Addiction - Alcohol Flashcards
What are some high risk occupations for alcoholism?
Itinerant workers, bartenders and professionals
1 unit = how much alcohol?
10mls
How can you calculate the number of units in an alcoholic drink?
(Percentage x volume) / 10
What is the definition of high risk drinking?
Regularly consuming 35+ units of alcohol per week
What is the definition of increased risk drinking?
Regularly consuming 15-35 units of alcohol per week
Explain the drinking regulations for men and women?
Men and women should both not exceed 14 units per week, ideally spread over at least 3 days
What is the definition of the harmful use of alcohol?
A pattern of use which is causing damage to health - this can be physical or mental
What are the defining factors of alcohol dependence?
A strong desire to take the substance / difficulty controlling the use of the substance / physiological withdrawal state / tolerance / neglect of other pleasurable activities / persistence despite evidence of harm
What is the most common tool used to screen for alcohol dependence in Scotland?
AUDIT
What is the pro and con of using CAGE screening for alcohol use?
Good for detecting dependence but not good at detecting evidence of harm
Describe the process of stopping alcohol if a person is mildly dependent?
It is mostly possible to stop, there may be a few withdrawal symptoms but they will be transient
If a person is any more than mildly dependent on alcohol, what is the management for stopping and why?
Medication - to avoid severe withdrawal
When would hospital admission for stopping alcohol be required?
If there are lots of medical co-morbidities or an SADQ test result of 30+
What is the role of lab testing in alcohol misuse?
Not good for detecting alcohol related problems, but may play a role in monitoring response to therapy
GGT is an indicator of what?
Liver injury
Carbohydrate deficient transferrin is able to identify what?
Men drinking 5+ units per day for 2+ weeks
Why is MCV a useful test in the investigation of alcoholism?
Alcohol is the most common cause of a raised MCV
Who is the target audience for brief interventions related to alcohol?
Adults who have been identified by screening as drinking hazardous or harmful amounts of alcohol, and those attending NHS or NHS commissioned services
How long should a brief intervention last? What should you ask them to consider?
5-15 minutes, ask them to consider alternative behaviours
Brief interventions are very useful at decreasing alcohol consumption in who?
Adults who are not dependent
When should you consider referring patients for specialist alcohol withdrawal treatment?
If they have moderate-severe dependence or a severe alcohol related impairment OR if they have failed to benefit from brief advice but want further help
What is detoxification?
The process by which patients become alcohol free
What is relapse prevention?
A combination of psychosocial and pharmacological interventions aimed at maintaining abstinence or problem free drinking following detoxification
What type of neurotransmitter is a) NMDA-glutamate? and b) GABA?
a) excitatory b) inhibitory
What effect does alcohol have on NMDA-glutamate controlled ion channels? Chronic use leads to what?
Inhibition / upregulation of receptors
What effect does alcohol have on GABA controlled ion channels? Chronic use leads to what?
Stimulation / downregulation of receptors
Overall, what effect does chronic alcohol use have on glutamate and GABA activity?
Excess glutamate activity and reduced GABA activity
What is the effect of excess glutamate activity?
Nerve cell toxicity
How long after stopping drinking do the first symptoms of alcohol withdrawal occur? When do they peak?
Within hours / 24-48 hours
What are the main features of alcohol withdrawal?
Restlessness, tremor, sweating, anxiety, N+V, loss of appetite and insomnia
What are some evident signs of alcohol withdrawal?
Tachycardia and systolic hypertension
When can generalised seizures occur as a result of alcohol withdrawal?
The first 3-5 days
What is delirium tremens? When can it start to occur following alcohol withdrawal? When does it peak?
An acute confusional state / 24 hours / 2 days
In most people, symptoms of alcohol withdrawal resolve within how long?
5-7 days
In what % of cases of alcohol withdrawal is DT seen? How does it present?
5% / Insidiously, with nighttime confusion
What are some features of DT?
Confusion and disorientation, agitation, hallucinations and paranoia
DT has a 2-5% mortality rate - what is this associated with?
CV collapse or infection
How should DT be managed?
In a medical ward with IV fluids and antibiotics
What are the 3 key factors in managing alcohol withdrawal?
General support, benzodiazepines and vitamin supplementation
How do benzodiazepines work in alcohol withdrawal?
They are cross tolerant to the alcohol as they act on GABA-A receptors
Which benzodiazepines could be used for alcohol withdrawal? Why are these used?
Diazepam or chlordiazepoxide / they are long-acting
Benzodiazepines used for alcohol withdrawal should be reduced how?
Gradually over 7 days or more
What vitamin supplementation must be given in alcohol withdrawal? How? Why?
Parenteral thiamine / prophylaxis against Wernicke’s encephalopathy
Why do people who drink alcohol need thiamine supplements?
They don’t eat enough food containing it and also don’t absorb it
What are some psychosocial interventions that can be used for alcohol relapse prevention?
CBT, motivational enhancement therapy, 12 step facilitation therapy, behavioural training, couples/family therapy
What is the first line pharmacological agent for relapse prevention? How does it work?
Naltrexone - opioid antagonist works to reduce the reward from alcohol
How does acamprosate work?
Acts centrally on GABA and NMDA receptors to reduce cravings for alcohol
When should acamprosate be started if you are going to use it? Should it be continued through a relapse?
Straight away after detoxification / yes
What are some side effects of acamprosate?
Headache, diarrhoea and nausea
How does disulfiram (antabuse) work?
Inhibits acetaldehyde dehydrogenase leading to an accumulation of acetaldehyde when alcohol is consumed, making the effects of drinking unpleasant
If you are taking disulfiram and ingest alcohol, what kind of symptoms does this cause?
Flushing, tachycardia, N+V, arrhythmias
