Addiction medicine Flashcards
What are the clinical features of acute alcohol intoxication?
Cerebellar: ataxia, dyarthria, nystagmus. Cerebral: confusion, coma, memory impairment. CV: hypotension, tachycardia. Resp depression.
What are the symptoms of B1/thiamine deficiency? When does it occur?
Peripheral neuropathy, wernicke’s encephalopathy - confusion, opthalmoplegia, ataxia. Korsakoff - retrograde + anterograde amnesia, confabulation. Alcohol, liver disease, bariatric surgery.
How do you treat acute B1 deficiency?
Healthy - 300mg PO 5 days, then 100mg for 2 weeks. Severe/chronic: 200-500mg IV or IM TDS for 3-5 days then 2 weeks further IV. Give thiamine before glucose. Maintenance therapy 100mg daily.
What are the features of alcoholism on blood tests?
Anaemia, AST double ALT, GGT elevation, High INR, low albumin, folate/b12 deficient, high ferritin.
What are the features of mild and severe alcohol withdrawal? How is it managed?
Anxiety, agitaiton, nausea, sweating. Severe: persistent vomiting, delirium tremens, paranoia, autonomic instability. Thiamine, low stimulus environment, hydration, analgesia, antiemetic. Fixed dose benzodiazepines for severe 5mg QID for 5 days, TDS>BD>D.
What should be in place for a successful alcohol home detox?
No previous withdrawal seizures/delirium; no current acute medical illness; no other drug or benzo use; no suicidality. Support person available and thiamine used.
What are the non-pharm features and most popular drug for alcohol reduction?
Effect, SE, duration, contraindications.
Low-alcohol drinks, alternative activities, change friends, support (AA), CBT helpful. Naltrexone - once daily, reduces cravings/binge. Nausea (use at night), liver toxicity monitor for 3mo, then 3mthly. Takes 3-6mo up to 12mo. C/I: opioid use, liver failure, hepatitis.
What are 2 alternative drugs to use in alcohol reduction?
Acamprosate (Campral) - reduces neuronal hyperexcitability, slight anxiolytic, reduces cravings and long withdrawal. TDS dosing, okay with liver impairment but not with kidney disease. Disulfiram (antabuse) - acetaldyhyde buildup with alcohol (vomit, flushing, headache), on special access scheme, no effect on cravings, not safe w kidney, liver or heart disease
What are the features of motivational interviewing in relation to cycle of change? What techniques can be used?
Precon: harm reduction, educate about risks. Con: weigh up pros/cons, identify barriers.Preparation: develop realistic plan. Maintenance: stategy to avoid relapse. OARS - open ended questions, affirmations, reflection, summarising.
What are the 5 A’s of preventive care?
Ask, assess, advise, assist, arrange.
What are the non-pharm methods for smoking reduction?
Counselling, written information, quitline, CBT. 4 D’S for cravings: delay urge, deep breath, drink water, do something else.
No evidence for hypnotherapy and acupuncture.
When is pharmacotherapy indication for smoking? What is a 2nd line option?
If nicotine dependent - smoking < 30min of waking, > 10 per day or previous withdrawal. Nortriptyline 2nd line. E-cigarettes not approved/tested, long term unclear.
Vareniciline - use, SE, C/I, timing.
As effective as combo NRT. ?More effective in females, alcoholics, schizophrenia. Nausea common, take with food. Not recommended pregnancy and adolescence. Okay in psych conditions, monitor mood/behaviour. Renal excretion. 12 week course, can repeat.
Nicotine replacement therapy - use, caution, SE
Combo patch + oral best, 21mg/24hr patch if dependent. Only C/I are allergy or age under 12, but last line in pregnancy and avoid long patch. SE: skin irritation, sleep disturbance.
What is zyban - use, C/I, SE
Bupropion for smoking cessation. C/I: seizures,eating disorders, MAO inhibitors, pregnancy. Can lower seizure threshold. 9 week course. Less effective than others, may be good in depression.
