Alcohol

Question 1

Audit C scoring and 3 questions?

Answer 1

1. how often to do you have a drink containing alcohol?
2. HOW MANY ALC DRINKS ON A DAY YOU ARE DRINKING?
3. How often 6 or more drinks?
   positive F >3, male >4
   >5 hazardous drinking

Question 2

AUDIT questions x 9?

Answer 2

1. How often drink containing alc?
2. on drinking days, how many drinks?
3. how often >6 drinks?
4. how often felt guilty?
5. missed responsibility due to drinking?
6. cannot remember yesterday?
7. drink in the morning after a heavy session?
8. accident to you or others?
9. Friend/relative/dr/HCA advised cutting down?

Question 3

AUDIT SCORING?

Answer 3

5-10 - at risk drinker (20% have AUD)
11-15 - more at risk (40% with AUD)
16-20 - high probability of mod-severe AUD (90%)

Question 4

Scoring for DSM-5 alc?

Answer 4

0-1 noRmal
2-3 - mild (10% M, 5% F)
4-5 - mod (6% M, 2% F)
6+ severe

Question 5

DSM-5 questions?

Answer 5

1. how often drank more/longer than intended?
2. tried stopping more than once?
3. spent lots of time recovering/trying to obtain alcohol?
4. spent lots of time recovering/being sick/drinking?
5. continue to drink even though trouble with fam/friends?
6. drinking/sick interferes with job/fam/school
7. Given up interests/importants to drink?
8. been in situations where >1 drink dangerous e.g. sti/swimming
9. continue to drink despite blackout/anxiety/depression?
10. drink more due to tolerance
11. continue despite withdrawal effects

Question 6

Who to annually screen?

Answer 6

FH/preg/planning/younger/region/trauma/heavy smokers/ clinical suspicion

Question 7

what to ask when screening high risk patients?

Answer 7

how many times in the past had more than 4 F/ 5 M drinks

if >1 = no of drinking days per week and no of drinks/day?

if F >3 per day or >7/week - cut down
if M >4/day or >14/week - cut down

Question 8

88,000 deaths a year in america are alcohol related. Breakdown?

Answer 8

20% intentional injuries
10% cancers
7% OF ALL DEATHS - ROAD ACCIDENTS, CANCER, SUICIDE

Question 9

High prev groups for alcohol?

Answer 9

white, rich, FH, PSYCH trauma, 18-34 years, SMOKERS

Question 10

What % exceed daily limit once a year?

Answer 10

30% Americans - 26% at risk-mild AUD, 3% mod AUD, 1% risky AUD.

Question 11

Mod alc benefits?

Answer 11

red grapes

Question 12

Risks of heavy drink?

Answer 12

stroke, unintentional injuries, cancers, HTN

Question 13

How many get help from primary care?

Answer 13

10%

Question 14

How much is moderate alcohol intake for men and women?

Answer 14

Men - 2/days (no more than 4 in any day)

Women - up to 1 day (no more 3 in a day)

Question 15

What is AUD?

Answer 15

Significant impairment
cravings
using despite handover/heartburn/nausea
10% in jail/hospital/rehab

Question 16

Binge?

Answer 16

0.08mg/L in blood

>5 drinks in 2 hours men/>4 drinks in 2 hours women

Question 17

Heavy binge?

Answer 17

binge >5 days/month (or 4 drinkgs any dar - men/ >3 Females)

Question 18

At risk drinker?

Answer 18

binge once a month

Question 19

Meds started by secondary care. Naltrexone?

Answer 19

px up to 6 months
MU-opiod Receptor 
50mg OD/BD
decreases risk of heavy drinking by 83%
decrease drinking days by 4%

Question 20

First line meds?

Answer 20

naltrexone and acamprosate

Question 21

Acamprosate?

Answer 21

NO EFFECT ON HEAVY DRINKING
decreases cravings
decreased absteinance by 11 days
modulates glutamine

Question 22

second line meds?

Answer 22

toipiramate
gabapentin
disulfiram

Question 23

Disulfiram?

Answer 23

250mg OD

inhibits aldehyde dehydrogenase causing aceta-aldehyde to build up - N&V, headaches, sweating

Question 24

gabapentin?

Answer 24

300-600mg tds

absteinance rates higher in 900 & 1800mg compared to palcebo over 12 wees

Question 25

varenicline?

Answer 25

also reduces alcohol use in smokers

Question 26

Toipiramate?

Answer 26

100-150md BD
off label AUF
decrease heavy drinking days

Question 27

drinks in wine, spiriti 750, spirit 1 litre

Answer 27

wine - 5
spirit - 18
spirit 24 drinks