Alcohol Flashcards
Signs of DT x6
Agitation
Anxiety
Sweating
Shaking
Tremors
Tachycardia
Define alcohol use disorder
A cluster of behavioral and physical symptoms that include alcohol cravings, withdrawal and tolerance
TIME 2 CUT DOWN PAL
Time spent
2+ symptoms
Cravings
Unable to stop
Tolerance
2 enzymes involved in alcohol use disorder
Alcohol dehydrogenase
Aldehyde dehydrogenase
Risk factors of AUD x5
Male gender
Age 18-25
Mood disorder
Personality disorder
Other substance use disorders
Dopamine pathways in the brain x4 and what they connect
Mesolimbic - ventral tegmental area to limbic sysytem
Mesocortical - ventral tegmental area to frontal cortex
Nigrostriatal - substantia nigra to dorsal striatum
Tuberoinfundibular- arcuate nucleus to pituitary gland
Describe how ethanol acts as a neurotransmitter x2
Ethanol is a GABA agonist > inhibition of neuronal stimulation and signaling
It acts as a glutamate (ie excitatory) antagonist
Effect of chronic alcohol use on neurotransmitters x2
Upregulation of glutamate as a compensation of the suppressing effect from ethanol
Downregulation of GABA
How do neuroadaptive changes cause alcohol withdrawal syndrome x3
Alcohol withdrawal leaves an excess of glutamate > Hyperexcitable brain state > seizures
Reward centers of the brain x2
Nucleus accumbens
Amygdala
Psychological causes of AUD x2
Personality traits
Conditioned learning
Biological causes of AUDx2
Genetics
Psychiatric comorbidities
Investigations in AUD and justification x3
FBC- r/o macrocytic anemia
LFTs- to check GGT, AST, ALT
RBS -damage to pancreas
Pharmacotherapy for AUD x5
Naltrexone- blocks euphoric effects
Acamprosate- decreases cravings
Disulfiram - unpleasant effects
Thiamine and vitamin B supplements
Describe motivational interview and its 4 principles
Used to enhance the patients motivation to change
Resist the righting reflex
Understanding patients own motivation
Listen with empathy
Empower
Psychological management of AUD x3
CBT
Motivational interview
Peer support groups
Public health approach to management of AUD x5
Strict age limit
Heavy taxation
Advertising restrictions
Time for selling alcohol
Limit availability of alcohol
Risk factors of AWS x5
Prior withdrawal
Family history of withdrawal
Concurrent medical conditions
Consumption of sedatives
Increased quantity and frequency
Pathophysiology of AWS x5
- Desensitization of the sympathetic nervous system > autonomic disturbance > tachycardia, hypertension and orthostatic changes
Pathophysiology of withdrawal seizures
Decreased GABA > decreased Cl influx > decreased hyperpolarization > more action potentials > seizures
Triad of Wernicke encephalopathy
Ataxia
Ophthalmoplegia
Acute cognitive impairment
DSM criteria for AWS x4
- Cessation of prolonged heavy alcohol use
- Two or more of; anxiety, autonomic hyperactivity, N&V, Insomnia, hallucinations
- Those in B cause distress and functional impairment
- Not due to any medical condition or mental disorder
Differential for AWS x4
DKA
Hypoglycemia
Essential tremor
Sedative withdrawal
Management of AWS x4
Rehydration
Benzodiazepines
Antipsychotics
Correct electrolyte imbalances
Where are cannabis receptors present x4 and function of each
Hypothalamus- appetite
Amygdala- fear and anxiety
Brain stem- vomiting reflex
Spinal cord - pain sensation
Effects of acute and chronic cannabis use x2 each
Acute- euphoria and relaxation
Chronic- paranoia and depression
Syndrome caused by
heavy cannabis use
Amotivational syndrome - loss of energy and drive
Cannabis withdrawal symptoms x3
Irritability
Insomnia
Hostility
What specific substance is responsible for cannabis induced psychosis
THC tetrahydrocannabinol
What do opioids do in the brain
Activation of brain reward system > reinforcement of behaviors
Conditions and outcomes that opioid use is associated with x5
Hepatitis
High HIV prevalence
Preterm delivery
Fetal death
IUGR
Screening tool of opioid use disorder
ASSIST- alcohol smoking and substance involvement screening tool
Pharmacotherapy for opioid disorder X3
Naltrexone
Methadone
Buprenorphine - good neonatal outcomes
Treatment goals for Opioid used disorder x3
Reduce HIV
Reduce criminality
Reduce drug associated mortality
Management of opioid use disorder X6
Motivational interview
Harm reduction strategies
Mutual help groups
Causes of death in DT x3
Hyperthermia
Cardiac arrhythmias
Complications of seizures
Effects of chronic cannabis use x3
Paranoia
Low motivation
Depressive symptoms
Features of cannabis dependence x2
Tolerance with heavy use
Abstinence leads to withdrawal symptoms
5 stages of motivational enhancement therapy
Express empathy
Develop discrepancy
Avoid argumentation
Roll with resistance
Support self efficacy
