Alcohol Flashcards
T/F: You should tell alcohol abusers to simply quit drinking
FALSE: withdrawal can be dangerous
What is the mechanism of alcohol?
- GABA inhibition
- NMDA inhibition
- Diminishing glutamate
Withdrawal causes hyperexcitation (uncontrolled excitatory pathways)
Alcohol withdrawal symptoms
Two or more:
- N/V
- Insomnia, anxiety
- Grand mal seizures
- Psychomotor agitation
- Hand tremor
- Autonomic hyperactivity
- Hallucinations
Timeline of withdrawal symptoms
Tremors (6-36h) ->
Hallucinations (12-48h) -> Seizures (6-48h) ->
Delirium tremens (48-96h)
What percent of withdrawal patients who have seizures will have delirium tremens?
30%
Delirium tremens
- 3-5 days after last drink
- Less than 5% of patients
- 2-3 days usually, but can last up to 30 days
- Delirium +/- tremens
- HTN, fever, tachycardia, confusion, hallucination
- Significant mortality risk
Withdrawal treatment/prophylaxis
- Thiamine 50-100 mg
- Maintenance fluids
- Multivitamin
- Standing order: benzo/clonidine
Benzodiazepine
- Better long acting
- Malnourished/liver disease: short acting better (alprazolam/midazolam)
- Tailored dosing using CIWA-Ar score
Maintenance of sobriety
Support groups** (maximizes treatment efficacy)
- Disulfiram
- Naltrexone
- Acamprosate
Disulfram
Sucks
- Punishes patient for having a drink
- Makes you extremely sick
- HypoTN, N/V, produces seizures
- Many side effects
- Don’t use <12h after alcohol use
Drugs that can precipitate disulfiram reaction
- Antibiotics (metro)
- Sulfonylureas (tolbutamide)
- Cephalosporins with N-methylthio-tetrazole moeity
- Griseofulvin (antifungal)
Naltrexone
- Decreases cravings (just like opioids)
- CANNOT use opioids (won’t work)
Acamprosate
- Drug of choice*
- Similar to GABA
- Decreases cravings
- Renal dosing
- Risk of relapse
