Alcohol

Question 1

Disulfram

Answer 1

-Blocks aldehyde dehydrogenase and makes acetaldehyde build up and make pt sick (neg reinforcement) - other meds do this (Flagyl)
-Pt needs to be alcohol free for at least 12 hours
-Dose: 500 mg qd for 1-2 weeks
-Maintenance: 250 mg qd until recovered
-SE: drowsiness, HA, rash, acne, hepatic failure, etc.
Use caution: diabetes, hepatic impairment, hypothyroidism, nephritis, seizures

Question 2

Naltrextone

Answer 2

-50 mg daily
-If pt requires narcotics they won’t work

Question 3

Acamprosate

Answer 3

-Take 3 times daily
-Give when patient is abstinent
-CI: severe renal impairment

Question 4

Type 1 alcoholic

Answer 4

develops gradually

Question 5

Type 2 alcoholic

Answer 5

Early onset

Question 6

Tests

Answer 6

MCV elevated
high levels of GGT
high AST, ALT
high uric acid, triglycerides
ethyl glucuronide and ethyl sulfate are good markers

Question 7

Neuropharmacology of ethanol

Answer 7

-enhances GABA system
-inc dopamine
-activates opioid peptide system
-block NMDA receptor

Question 8

Gender differences

Answer 8

-ethanol distributes to total body water and lean mass - women tend to have smaller vd
-women have less efficient pre-hepatic alcohol dehydrogenase - greater bioavailability

Question 9

Wernickes syndrome

Answer 9

thiamine withdrawal

Question 10

Korsakoff syndrome

Answer 10

from long standing wernickes

Question 11

Management/prophylaxis

Answer 11

-thiamine 50-100 mg/d
-D5 and 0.45 NS
multivitamin
standing orders for clonidine, benzos

Question 12

Symptom triggered regimens

Answer 12

admin 1 every hr when >/= 8-10 (diazepam, lorazepam)

Question 13

Fixed schedule regimens

Answer 13

-Diazepam 10 mg every 6 hrs for 4 does, then 5 mg every 6 hrs for 8 doses
-Lorazepam 2 mg every 6 hours for 4 does, then 1 mg every 6 hours for 8 doses