Substance misuse

Card Set Information

Author:
trincam2008
ID:
277587
Filename:
Substance misuse
Updated:
2014-06-25 15:41:48
Tags:
psy
Folders:
psy
Description:
Substance misuse, mnemonics, units etc..
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  1. Substance misuse categories
    • - Intoxication
    • - Harmful use
    • - Dependency
    • - Withdrawal
  2. Features of dependency 
    (8, or 6 bigger)
    • 1.a Compulsion
    • 1.b Difficult controlling use - starting, stopping, or amounts used

    2. Tolerance

    • 3. Withdrawal - physiological withdrawal state
    • a) characteristic withdrawal state 
    • b) substance use to prevent/relieve withdrawal symptoms

    • 4.a. Continued used despite harm
    • 4.b. Salience (primacy)
    • stinence
    • 5. Narrowing of repertoire

    6. Reinstatement after ab
  3. Neurological models: all drug uses affect/
    Dopaminergic 'reward' pathway in the barin. 

    Cocain and amphetamine block dopamine reuptake. Alcohol and opiates also increase dopamine.
  4. Alcohol 'flush reaction'
    Ethanol is metabolised to acetaldehyde, by aldehyde dehydrogenase. 

    East Asian, a variant enzyme -> acetaldehyde accumulates, causing flushing, palpitations and nausea.
  5. Calculate exact alcohol content
    units = (volume of drink in mL x % alcohol)/1000
  6. Levels of alcohol consumption: safe and harmful
    • Safe
    • - women: 2-3/day, 14/w
    • - men: 3-4/day, 21/w

    • Harmful
    • - women: >6, >35
    • - men: > 8, >50
  7. Withdrawal of alcohol
    ALcohol is a CNS depressant, stimulate GABA inhibitory system to reduce brain excitability. 

    Suddenly stop drinking -> neural pathway become hyper-excitable and seizures

    Delirium tremens
  8. DDx for alcohol and drugs
    • 1. Organic
    • (not to assume: confusion, ataxia, or psychotic symptoms are solely due to s misuse; 
    • Beware: head injury, subdural haematoma)


    • 2. Psychiatric illness: primary or comorbid
    • dual diagnosis
    • DDx
    • - depression/mania
    • - functional psychosis
    • - anxiety disorder

    - personality disorder
  9. Distinguish subtance misuse from psychiatric prob
    • - Which problem came first?
    • - Do the psychiatric symptoms 'fit' with known symptoms of that substance?
    • - Have psy symptoms continued after abstinence?
    • - Is there a FHx or prev diag?
  10. Pharm mx of alcohol
    1. Detoxication of alcohol
    2. Prevention
    • - Long acting benzodiazepines
    • - Thiamine

    • Prevention:
    • - Disulfiram (mimic flush reaction)
  11. Opiates (heroin, morphine, codein): notable
    1. intoxication px
    2. withdrawal
    3. overdose
    4. substitute prescribing
    5. prevention
    • 1. pinpoint pupils
    • 2. 'runs' (diarrhoea, vomitting, lacrimation, and rhinorhoea)
    • 3. Naloxone - opiate antagonist 
    • 4. Methadone (full agonist) & buprenorphine (partial agonist)
    • 5. Naltrexone - opiate antagonist
  12. Cocaine users may experience
    Formication - sensation of insects crawling on/below skin, also known as cocaine bugs
  13. Snorting cocaine causes?
    Cocaine is a powerful vasoconstrictor and snorting it damages the nasal mucosa, causing necrosis and septal perforation.
  14. Benzodiazepines overdose
    Treated with flumazenil, a benzo anatagonist

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