Alcohol

Question 1

What are the first line treatments of ETOH use disorder? What are their mechanism of action?

Answer 1

Naltrexone (blockage of mu opioid receptor, blocks the reinforcing effect of alcohol)
Acamprosate (GABA agonist and glutamate antagonist)

Question 2

What are second line treatments for ETOH use disorder?

Answer 2

Disulfiram
Topiramate
Gabapentin
Baclofen

Question 3

What are contraindications for naltrexone?

Answer 3

• On opioids
• Liver dysfunction
• Elevated liver enzymes - AST ALT (>3x normal)
• Pregnancy

Question 4

What advantage does naltrexone have over acamprosate?

Answer 4

• Do not need to abstain from alcohol prior to starting

- Daily dosing instead of TID

Question 5

What are side effects of naltrexone?

Answer 5

Nausea

Elevated liver enzymes

Question 6

What do you need to monitor for for naltrexone?

Answer 6

Liver enzymes at:

• baseline
• 4 weeks
• 3 months

Question 7

What are side effects of acamprosate?

Answer 7

nausea
agitation
diarrhea

Question 8

What are contraindications for acamprosate?

Answer 8

• renal disease

- pregnancy

Question 9

What is the mechanism of action of disulfiram?

Answer 9

Blocks conversion of acetaldehyde to acetate and causes build-up of acetaldehyde, making patient feel very unwell

Question 10

What are contraindications for disulfiram?

Answer 10

• Pregnancy
• Cardiac disease
• Liver dysfunction
• Psychosis
• Cognitive dysfunction
• Elderly

Question 11

What are side effects of disulfiram?

Answer 11

Hepatitis
Neuropathy
Depression
Psychosis

Question 12

When is disulfiram helpful?

Answer 12

In supervised settings, better evidence than naltrexone/acamprosate

Question 13

What should you make sure of when starting/stopping disulfiram?

Answer 13

• MUST be abstinent for at least 2 days prior to initiation

- Reaction can happen up to 7 days after stopping medication

Question 14

Describe the low risk drinking guidelines for men, women, elderly

Answer 14

Men:
- 15 drinks a week, with no more than 3 drinks a day most days, up to 4 for special occasions
Women:
- 10 drinks a week, with no more than 2 drinks a day most days, up to 3 for special occasions

Elderly men:
- no more than one per day
Elderly women:
- less than one per day on average

Question 15

What are signs of alcohol intoxication?

Answer 15

Ataxia
Incoordination
Slurred speech
Nystagmus
Attention/memory impairment
Stupor/coma

Question 16

What are signs of alcohol withdrawal?

Answer 16

N/V (6-12)
Tremor (6-12)
Insomnia (6-12)
Anxiety (6-12)
Autonomic instability e.g. HTN, tachy, sweating, fever (12-48)
Seizures (12-48)
Agitation (48-72)
Hallucinations (48-72)

Question 17

What are the thiamine complications?

Answer 17

Wernicke’s encephalopathy:
Ataxia
Confusion
Ophthalmoplegia

Korsakoff's syndrome:
Ataxia
Confusion
Ophthalmoplegia
Amnesia
Confabulation

Question 18

What is the most severe form of alcohol withdrawal?

Answer 18

Delirium tremens:
*Global confusion
Hallucinations
Autonomic hyperactivity

Question 19

What are the criteria for alcohol use disorder?

Answer 19

2/11:

• Using more, for longer
• spending lots of time
• attempt to cut down
• cravings
• give up work
• give up activities
• give up relationships
• give up safety
• give up physical/mental health
• tolerance
• withdrawal