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September lectures yr 3 (2018) > Alcohol > Flashcards

Alcohol Flashcards

1
Q

Define alcoholic:

A

primary chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking

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2
Q

Define: dependence

A

needs 3 of 7 conditions over 12 months

  • tolerance
  • withdrawal symptoms
  • ingestion in larger amounts
  • persistent desire
  • expenditure of increase time in drinking/recovering
  • abandoning social/work activities
  • continued ingestion despite problem
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3
Q

What does the DSM-5 state about alcohol abuse?

A

integrates alcohol abuse and alcohol dependence into alcohol use disorder (AUD)

  • mild, moderate or severe subclassifications
  • > 6 = severe
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4
Q

Is alcohol ever good for you?

A

Definitive data lacks proof of the cardiovascular benefits of alcohol whereas the harms are well established

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5
Q

What is 1 unit of alcohol?

A

10ml ethanol = 8 g ethanol

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6
Q

How is alcohol absorbed?

A

duodenum-jejunum over 80%
process of simple diffusion
rate is concentration dependent and related to stomach emptying

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7
Q

How is alcohol distributed following absorption?

A

rapidly distributed - rich blood supply = faster effect
crosses BBB easily
Volume of distribution equal to total body water - 0.6L/kg
differences between men and women - higher effect on women
fatter people high relative blood concentration - reason affects women more

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8
Q

How is alcohol metabolised?

A

98% by ADH to acetylaldehyde and then by ALDH to acetate

  • acetylaldehyde is toxic and causes nausea, flushing and headaches
  • there are genetic variations in ALDH
  • ADH is rate limiting step
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9
Q

What is the normal clearance rate of alcohol?

A

6g/hour

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10
Q

How is alcohol excreted?

A

small amounts not metabolised and excreted unchanged

- in urine and breath - useful for detection

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11
Q

What is the pharmacological effect of alcohol?

A

Central nervous system depressant - (apparent stimulatory effects are due to depression of inhibitory control mechanisms in the brain)
GABA-A potentiation
NMDA antagonist - causing glutamate inhibition
effects on serotonin, opioid and dopaminergic neurotransmission (reward centres)

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12
Q

What is the legal driving limit in England and wales?

A

80mg alcohol /100ml blood
35 micrograms alcohol / 100ml breath
107mg alcohol / 100ml urine

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13
Q

What effect does alcohol have on CNS drugs ?

A

increased drowsiness/sedation

e.g. SSRIs, benzodiazepine, antihistamines

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14
Q

What effect does alcohol have on antihypertensives/cardiovascular drugs?

A

enhanced hypotensive effects

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15
Q

What effect does alcohol have on warfarin?

A

major changes in consumption of alcohol may affect anticoag control with coumarins

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16
Q

What effect does alcohol have on metronidazole / ketoconazole?

A

inhibits ALDH - gives you an awful hangover effect - like a disulfiram like reaction

17
Q

What does disulfiram do?

A

certain drugs inhibit ALDH causing accumulation of acetylaldehyde
- used as an aversion therapy - help alcoholics stop drinking

18
Q

What are the medical uses of alcohol?

A

local use - bacteriocidal swabs/gels
used in pharmaceutical solutions - awareness of their use in children
methanol/ethylene glycol poisoning - competitively inhibiting ADH - now fomepizole is more commonly used

19
Q

What are the main medical / psychiatric problems associated with alcohol?

A

acute alcohol intoxication
alcohol withdrawal reactions - inc delirium tremens
chronic alcoholism
contributes to obesity epidemic

20
Q

What are the characteristic features of acute alcohol intoxication and common causes of death?

A

AAI associated with violence, accidents, injuries, sexual victimisation and suicides
Common causes of death - aspiration from vomiting when reduces GCS or trauma
Beware of associated hypoglycaemia (esp. in children)

21
Q

What is binge drinking classified as?

A

> 8 in males and >6 in females at once

22
Q

What does the CAGE questionnaire stand for?

A 
Cut down amount of drinking 
Annoyed by criticism 
Guilty feelings about drinking 
Eye opener in the morning 
- this questionnaire is not as sensitive in white females or pregnancy
23
Q

What are a couple of other screening tests?

A

Fast and audit

24
Q

When trying to diagnose an alcohol problem what physical examinations are carried out?

A 
usually no findings
Signs of chronic liver disease
parotid enlargement 
rhinophyma 
peripheral neuropathy
signs of withdrawal
25
Q

When trying to diagnose an alcohol problem what laboratory tests are carried out?

A

FBC - macrocytosis in the absence of anaemia can be due to alcohol
U&Es - low urea
LFTs - raised transaminases
Gamma GT - elevated - if associated with liver pathology
INR - prolonged

26
Q

What are the alcohol withdrawal symptoms at 6-12 hours?

A 
insomnia
tremulousness
anxiety
GI upset
headache
diaphoresis
palpatations
anorexia
27
Q

What are the alcohol withdrawal symptoms at 12-24 hours?

A

alcoholic hallucinosis: visual, auditory or tactile hallucinations

28
Q

What are the alcohol withdrawal symptoms at 24-48 hours?

A

generalised tonic clonic seizures

29
Q

What are the alcohol withdrawal symptoms at 48-72 hours?

A 
delirium tremens
halluncinations 
disorientation
tachycardia
increase BP
mild fever
agitation 
diaphoresis
30
Q

What are the principles of managing alcohol withdrawal?

A

ABC - resus
Prevention/ treatment of encephalopathy
Prevention/treatment of withdrawal
Prevention/treatment of complications

31
Q

What is involved in the prevention/ treatment of encephalopathy?

A

vitamins-thiamine and other B vitamins
Severe deficiency states (e.g. wernickes) best treated by parenteral therapy
High potency vitamin B complex (parabrinex)- contains high dose thiamine (B1), riboflavin (B2), pyridoxine (B6), nicotinamide and vit C
2-3 pairs of ampoules every 8 hours
SE: potentially serious allergic reaction

Followed by..

  • oral thiamine 200-300 mg daily
  • and vit B compound strong 2 tabs TDS
32
Q

What is involved in the prevention/ treatment of alcohol withdrawal?

A

Community / hosp setting
- benzodiazepines
treatment of symptoms / prevention of seizures
reactive- prescribe according to symptoms (clinical institute withdrawal assessment for alcohol (CIWA))
expectant - prescribe fixed dose

33
Q

What is involved in the prevention/ treatment of complications and abstinence?

A

associated psychiatric problems
social interventions - AA, aquarius
pharmacological maintence of abstinence
- acamprosate - stabilises glutamate and GABA systems = reduces cravings, anxiety and insomnia
- naltrexone - opioid antagonist - helpful as an adjunct to alcohol dependence after withdrawal treated, reduce rate of relapse
- nalmefene - opioid receptor modulator - reduction of alcohol consumption - take 1-2 hours before drinking
- disulfiram - inhibits ALDH leading to flushing, sweating and nausea

September lectures yr 3 (2018) (56 decks)

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