02 Alcohol Flashcards
Ethyl alcohol
Alcohol is the psychoactive substance that causes the greatest harms of health, legal, social and economic costs and problems…second only to?
tobacco
Control and sale of alcohol is regulated by?
provincial and territorial governments
Revenue in 2003-2004 =
$16.1 billion
2002: costs of alcohol abuse in Canada were estimated @ ??????? in additional health care, law enforcement, and loss of productivity in the workplace or at home.
$14.6 billion
2002: alcohol abuse accounted for $??? in direct health care costs
*
Majority of hospital admissions involving alcohol-related conditions were?
$3.3 billion * men for alcohol dependence or abuse, alcoholic psychosis, liver-related diseases other
2004 Canadian Addiction Survey, ?? % of people age 15 or older consumed alcohol in the past year.
80%
Of these people:
??% drank 1 X weekly
??% consumed alcohol 4 or more times a week
44% drank 1 X weekly
10% consumed alcohol 4 or more times a week
Prevalence of alcohol dependence (2002 Canadian Community Health Survey) revealed that ??% of Canadians 15 and over reported symptoms consistent with alcohol dependence
2.6%
Highest in heavy and hazardous drinking?
NWT
2004 survey based on the Alcohol Use Disorder Identification Test ??% of current drinkers in NWT had engaged in hazardous drinking in the last 12 months.
40%
1998-1999 National Longitudinal Survey of Children and Youth showed that ??% of children aged 12 to 15 reported that they consumed @ least one drink of alcohol in the past.
40%
1998-1999 National Longitudinal Survey of Children and Youth showed that what percent of boys and what percent of girls in grade 10 reported weekly alcohol use?
35% boys
25% girls
Furthermore, ??% of boys and ??% of girls in grade 10 indicated that they had been “really drunk” @ least twice.
around 45% for both
Alcohol-Related Harms (7)
CC DAN LL
CV and GI diseases
Cancer
Diabetes
Alcohol dependence syndrome
Neuropsychiatric diseases
Liver cirrhosis
Lungs/kidneys/heart damage
It affects the nervous system and therefore impairs?
JCC
It also lowers?
judgment
concentration and coordination
lowers inhibitions
Drinking to intoxication and binge drinking increases?
UV RAI PUS
Use of other psychoactive substances
Violent / criminal behavior
Risk of alcohol poisoning
Accidents
Injuries
Problems in the workplace
Unsafe sex / unwanted pregnancy
Suicide
How many people will have severe substance abuse problems?
1 in 10!
Alcohol use during pregnancy can cause? (4)
birth defects
FASD
FAE
alcohol-related neurodevelopmental disorders
2002-2003 more than half of the alcohol-related severe trauma hospitalizations in Canada were
MVAs
Alcohol-related severe trauma hospitalizations in Canada
Falls?
20%
Alcohol-related severe trauma hospitalizations in Canada
Assaults and homicides?
20%
Admissions:
??% were age 10-24
??% were age 25-29
27% were age 10-24
22% were age 25-29
Death: alcohol-related road crashes (Traffic Injury Research Foundation 2002) = 1,055.
Say more.
80% male, 2/3 were drivers
Snowmobile accidents (2003-2004)?
50% were alcohol related
Drinking Onset – age range and average age
12-20, average age 14
Drinking Onset – before 15 = ? (2)
4 x more likely to develop alcohol dependence
These rates increase with earlier age of onset
Drinking Onset – Most important factor that predicts progression into adulthood is?
an early age of onset of drinking problems
Children who drink alcohol frequently have?
prior behavioral problems esp. conduct disorder
Adolescents: what may precede alcohol abuse?
symptoms of depression and anxiety
Clinical picture – Skin and Muscle
Many skin conditions are exacerbated by heavy alcohol use:
ABC RR SSS
acne
blistering
crusting
rosacea red palms (palmer erythema)
skin eruptions such as bullous erosions
scarred healing with hyperpigmentation especially to the face, side of neck and back of hands,
spider angiomas
Limbs (3)
Tremors
Peripheral neuropathy (same as diabetes…losing circulation in fingers/toes and anything out to periphery like tip of nose)
Asterixis (liver flap)
Cardiovascular system (3)
Hypertension
Arrhythmias (bounding, thumping out of chest)
Cardiomyopathy (deterioration of heart muscle)
GI System (11)
EE EE RR
GUI DD
Enlarged salivary glands
Enlarged liver
Esophageal tears
Esophageal cancer
Reflux Red blood (frank vomiting of)
Gastritis
Ulcers - stomach
Intestinal malabsorption
Dark to clay colored stools
Diarrhea
Endocrine system
Heavy alcohol consumption can exacerbate (3)
hypoactivity of the
thyroid
hyperthyroid
pancreas
Immune system
Heavy drinkers are more susceptible to developing infections
Erythropoiesis: (formation of red blood cells)
What are common?
How can these be seen clinically?
Anemias are common and can be seen clinically by inspecting the lower eye-lids and the beds of the finger nails.
Erythropoiesis: (formation of red blood cells)
Why are Anemias common?
Blood loss from ulcers or cancer
Mamm glands?
Heavy-drinking women are at increased risk for breast cancer
CNS (3)
Impairment of cognitive function
Korsakoff syndrome
Dementias
what is Korsakoff syndrome?
Korsakoff syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1)
Thiamine (vitamin B-1) helps brain cells produce energy from sugar. When levels fall too low, brain cells cannot generate enough energy to function properly. As a result, Korsakoff syndrome may develop.
Lab findings
CBC: (low) anemia Triglyceride: (elevated) Abnormal liver function tests (elevated) – GGT – bilirubin – uric acid
CBC
Hemoglobin normal range women - 110-140 g/L
Hemoglobin normal range men - 140-180 g/L
*
Normal WBC range - 4.0-11.0
Triglyceride
Normal — Less than 1.7 mmol/L
Borderline high — 1.8 to 2.2 mmol/L
High — 2.3 to 5.6 mmol/L
Very high — 5.7 mmol/L or above
gamma-glutamyl transferase (GGT)
an enzyme
0-30 IU/L
bilirubin
Direct bilirubin: 0 to 0.3 mg/dL (made by liver) * Total bilirubin: 0.3 to 1.9 mg/dL (travels through bloodstream to liver where it is made into direct bilirubin)
uric acid
> 6.0 mg/dL in females
8.0 mg/dL in males
= Hyperuricemia
Acute effects of alcohol on the body.
Initial period.
Initial period: up to 30 min. has a stimulating effect followed by sedative and anxiolytic effect.
Acute consumption of large amounts of alcohol can lead to…?
profound respiratory depression, followed by comma and death.
Wernicke encephalopathy: life-threatening condition
associated with ?
from?
thiamine deficiency
severe malnutrition
Wernicke encephalopathy - tx? (3)
(ICU)
– I.V. hydration (fluid/electrolyte support) and thiamin
– Mechanical ventilation
– Magnesium sulfate often used to reduce seizure
Wernicke mortality rate?
can be > 50%
Alcoholism tx must match?
the level of use and type of use
Along with Wernicke encephalopathy, emergency tx would also be needed when?
Procedure?
– Respiratory depression
– Flumazenil to reverse toxic and/or sedative effects. Given I.V.
Mild withdrawal symptoms
– Vitamin therapy
– Small doses on long-acting benzodiazepines
Typical benzo used? For how long? Reason? Successful for? Route? Dose?
– Chlordiazepoxide (Librium) – Only a few days – Decreases anxiety – Successful for alcohol withdrawal, relaxation. – Given PO 5-10mg tid-qid
Severe withdrawal sx = Hospitalization or detox detox timeframe hardest stretch? What does not happen in detox? Model used in detox?
– can go 5 days - 6 weeks
– if can get through first 48 hours will likely be ok
– person must be able to take oral b/c no IV mgmt in detox
– all detoxes operate from abstinence model
Alcohol Withdrawal
Chronic heavy drinkers who abstain from alcohol for more than a few hours can experience withdrawal symptoms.
Early signs? (3)
tremors, palpitations & sweating
Delirium tremens:
How long after alcohol cessation?
S/S? (3)
Mortality rate?
– 24-48 hours after alcohol cessation – clouding of consciousness auditory / visual hallucinations (persecutory type) seizures – 5-15%
Comorbidity (4)
SNMM
Smoking
Narcotics (Hugely used to deal with withdrawal effects)
Misuse of other drugs
Mental illness
*Tolerance (3)
– a need for more alcohol to get the desired effect. – Builds up the more the person drinks.
– first 5 times is experimentation, past this point, starts taking more/more
*Dependence (2)
drinkers can become psychologically dependent (they feel they need it) as well as physically dependent (the body needs it) on alcohol.
Experience withdrawal symptoms from mild to severe.
Treatment Supports (4)
Detox
Treatment Centers
Alcoholics Anonymous
Pharmacotherapy: Disulfiram (Antabuse)
what does Disulfiram (Antabuse) do?
Inhibits aldehyde dehydrogenase, thereby preventing the metabolism of the primary metabolite of alcohol: acetaldehyde.
This leads to the production of a range of unpleasant side effects, i.e. nausea, vomiting, flushing, sympathetic overactivity & palpitations, if they drink!
Why age ltd. for drinking?
Brains are just finishing developing. When systems not mature, more damage is done
In addition to the physiological, kids are mentally/emotionally not able to handle alcohol. Say more.
depression, anxiety, low self-esteem, social rejection
OUTCOME?
self-harm (suicide!) often occurs w/ substance abuse!
re. withdrawal, shortest vs. longest timeframes?
shortest - booze
longest - benzos
Drug used to take down effect of heroin?
Narcan
