Answer 59

* longitudinal and cross sectional history * Basic Investigations : Blood test, Urine drug test * Diagnosis: Evidence of dependence * Complications. (Physical, Mental, social) * RISK

Question 60

blood tests for alc?

Answer 60

GGT, MCV, ALT

Question 61

questionnaires for alc?

Answer 61

CAGE and AUDIT-C

Question 62

CAGE?

Answer 62

score >2

Question 63

AUDIT-C?

Answer 63

* AUDIT-C: score of 5+ indicates higher risk drinking * overall total score of 5+ is AUDIT-C positive

Question 64

Physical withdrawal symptoms?

Answer 64

* hand tremors (‘the shakes’) * sweating * nausea * visual hallucinations (seeing things that are not actually real) * seizures (fits) in the most serious cases

Question 65

Psychological alcohol withdrawal symptoms include:

Answer 65

* depression * anxiety * irritability * restlessness * insomnia (difficulty sleeping)

Question 66

Longitudinal and cross-sectional history ?

Answer 66

* Age of onset. * Type of substance/s * Progression of Substance/s use. * Possible precipitating and perpetuating factors. * Current pattern of use   

Question 67

1 unit = ? of pure alc

Answer 67

10ml

Question 68

most sensitive screening tool for alc?

Answer 68

GGT

Question 69

Tx of det

Answer 69

* benzos * fixed dose schedule best - acamprostate can be added

Question 70

acamprostate?

Answer 70

- antagonises glutamate function * Repeated ethanol withdrawal leads to greater levels of glutamate and increased mortality but acamprosate blocks this.   

Question 71

preventing alc related complications?

Answer 71

- thiamine replacement * Must assess for signs of Wernicke’s encephalopathy

Question 72

naltrexone?

Answer 72

* opiod antagonist * not good for abstinence it seems to prevent people who relapse from going back to a full blown dependence

Question 73

relapse preventing therapies?

Answer 73

- naltrexone - acamprostate

Question 74

acamprostate?

Answer 74

* increases cumulative abstinence * reduces endogenous excitatory NTs and enhancing GABA transmission

Question 75

what is the benefit of acamprosate?

Answer 75

* Few contraindications – can “safely” drink

Question 76

busipirone?

Answer 76

1.is a 5-HT1A agonist 2.can improve outcome in anxious alcoholics

Question 77

what does disulfiram work?

Answer 77

* Works by preventing the breakdown of acetaldehyde to acetate so if alcohol is drunk will lead to facial flushing, headaches, palpitations, nausea, vomiting headache, increased temp, increased pulse, decreased BP

Question 78

what else does disulfiram do?

Answer 78

* Increases dopamine in the nucleus accumbens by reducing conversion to noradrenaline by dopamine B hydroxylase

Question 79

what can disulfiram precipitate?

Answer 79

* Can precipitate anxiety, mania, psychosis and depression

Question 80

side effects of disulfiram?

Answer 80

* Patients must have capacity and many contraindications and cautions (eg PD, suicidal risk, cardiovascular....). - Rarely can cause fulminant hepatitis

Question 81

NICE recommends disulfiram only after?

Answer 81

a trial of naltrexone or acamprosate  

Question 82

what is MI?

Answer 82

A directive, patient-centred counselling style that aims to help patients explore and resolve their ambivalence about behaviour change.

Question 83

4 principles of MI?

Answer 83

- empathy - discrepency - address resistance - support self efficacy

Question 84

MI - empathy?

Answer 84

* Express empathy by using reflective listening to convey understanding of the patient’s point of view and underlying drives

Question 85

MI - discrepency?

Answer 85

* Develop the discrepancy between the patient’s most deeply held values and their current behaviour (i.e. tease out ways in which current unhealthy behaviours conflict with the wish to ‘be good’ – or to be viewed to be good)

Question 86

MI - resistance?

Answer 86

* Sidestep resistance by responding with empathy and understanding rather than confrontation

Question 87

MI - self -efficacy?

Answer 87

* Support self-efficacy by building the patient’s confidence that change is possible

Question 88

stages of change in the cycle of change model?

Answer 88

PCPAML

Question 89

pre-contemplation?

Answer 89

* doesn't recognise the problem * no reason to change

Question 90

contemplation stage?

Answer 90

*Ambivalence *“I might have a problem” *Apprehension, fear of change.

Question 91

preparation stage?

Answer 91

ppt ready to engage in change process

Question 92

action stage?

Answer 92

- noticable change in beh * re-inforcement and support * understand factors and strategies supporting the new behaviour

Question 93

maintenance stage?

Answer 93

* consolidation of change * skills development

Question 94

what can be done during the maintenance stage?

Answer 94

* Support and encouragement * Provision of support systems * Design of relapse prevention plans

Question 95

What can be done during the lapse/relapse stage?

Answer 95

* Re-engagement with services and supports available. * Exploration of reasons for relapse and learn from lapse experience * Review of relapse prevention plan.

Question 96

what do psychoactive drugs do?

Answer 96

* alter, mood, cognition, behaviour

Question 97

stimulants?

Answer 97

* Euphoria  * Increase energy/activity  * Reduced need for sleep & food 

Question 98

examples of stimulants?

Answer 98

* e.g. cocaine, amphetamine, caffeine, ephedrine, methylphenidate

Question 99

what do depressants do?

Answer 99

* Impair consciousness * Impair co-ordination * Disinhibition * Analgesia * Amnesia

Question 100

examples of depressants?

Answer 100

* e.g. benzodiazepines * zimovane (“z” drugs) * chloral hydrate * barbiturates  * chlormethiazole * alcohol

Question 101

opiods?

Answer 101

* Dreamy/detached/euphoria * Sedation * Analgesia * Constipation

Question 102

examples of opiods?

Answer 102

* e.g. heroin, morhine, codeine * tramadol * fentanyl * pethidine

Question 103

hallucinogens?

Answer 103

* Visual illusions/hallucinations * Euphoria/emotional liability * Time distortion

Question 104

examples of hallucinogens?

Answer 104

* LSD, psilcybin, fly agaric

Question 105

cannabis?

Answer 105

–depressant & hallucinogenic

Question 106

solvents?

Answer 106

–depressant & hallucinogenic & anaesthetic

Question 107

MDMA?

Answer 107

–stimulant & hallucinogenic

Question 108

Pharmakokinetics of psychoactive drugs?

Answer 108

*rapid absorption esp i.v. (rush with opiate buzz with amphetamines) *rapid distribution, high affinity for CNS, lipophilic e.g. cannabis *slow elimination

Question 109

plasticity?

Answer 109

* = extent to which drug effects are shaped by * internal cues (anxiety, depression, relief etc) * external cues (friends,work etc)

Question 110

low plasticity drugs?

Answer 110

* low plasticity  →  predicable results from use * low plasticity: heroin. amphetamines

Question 111

high plasticity drugs?

Answer 111

* high plasticity: LSD, cannabis, solvents

Question 112

tolerance?

Answer 112

* ↓effect of same dose of a drug on repeated exposure * need to ↑ dose to maintain same level of effect

Question 113

Tolerance is from a combination of?

Answer 113

* pharmacokinetics: e.g. alcohol and enzyme induction and neuroadaptation * psychosocial - –tolerance may develop faster to behaviours important to the   individual)

Question 114

alcohol duration of effects?

Answer 114

Duration - 5 – 10 minutes, lasts several hours

Question 115

amphetamines duration?

Answer 115

Duration - 15 minutes – effects may last 2 days

Question 116

barbituates duration

Answer 116

Duration - begins in 10 minutes – lasts 3 – 5 hours

Question 117

caffiene duration

Answer 117

Duration - begins within minutes – can last several hours

Question 118

cannabis duration

Answer 118

Duration - begins after a few minutes, lasts up to an hour

Question 119

cocaine duration

Answer 119

Duration works within minutes – peaks 15 – 30 minutes, dies quickly

Question 120

opiates duration

Answer 120

Duration immediate, last 10 – 30 minutes

Question 121

tobacco duration

Answer 121

Duration effects 5 – 10 minutes, lasts 10 – 30 minutes

Question 122

NS effects of opiods

Answer 122

* euphoria * analgesia (mind & body) * drowsy detached state * sleep disturbance (â REM &   stage 4) * pin point pupils

Question 123

hormonal effects of opiods

Answer 123

* dec sperm motility * amenorrhoea

Question 124

GI effects of opiods

Answer 124

* nausea/ vomiting * constipation * anorexia * dec secretions

Question 125

Genitourinary effects of opiods?

Answer 125

urgency & retention of urine

Question 126

CV effects of opiods?

Answer 126

* dilated BVs, dec BP * sweating * itching

Question 128

resp effects of opiods?

Answer 128

* reduced resp rate * reducted cough reflex

Question 129

tolerance to opiods?

Answer 129

* Develops rapidly (within days of continuous use) to euphoria, analgesic, respiratory depressant and emetic effects * Constipation may persist * Pin point pupils remain despite prolonged use

Question 130

drug effects of opiods - intoxication vs toxicity?

Answer 130

Question 131

dependence involves?

Answer 131

– tolerance – characteristic withdrawal effects – Psychosocial changes

Question 132

NS effects of amphetamines?

Answer 132

* euphoria * alerting * inc self confidence  * dec fatigue & need for sleep * inc activity * tremor * dilated pupils

Question 133

CV effects of amphetamines?

Answer 133

* inc pulse - palpitations * inc BP - headaches

Question 134

GI effects of amphetamines

Answer 134

* anorexia * abd cramps

Question 135

endocrinological effects of amphetamines?

Answer 135

* sweating * inc body temp * dry mouth

Question 136

amphetamine - withdrawal symptoms

Answer 136

* hypersomnia  + vivid dreams * hunger & hyperphagia * fatigue/lethargy * depressed mood + suicidal thoughts (variable)

Question 137

amphetamine overdose?

Answer 137

* Overdose–confusion inc BP, inc pulse, chest pain, palpo * inc temp, convulsions, myocardial infaret, CVA * Bruxism * Sterotyped behaviour * Suspiciousness à paranoid psychosis * Acute schizophroniform psychosis

Question 138

stimulant effects of LSD?

Answer 138

* dilated pupils * inc pulse inc BP * tremor * piloerection * weakness * nausea

Question 139

Amphetamine overdose?

Answer 139

* acute overdosage (convulsions, hyperthermia etc) * bad trips * accidents * flashbacks * acute psychosis

Question 140

paraxodical reactions from benzodiazepines?

Answer 140

* aggressiveness (in some individuals violent behaviour), * depression (with or without suicidal thoughts or intentions), * personality changes. * Rarely reactions such as hallucinations, depersonalisation, derealisation and other psychiatric symptoms occur.

Question 141

which 2 benzos are more likely to produce dissociation and psychiatric symptoms?

Answer 141

* Lorazepam and triazolam in particular may produce dissociation and other psychiatric symptoms.

Question 142

risk of paradoxical reactions?

Answer 142

* 5% * ↑risk with short-acting compounds, may occur with all benzodiazepines * can occur in short-term use and rarely following first use

Question 143

tolerance to benzos - ? within a few weeks

Answer 143

sedation

Question 144

tolerance - ? effects within a few months

Answer 144

anxiolytic

Question 145

tolerance - anticonvulsant effects

Answer 145

after several months

Question 146

benzos - dependnce?

Answer 146

* Can develop within weeks of regular use * More likely with the short acting potent benzodiazepines e.g. lorazepam, alprazolam

Question 147

brain disabiling effects of benzodiazepines

Answer 147

* sedation or hyponsis * cognitive dysfunction - ST memory impairment, confusion, delirium * disinhibition and other behavioural aberrations * extreme agitation * psychosis * paranoia * depression * sometimes with violence toward self or others

Question 148

Benzos withdrawal?

Answer 148

* anxiety and insomnia after routine use to * psychosis and seizures after the abrupt termination of long-term high doses

Question 149

screening tool for alcoholism?

Answer 149

* CAGE questionnaire: . * AUDIT-C: a shortened version of the AUDIT screening tool, consisting of three questions. * score of 3+ requires use of a full AUDIT questionnaire

Question 150

questions to ask abt alcohol intake?

Answer 150

* origin of the drinking problem - what was going on? * current drinking pattern * quantify * drinking behaviours - where and who with * previous attempts to stop

Question 151

asking abt biological signs of dependence?

Answer 151

* If you stop drinking, do you…get the shakes/sweat a lot/feel sick/notice any physical changes?” * “Do you have to drink more than you used to, to get the same effects?”

Question 152

psych signs of dependence?

Answer 152

* compulsion * how imp is drinking * on stopping - feel down, angry, anxious?

Question 153

effects on life of drinking?

Answer 153

* relationships * occupation * do they currently drive? for work? driving under the influence

Question 154

impacts of addiction on society

Answer 154

* child neglect * loss of productivity - days off associated w ill health * increased crime rates * substance related conditions e.g. liver disease -> increased healthcare cost * increased risk of homelessness and provery

Question 155

impact of addiction on family

Answer 155

* distressing for the family * child neglect/ abuse * children may develop addiction at an early age * increased domestic disputes

Question 156

envir damage from drugs?

Answer 156

* environmental damage from drugs e.g. methamphetamine or cannabis

Question 157

impacts of addiction on the indiv?

Answer 157

* health conditions - MH, lung, cardiac etc * side effects - depression, psychosis * loss of job * loss of relationships * finances - cost of alcohol/ drugs, inability to work

Question 158

RF for drug taking

Answer 158

* early aggressive factors * lack of parental supervision * academic problem * peer substance use * drug availability * child abuse/ neglect * poverty

Question 159

indiv RF for taking drugs

Answer 159

* genetic disposition * prenatal alcohol exposure * difficult temperament * poor impulse control * low harm avoidance * lack of self regulation * ADHD/ anxiety/ depression/ antisocial behaviour * rebelliousness * Personality traits: including disinhibition, poor impulse control, novelty or sensation seeking may increase the risk of substance misuse. * Psychiatric co-morbidities (depression, anxiety, PTSD, psychosis): illicit drugs may be used in an attempt to self-medicate.

Question 160

social RF for taking drugs?

Answer 160

* peer pressure * lack of family involvement * attitudes towards drugs/ alcohol

Question 161

social and environmental factors for taking drugs?

Answer 161

* poor school achievement, unemployment, social deprivation, history of criminal activity, peer influence, and normalisation of substance misuse in the individual’s culture or peer group.

Question 162

psych theories of dependence - classical conditoning?

Answer 162

* drinking alcohol is associated with a pleasurable feeling * triggering craving for the drug * craving may be triggered by familiar internal states (like anxiety, depression, loneliness) that were previously alleviated by taking drugs.

Question 163

psych theories of dependence - operant conditioning?

Answer 163

* A person might use a drug for the first time and enjoy the feelings it creates, which is a positive reinforcement for the behavior. * negative reinforcement - relief of pain, low, mood, anxiety

Question 164

psych theories - SLT?

Answer 164

* watching others engaging in the behaviour - modelling

Question 165

Psych theories of dependence - self medictaion theories?

Answer 165

* The underlying basis for the pain that is being medicated is usually attributed to trauma—adverse childhood experiences (ACES), sexual or violence trauma as an adult, or other experiences associated with post-traumatic stress.

Question 166

biological theories - dopamine?

Answer 166

* positive reinforcing effect of alcohol comes from the dopaminergic reward pathway in the limbic system * dopamine is released in the VTA and projects to the NA where it is involved in motivation and reinforcement behaviours - mesolimbic pathway

Question 167

how do endogenous opiods influence drinking behaviour?

Answer 167

* endogenus opiods influence drinking behaviour via interaction w the mesolimbic system

Question 168

GABA in alcohol dependence?

Answer 168

* GABA - alcohol acts presynaptically at the GABA neuron, increasing GABA release and post-synaptically enhancing GABA action

Question 169

glutamate in alcohol dependence?

Answer 169

* glutamate - alcohol reduces glutamate levels in the NA and supresses glutamate mediated signal transmission in the central nucleus of the amygdala

Question 170

genetics involved in alc dependence?

Answer 170

* alcohol dehydrogenase 1B (ADH1B) and aldehyde dehydrogenase 2 (ALDH2)

Question 171

Psych management of alcohol dependence?

Answer 171

* MI in the initial assessment * psychological interventions - CBT, behavioural therapies or social network therapies focused on alcohol-related cognitions, behaviour, problems and social networks

Question 172

when should pharm interventions be used in alc dependence?

Answer 172

- harmful drinkers/ mild alc dependence who haven't responded to psych interventions alone - or who spec request ot - offer oral naltrexone in combination with an individual psychological intervention 

Question 173

assisted withdrawal?

Answer 173

* fixed dose regimens * benzodiazepines - chlordiazepoxide or diazepam

Question 174

when should acamprosate be used?

Answer 174

* start treatment as soon as possible after assisted withdrawal

Question 175

side effects of acamprosate?

Answer 175

* abd pain * sexual dysfunction * nausea * skin reactions

Question 176

naltrexone CI?

Answer 176

opiod dependence

Question 177

side effects of naltrexone?

Answer 177

palpitations, sexual dysfunction, tachycardia, constopation, hyperhydrosis

Question 178

when should disulfiram be started?

Answer 178

* start at least 24 hrs after the last alcoholic drink consumed * need to stay under supervision for at least every 2 weeks for the first 2 months, then monthly for 4 months

Question 179

interaction between disulfiram and alc?

Answer 179

flushing, nausea, palpitations and, more seriously, arrhythmias, hypotension and collapse

Question 180

amount of alcohol needed to trigger a reaction w disufiram?

Answer 180

* reactions may occur following exposure to small amounts of alcohol found in perfume, aerosol sprays, or low alcohol and "non-alcohol" beers and wines

Question 181

risk of ? w disulfiram that requires urgent medical attention

Answer 181

* the rapid and unpredictable onset of the rare complication of hepatotoxicity; advise service users that if they feel unwell or develop a fever or jaundice that they should stop taking disulfiram and seek urgent medical attention.

Question 182

contra-indications of disulfiram?

Answer 182

psychosis, suicide risk, severe personality disorder

Question 183

SE of disulfiram?

Answer 183

hepatocellular injury, encephalopathy, psychotic disorder, paranoia, depression

Question 184

signs of opiod intoxication?

Answer 184

* constriction of pupils, itching and scratching * sedation and somloence * lower BP * slower pulse * hypoventilation

Question 185

opiod withdrawal signs?

Answer 185

* Watering eyes, rhinorrhoea, yawning, sneezing, cool and clammy skin, dilated pupils, cough. * Abdominal cramps, nausea, vomiting, diarrhoea. * Tremor, sleep disorder, restlessness, anxiety, irritability, hypertension.

Question 186

methadone vs buprenorphine for opiod dependence?

Answer 186

* Methadone and buprenorphine are equally effective as substitution therapy for opioid dependence * buprenoprhine is available with naloxone in a combined sublingual tablet

Question 187

opiod dependence -? is more effective in retaining ppl in Tx?

Answer 187

methadone

Question 188

what might be preferrred for ppl that use large amounts of heroin?

Answer 188

- low dose methadone

Question 189

clouding can occur w ? use

Answer 189

* buprenorphine - clear head * clouding can occur with methadone or heroin use

Question 190

what is preferred in ppl on LT treatment with drugs that affect liver enzymes?

Answer 190

* buprenorphine preferred in people who are on long-term treatment with drugs that either induce or inhibit liver enzymes (such as anticonvulsants, rifampicin, ribavirin), as it is less affected by these liver enzymes than methadone.

Question 191

CI for methadone (and all opiods)

Answer 191

* ARD * comatose patients * raised ICP * risk of paralytic ileus

Question 192

CI for methadone specifically?

Answer 192

* Phaeochromocytoma

Question 193

side effects of methadone?

Answer 193

* arrhythmias * dizziness * hallucinations * resp distress * vomiting - common on initiation

Question 194

when can methadone overdose occur?

Answer 194

* can occur if methadone is taken with certain painkillers like oxycontin, hydrocodone, morphine

Question 195

methadone overdose signs?

Answer 195

* pinpoint pupils * constipation * low BP/ weak pulse * slow, labored, shallow breathing * coma * cyanosis

Question 196

CI of buprenorphine?

Answer 196

* resp distress * comatose patients * head injury * risk of paralytic ileus

Question 197

side effects of buprenorphine?

Answer 197

* anxiety, depression, diarrhoea, tremor

Question 198

benzodiazepine withdrawal?

Answer 198

* The two potential approaches for withdrawal are slow dose reduction of the person's current benzodiazepine or z-drug, or switching to an approximately equivalent dose of diazepam, which is then tapered down. 

Question 199

what should MI include?

Answer 199

* helping people to recognise problems or potential problems related to their drinking * helping to resolve ambivalence and encourage positive change and belief in the ability to change * adopting a persuasive and supportive rather than an argumentative and confrontational position.

Question 200

how does co-working with other NHS specialities maintain high qual patient care?

Answer 200

* collaborative approach - combined expertise * seamless care * improvement in decision making * working with local authorities - supported employment * better targeting of resources * better prevention

Question 201

symptoms of acute alc withdrawal

Answer 201

* autonomic hyperactivity such as agitation, * tremors, * irritability, * anxiety, * hyperreflexia, * confusion, * hypertension, * tachycardia, * fever * diaphoresis:

Question 202

when does alc withdrawal usually occur?

Answer 202

* usually develops 6-24 hrs after abrupt discontinuation or decrease in alcohol consumption

Question 203

mild alc withdrawal?

Answer 203

characterized by tremors, nausea, anxiety, and depression

Question 204

severe forms of alc withdrawal?

Answer 204

* severe forms characterized by hallucinations, seizures, delirium tremens (DT) and coma

Question 205

management of AAW?

Answer 205

* benzodiazepine or carbamazepine * Clomethiazole may be offered as an alternative to a benzodiazepine or carbamazepine. 

Question 206

First line in delirium tremens?

Answer 206

lorazapam - oral

Question 207

if lorezapam doesn't work in DT, use...

Answer 207

* If symptoms persist or oral medication is declined, offer parenteral lorazepam or haloperidol.

Question 208

peak incidence of DT?

Answer 208

48-72 HRS

Question 209

signs of DT?

Answer 209

- coarse tremor, - confusion, - delusions, - auditory - visual hallucinations - fever - tachycardia

Question 210

triad in WE?

Answer 210

1. oculmotor abn - lateral rectus palsy, nystagmus, opthalmoplegia 2. cerebellar dysfunction - ataxia 3. altered mental state - confusion

Question 211

KS symptoms?

Answer 211

*** anterograde amnesia - impaired ability to acquire new episodic memories * * confabulation ** * retrograde amnesia * lack of insight * disorientation in time and place * executive dysfunction * sequelae of WE