Addiction + Alcohol Misuse

Question 1

UK Drinking guidelines

Answer 1

men + women 14 units a week with 2 alcohol free days a week

Question 2

binge drinking for men

Answer 2

8 units

Question 3

binge drinking for women

Answer 3

6 units

Question 4

high risk drinking

Answer 4

regularly consuming >35 units a week

Question 5

features of alcohol dependence syndrome

Answer 5

strong desire/compulsion to drink 
difficulty controlling use
physiological withdrawal state 
evidence of tolerance 
persistence with use despite evidence of harm

Question 6

how does alcohol effect the brain

Answer 6

inhibits action of excitatory NMDA glutamate controlled ion channels

potentiates inhibitory actions of GABA controlled ion channels

Question 7

what does alcohol withdrawal leads to

Answer 7

excess glutamate activity – toxic to nerve cell

reduced GABA activity

Question 8

effects of acute alcohol withdrawal in dependent individual

Answer 8

CNS excitability

neurotoxicity

Question 9

symptoms of alcohol withdrawal

Answer 9

restlessness, tremor, sweating, anxiety, N+V, loss of appetite, insomnia, tachycardia, hypertension

Question 10

onset of seizures / delirium tremens in alcohol withdrawal

Answer 10

seizures = 36 hours

delirium tremens = 72 hours

Question 11

symptoms of delirium tremens

Answer 11

confusion 
agitation 
disorientation 
visual/ auditory hallucinations 
paranoid ideation

Question 12

what do benzodiazepines act on

Answer 12

GABA A receptors

Question 13

why is thiamine given in alcohol withdrawal

Answer 13

prophylaxis against wernicke’s encephalopathy

Question 14

what is wernicke’s encephalopathy

Answer 14

haemorrhage into mammillary bodies due to thiamine deficiency

Question 15

patient with alcohol dependence ‘staggering, confused + restricted eye movements’

Answer 15

wernicke’s encephalopathy

Question 16

what is Korsakoff syndrome

Answer 16

patient acting strange, confabulating, short term memory problems

Question 17

what is given for Korsakoff syndrome

Answer 17

pabrinex then thiamine

Question 18

first line for alcohol dependence relapse prevention

Answer 18

naltrexone

Question 19

mode of action of naltrexone

Answer 19

opioid antagonist

-reduces reward from alcohol

Question 20

contraindications of naltrexone

Answer 20

cirrhosis or renal failure

Question 21

other drugs used to preventi alcohol dependence relapse

Answer 21

disulfiram
- inhibits acetaldehyde dehydrogenase

acamprostate
- acts on glutamate + GABA systems to decrease cravings

Question 22

what is the reward pathway

Answer 22

mesolimbic

Question 23

what neurotransmitter is involved in addiction

Answer 23

dopamine

Question 24

what part of the brain is the key creator of motivation to act

Answer 24

orbito-frontal cortex

Question 25

role of pre-frontal cortex

Answer 25

modulates powerful effects of reward pathway

• keeps emotions + impulses under control
• makes sound decisions

Question 26

how does drug abuse affect dopamine receptors

Answer 26

down regulates them - need more dopamine for same effect each time

Question 27

opioid substitution therapies

Answer 27

methadone

buprenorphine

Question 28

opioid overdose treatment

Answer 28

naloxone