alcohol Flashcards
what are the effects of a low dose of alcohol
euphoria
reduced anxiety
relaxation
sociability
what are the effects of higher doses (intoxication) of alcohol
impaired attention impaired judgement flushing unbalanced nystagmus mood instability disinhibition slurring stupor unconsciousness
what are the criteria for ‘harmful use’ of alcohol
using alcohol >1 month or repeatedly over 12 resulting in damage to physical or mental health
what are the requirements for ‘dependence’ on alcohol
3 of the following for > 1 month or repeatedly over 12 cravings/compulsions difficulty controlling use primacy increased tolerance persistent use despite consequences
what is a withdrawal state
symptoms caused by complete/relative withdrawl of a psychoactive substance
what are symptoms of alcohol withdrawal
tremor nausea weakness vomiting dehydration anxiety seizures confusion agitation
what are some screening tools used for alcoholism
CAGE
AUDIT
FAST
PAT
how do you manage alcohol dependence
depends on patient
offer advice, education
holistic approach involving support for family/friends, psychological help, social workers, community support (AA)
what medications could you use in alcohol withdrawal
benzodiazepines - usually chlordiazepoxide but can use diazepam
what is disulfiram used for
its a deterrent drug for alcohol
what drugs can be used for alcohol cravings
acamprosate
naltrexone
nalmefene
what are cautions for naltrexone and nalmefene
avoid any kind of alcohol (in foods, mouthwash etc) because ingestion of alcohol will cause rapid increase in BP, tachycardia, flushing
how does alcohol create a relaxing effect
stimulates GABA receptors
inhibits glutamate receptors
this causes inhibition of electrical activity
what is the pathophysiology of delerium tremens
alcoholics have a down regulated GABA and upregulated glutamate system because of tolerance to alcohol
if alcohol is removed from their system there will be extreme excitability causing excess adrenergic activity
what are symptoms of delirium tremens
confusion severe agitation delusions hallucinations tachycardia hypertension hyperthermia ataxia arrhythmias sleeplessness autonomic overactivity usually come on in 48-72hrs of stopping
how do you manage delirium tremens
benzodiazepine (high dose titrated to low over about 5 days)
IV B vitamins
thiamine at a low oral dose
what is wernicke’s encephalopathy
reversible condition caused by thiamine deficiency
symptoms of wernikes
triad of ataxia, oculomotor disturbance, confusion
how do you manage wenickes
IV fluids
thiamine
what is korsakoffs syndrome
!medical emergency!
wernickes can develop into this if not treated
irreversible
symptoms of korsakoffs
memory impairment
behavioural changes
this is a serious disease and often requires institutional care
how do you manage korsakoffs
emergency
thiamine
fluids
how does alcohol consumption cause thiamine deficiency
thiamine is poorly absorbed across gut in presence of alcohol
alcoholics also normally have poor diets and get most of their calories from alcohol
how does alcohol consumption cause thiamine deficiency
thiamine is poorly absorbed across gut in presence of alcohol
alcoholics also normally have poor diets and get most of their calories from alcohol
alcohol also intervenes with thiamine storage and conversion
what is alcoholic ketoacidosis
condition where there is a metabolic acidosis due to alcohol and lack of food hypoglycaemia acidosis low bicarbonate increased resp rate
why are there increased ketones in AKA
The alcohol puts extra stress on the body, this increases cortisol and catecholamine levels
These hormones increase lipolysis resulting in FFAs in the blood
The FFAs get metabolised into ketones
how does alcohol impair glucose production and lactate metabolism
he metabolism of ethanol results in B-hydroxybutyrate production (a ketone) and it also increases NADH/NAD in the liver
The NADH/NAD levels impair ability to make glucose and metabolise lactate - this causes hypoglycaemia and acidosis
what is the role of thiamine in relation to lactic acid
thiamine is needed to metabolise lactic acid and prevent build up
what is acetaldehyde
a substance produced in metabolism of ethanol
it is toxic to hepatocytes
what will happen to clotting time in alcoholic liver disease
it will increase because the liver is damaged and less able to produce clotting factors for the cascade
why are chronic users of alcohol usually malnourished
tend to replace meals with alcohol
alcohol requires vitamins to be metabolised
would the Na, K, PO4 valued be raised or lowered in chronic users of alcohol
usually lowered because most chronic users are malnourished
