Alcohol abuse Flashcards
What is 1 standard drink? (4 points)
- 10g alcohol
- 1 port/sherry/small glass wine
- 1 nip cocktail
- 1 small glass beer
What are the safe alcohol limits for women to reduce long term health risks? (3 points)
- No more than 2 SD daily
- No more than 10 SD a week
- at least 2 alcohol free days/week
What are the safe alcohol limits for women to reduce risk of injury?
-no more than 4 SD on any single occassion
What are the safe alcohol limits for men to reduce long term health risks? (3 points)
- No more than 3 SD daily
- no more than 15 SD a week
- at least 2 alcohol free days per week
What are the safe alcohol limits for men to reduce risk of injury?
-no more than 5 SD on any single occassion
When is alcohol consumption more risky? (6 points)
- Pregnancy: risk of birth defects is greater. No safe drinking limit in pregnancy
- Thin people, young people, older people: metabolise alcohol slower
- Alcohol dependant
- Strong family Hx of alcoholism
- Are, or have been dependant on other drugs
- Poor diet, or are under-nourished
What activities are alcohol consumption more risky in? (6 points)
- When driving, operating machinery
- Boating, scuba driving etc
- with medication: sedatives, antidepressants, narcotics, NSAIDs,
- acute/chronic physical disease
- recovering from an accident, injury or operation
- mental illness
How do we define problematic drinking? (2 points)
- traditionally binary view,
- spectrum view more informative and less judgmental
What are the main categories on the alcohol continuum use? (6 points)
- no use
- moderate
- problematic
- hazardous
- harmful
- dependence
What is moderate use? (2 points)
- experimental use/social use
- no major problems
What is problematic use? (3 points)
some problems such as:
- missed work
- comedown/hangover
- family/whanau quarrels
What is hazardous use? (2 points)
problems AND increased risk of long term harm such as:
- relationship problems
- crime
What is harmful use? (4 points)
Problems AND increased risk of harm and long term damage such as :
- health
- violence
- break ups
- loss of job
What is dependence? (5 points)
All problems AND 3 or more of:
- withdrawal
- using to relieve withdrawal
- not able to predict/control use
- persist despite harm
- rapid return to dependence if relapse after abstinence
What are the 4L problem areas?
- Liver: (health problems)
- Lover: relationship problems
- Livelihood: employment-related issues
- Law: legal problems
What treatments are available for dependent drinking? (4 points)
- medication supported detox to manage withdrawal
- management of craving
- Psychosocial support
- prevent vitamin B deficiency
What is alcohol withdrawal? (5 points)
- affects 50% of dependent individuals
- onset 6-24 hours
- peaks 48 hours
- most severe Sx (delirium tremens) occurs after 3-7 days
- severe withdrawal can last up to 10 days
What are the withdrawal signs and symptoms? (9 points)
- Tremor
- Sweating
- Anxiety
- N&V
- diarrhoea
- insomnia
- tachycardia
- Hypertension
- dehydration
What are examples of severe alcohol withdrawal? (3 points)
- seizures
- hallucinations
- confusion
What is delirium tremens? (9 points)
- occurs 2-5 after cessation
- lasts 3-14 days
- autonomic instability
- paranoid delusions
- hypersensitivity to stimuli
- hallucinations (usually visual)
- confusion and disorientation
- agitation
- exclude head injury, sepsis etc.
What is detoxification?
short course medicine to prevent withdrawal symptoms when stopping alcohol
What does detox allow? (4 points)
- proactively apply motivational techniques
- facilitate insight building
- explore opportunities for after care
- facilitate links and transfer to aftercare
What medications are used in detox? (5 points)
- long acting benzo like diazepam
- start Tx early, when breath alcohol
What causes weincke encephalopathy and korsakoff syndrome?
thiamine deficiency (vitamin B1)
What are the symptoms of Wernicke’s? (3 points)
- eye movement abnormalities
- imbalance/other cerebellar signs
- confusion
What are the symptoms of Korsakoff? (5 points)
- memory
- blackouts
- minimal content in conversation
- lack of insight
- apathy
How is WE and KS treated and prevented? (2 points)
- Tx: B1 injection, nutrition and hydration. May be irreversible
- Prevention: healthy diet, thiamine supplements, may reduce development of WKS
What are some pharmacological supports for abstinence? (2 points)
- Antabuse
- Naltrexone
How does Antabuse work? (4 points)
- causes disulfiram reaction by inhibiting adlehyde dehydrogenase
- results in build up of acetaldehyde which is toxic
- within 5-30min of alcohol, hot flushes, throbbing of head and neck occur.
- Lasts up to several hours and may be ill for several days
Is disulfiram effective? (2 points)
- does not reduce craving for alcohol, but likely to deter drinking
- best with psychosocial support
What are the contraindications to disulfiram? (5 points)
- frailty
- Hx serious heart disease
- pregnancy
- advanced liver disease
- psychotic illness, severe personality disorder, risk of suicide
What cautions should be taken with disulfiram use? (5 points)
- may interact with metronidazole, isoniazid
- warn about sauces, mouthwash, cough mixtures, perfume, aftershave
- Px must be alcohol free for at least 24 hours
- must have full Px consent, disulfiram reaction explained, Family informed
- 3 weeks washout period if they want to drink again.
How does naltrexone work? (4 points)
- opioid antagonist which can be used after detox
- reduces craving for alcohol
- reduces feeling of intoxication
- reduces continuation of drinking
How much naltrexone is given? (2 points)
- 50mg daily
- initial dosage for Px at risk of ADRs are 12.5mg/day or 25mg/day for 1 week taken with food (2 weeks if necessary); then gradually increase to 50mg/day
Why does naltrexone work with alcohol abstinence?
-alcohol facilitates the brain opioid systems
What are the side effects and C/Is with naltrexone? (5 points)
- nausea, headache, dizziness, fatigue, insomnia, anxiety, sleepiness
- usually mild and short duration
- can have toxic effects on liver so LFTs are performed before Tx
- C/Ied in Px receiving opioid analgesics
- SA required for Px in Tx programmes
What is Audit C? (3 points)
- screening tool to identify Px who are risky drinkers
- enables health professionals to bring up the conversation without stigmatising and judging them
- total of 5+ indicates increasing or higher risk drinking: auditC positive
What are the questions in the shortened version of audit C? (3 points)
- how often do you have a drink containing alcohol?
- how many units of alcohol do you drink on a typical day when you are drinking
- how often hae you had 6+ units if female, or 8+ if male, on a single occasion in the lats year?
Once Px have been screened, what can we do? (5 points)
- determine how harmful the drinking currently is
- advise or refer
- willingness to change (HCPs and patients)
- teachable moments
- appropriate environment
What is the NNT for alcohol interventions?
-for every 7 interventions, 1 Px will reduce drinking to safer levels
What brief advice can you give to Px? (5 points)
- explain units/guidelines
- give feedback (risk level)
- offer info/advice
- establish goals/strategies
- empathy and encouragement
What are some barriers to alcohol intervention in pharmacies? (5 points)
- preventative health not my responsibility
- screening/brief intervention are not the things i should be doing
- don’t know who to refer to
- Px won’t take my advice and change their drinking behaviour
