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Psychiatry > Alcohol > Flashcards

Alcohol Flashcards

1
Q

What is the recommended weekly intake of alcohol for adults?

A

14units

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2
Q

What is the difference between an alcoholic and an alcohol abuser?

A

Dependancy

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3
Q

What are the potential consequences of being drunk?

A 
Trauma (fights, falls)
Vomiting
Radial nerve palsy
Risk taking behaviour
Vasodilation
Hyperglycaemia
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4
Q

What are the problems associated with vomiting when drunk

A

Light: Aspiration= pneumonia
Heavy: Airway obstruction and potential death

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5
Q

What are the problems associated with radial nerve palsy when drunk?

A

E.g fall asleep with your arm in an unusual position (over the back of a chair)
radial nerve can get stuck in the radial groove and compressed.
This can lead to nerve damage.
Sign= drooping wrist
Sometimes permanent, some cases last a couple of weeks.

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6
Q

How does alcohol work on the brain?

A

GABA agonist
GABA neurones are inhibitory
So alcohol suppresses brain activity- Depressant

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7
Q

How does alcohol withdrawal affect the brain?

A

1) Ethanol interacts with two major receptors in the central NS essential for normal CNS function (GABA &NMDA).
2) Chronic alcohol use upregulates NMDA receptors and down regulates GABA receptors
3) A decrease in concentration due to cessation results in imbalance between stimulatory & inhibitory systems in the CNS
4) Excessive stimulatory effect leads NS hyperactivity, dysfunction & development of the clinical signs & symptoms- can intensify as withdrawal episodes grow in number known as ‘Kindling’

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8
Q

What are the side effects associated with alcohol withdrawal?

A 
Hallucinations: Persecutory
Change in mental staus: Delusions
Delirium Tremens: Overactive peripheral NS
Tremor
Seizures: Unilateral tonic-clonic
Cardiac problems (Arrhythmia, tachycardia)
Hypertension
Vomiting & retching
Diarrhoea
Loss of appetite
Wernickes encephalopathy
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9
Q

What increases the risk of seizures in alcohol withdrawal?

A

Frequency of detoxing

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10
Q

What are the most common hallucinations in alcohol withdrawal?

A

Persecutory (spiders/snakes crawling all over them)

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11
Q

What is tremens?

A

CAN BE LIFE-THREATENING
Overactivity of the PNS
Acute confusional state associated with tremors & autonomic dysfunction
The patient will be very sweaty (possibly sweating up to 10L of fluid a day!) and will shake.
Develops usually 1week post- heavy OH-
Tx: Lorazepam

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12
Q

What is the most common seizure type in alcohol withdrawal?

A

Unilateral often resulting in Tonic-clonic

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13
Q

What drugs are used to treat alcohol withdrawal?

A 
Nutritional support
Chlordiazepoxide: 50-100mg
Phenobarbital
Benzodiazepines: Diazepam for seizures
Lorazepam, Haloperidol for Tremens
Acute: 50-100mg Chlordiazepoxide (Librium)/Diazepam 6hourly for first 3days
Oral Thiamine (severe = IM Pabrinex)
Folic acid & Vitamin B
Magnesium sulphate
Severe: Above
Dexmedetomidine (sedative)
Propofol (Benzo resistant withdrawal)
Carbamezapine (seizures)
OH- related hep: Corticosteroids
Tremens: Phenobarbital
Long-term: Disulfiram, Naltrexone
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14
Q

What are the consequences of long-term alcohol abuse?

A

Liver: NAFLD, Jaundice, Cirrhosis, Abnormal clotting, Alcoholic hepatitis, Reduced albumin production, Varices, Asterixis, Hypoglycaemia
Pancreas: Acute pancreatitis
GI Tract: Varices, Poor dentition, Oesophagitis, Inc risk of ulcers, Gastritis, Diarrhoea, Malnutrition
Heart: Alcohol cardiomyopathy, AF
Nervous System: Korsakoff’s syndrome, Peripheral neuropathy, thiamine deficiency
Endocrine: Diabetes, Problems metabolising oestrogen to testosterone

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15
Q

What are the consequences seen in the blood for long-term alcohol abuse?

A 
Hypertension 
Inc atherosclerosis
Folic acid & VitD deficiency
Inc RBC size & MCV
Bone marrow damage (reduced platelets)
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16
Q

What is Korsakoff’s Syndrome?

A

Caused by a lack of thiamine (vitamin B1) in the brain
Antero & retrograde amnesia & confabulation
Often alcoholics present just before their deficiencies are low enough for this syndrome to occur
!!Every alcoholic coming into hospital is put on a thiamine drip within an hour of admission!!

17
Q

What are the signs of thiamine deficiency?

A

Broad based gait

Eye movements affected

18
Q

How is an alcoholic managed?

A 
IV vitamin B12 + thiamine (Pabrinex)
Drain ascites
Librium 10-50mg/kg every 6hrs for 3days
Consider steroids
Nutrition
Tramadol
Laxatives
Spironolactone
19
Q

What is asterixis?

A

Shaking of the hands caused by encephalopathy secondary to build up of toxic metabolites in the brain which can no longer be metabolised by the liver

20
Q

How do varices occur?

A

If the liver is damaged, then intra-hepatic pressure increases causing portal hypertension.
Leads to oesophageal and rectal varices, as the blood tries to find another way to bypass the liver back to the systemic circulation.
Can burst & bleed, and common cause of death.
GI bleeding is a common emergency presentation in patients with alcoholic liver damage.

21
Q

What is the pathophysiology of alcohol dependence?

A

Pleasurable & stimulant effects of alcohol are mediated by a dopaminergic pathway projecting from the ventral tegmental area to the nucleus accumbens.
Repeated excessive alcohol ingestion sensitises this pathway & leads to the development of dependence.

22
Q

What are the long-term effects of alcohol on the brain?

A

Long-term exposure causes adaptive changes in neurotransmitter systems including down-regulation of inhibitory neuronal gamma-aminobutyric acid receptors, up-regulation of excitatory glutamate receptors & inc central norepinephrine activity

23
Q

What are the signs of alcohol dependence?

A 
Unable to keep to drinking limit
Missing meals
Difficulty in avoiding getting drunk
Memory lapse/blackout
Morning drinking
Spending a considerable time drinking
Excess sweating at night
Ascites & jaundice
Broad based gait
24
Q

What are the social problems related to drinking?

A 
Domestic violence
Marital/sexual difficulties
Child abuse
Financial & employment difficulties
Homelessness
accidents
25
Q

What are the different affects of alcohol at different concentrations?

A

20-99: Euphoria, impaired coordination
100-199: Ataxia, poorjudgement, labile mood
200-299: Marked ataxia, N&V, labile mood, poor judgement, slurred speech
300-399: Stage 1 anaesthesia, memory lapse, labile mood
400+: Resp failure, coma, death

26
Q

What are the psychological effects of drinking?

A 
Depression
Anxiety
Memory problems
Delirium tremens
Attempted suicide
Suicide
Pathological jealousy
27
Q

How is alcohol dependence investigated?

A

2/11 DSM-5 criteria over the same 12 month period
CAGE questionnaire
Alcohol level (blood & breath)
CIWA-Ar >8-10 significant alcohol withdrawal

28
Q

How is OH- withdrawal investigated?

A

U&Es
LFTs
Tox-screen: +ve for ethanol
Electrolyte panel: Metabolic acidosis

29
Q

If Wernicke’s encephalopathy is left untreated what can it become?

A

Korsakoff’s syndrome

Permenant irreversible brain damage

30
Q

What are the signs & symptoms of Wernicke’s encephalopathy? How is it treated?

A

TRIAD: Confusion, ataxia, nystagmus
Parenteral Thiamine (Pabrinex)
Other signs: ophthalmoplegia, memory disturbance, coma, hypothermia, hypotension

Psychiatry (19 decks)

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