Alcohol Abuse Flashcards
What is hazardous drinking?
What is harmful drinking?
What sex is it more common in?
Consumption that increases the risk of harm
Drinking that adversely affects physical or mental health
Men
Presentation:
Liver - how does it progress?
GI effects:
- General - 2
- Stomach and duodenum - 1
- Oesophagus - 2
- Biliary system - 1
D&V
Cancer
PUD
Varices, presenting with haematemesis and/or melena
Oesophageal erosions
Pancreatitis
Presentation:
Neurological
Memory and cognitive impairments Peripheral neuropathy Seizures Falls Wernicke's encephalopathy
Presentation:
Psychological - 2
What is alcoholic hallucinosis?
Psychosis
Morbid jealously e.g. delusions that their partner is unfaithful
In chronic alcoholism, the hallucinations are auditory, while in withdrawal they are often visual or tactile.
Presentation:
CVD - 3
Arrhythmia
HTN
Cardiomyopathy
Other presentations of alcohol abuse?
Anaemia Osteoporosis Reduced fertility Breast cancer Accidents Social problems
Investigations:
What tool can be used in any routine care?
Further assessment:
AUDIT - what does it stand for? what does it assess?
SADQ - what does it stand for? what does it assess?
APQ - what does it stand for? what does it assess?
CAGE alcohol questionnaire
FAST screening tool - UK
Alcohol Use Disorders Identification Test - assess pattern and severity
The Severity of Alcohol Dependence - to assess severity
Alcohol Problems Questionnaire - to assess secondary problems
Q’s to ask in history
What shouldn’t be forgotten?
Current and historical Hx
Typical day
Frequency
Volume
Psych - ask about mood and other psych symptoms - hallucinations for example
Social effects of alcohol:
Relationships
Work
Criminal behaviour
Social disintegration
Domestic violence
Divorse
Child neglect and abuse
Unemployment
Absent
Under-performance
Drunkenness Drunk and disorderly Drink driving Criminal damage Theft Bulglary Violence
Financial difficulties
Homelessness
How may units are in the following:
Regular pint - beer/lager/cider
Can of lager
Glass of wine
1 Shot
A bottle of wine
LOOK AT PRESENTATION
2
1.5
2
1
9
Investigations:
Why do you do FBC?
Why do you do LFT’s?
What can be used to diagnose cirrhosis in all persistent heavy drinkers?
Macrocytic anaemia
Raised GGT, AST and ALT
FibroScan
Management - Assisted withdrawal:
> How many units should the patient be drinking before this is offered?
A combo of drugs and individual, group or self-help psychotherapy is offered:
> How many weeks of community-based Rx is given for most people?
> How many meetings per wk does someone with moderate dependence need?
> What can be used to people with severe dependence?
> 15 units/day
3 wks
2-4 per week
Intensive day programmes for most of the wk
Management - Biological:
During withdrawal:
What drug is used?
What is given to prevent neurological complications?
Benzodiazepines - chlordiazepoxide or diazepam
Thiamine - Pabrinex
Management - Biological:
Maintenance:
What drugs are used for maintenance? - A, N
What can be used if the top 2 aren’t suitable? - D
What tests need to be done to establish baseline?
Acamprosate - reduces craving
Naltrexone - reduces pleasure as opioid receptor
Disulfiram
U&E, LFTs
Management - Psychological:
When is psychological Rx needed?
1st
What type of interviewing can be done?
What CBT’s are available? - 3
For mild dependence
Combination with pharmacotherapy for withdrawal and relapse prevention
Motivational interviewing
Individual, group or behavioural couples therapy
Management - Social:
Who needs to be contacted?
What else should you think about apart from the person?
What can be offered to the homeless
DVLA if they drive
Won’t be allowed to drive until 1 yr alcohol-free.
Safeguarding issues e.g. child neglect, domestic abuse
3 months of residential rehabilitation - try and find long-term housing before discharge.
Disulfiram:
MOA?
Side effects?
Contraindications? - don’t forget a AB!!
It prevents conversion to a chemical that causes hangover-like symptoms.
Headache and blurring of vision N&V Chest pain Anxiety and confusion Sweating --------- Severe CVD Pregnancy Psychosis Metronidazole
Alcohol Withdrawal:
How long after their last drink does it begin?
Physical signs - 3
Psychological signs - 3
6-24 hrs
Tremor
Sweats
Nausea
Insomnia
Altered mood
Alcoholic hallucinosis
Alcohol Withdrawal:
What type of seizure do they tend to get?
How long after their last drink could a seizure begin?
Generalised tonic-clonic seizure
12-48 hrs
Alcohol Withdrawal:
Alcoholic hallucinosis:
What types of auditory, visual, and tactile hallucinations do they have?
How long does it take for this to present?
When does it resolve?
What other symptoms do they get?
Auditory - e.g. hostile voices
Visual - e.g. Lilliputian - things and people seem tiny
Tactile - e.g. formication - insects crawling on/under skin
12-24 hrs
48 hrs
Headaches
Dizziness
Irritability
Alcohol Withdrawal:
Delirium tremens:
How many days after the last drink does it present?
2 physical symptoms
2 psychological symptoms
OBS??
3-7 days
Tremor and seizures
Delirium and confusion
High HR and low BP
Alcohol Withdrawal - Management:
What needs to be done as always?
How are symptoms monitored?
What drug is given orally for seizures and sedation?
What alternative can be used if there is liver impairment? - O
What drug can be given if the seizures continue? - L
What nutritional support needs to be given?
ABCDE
CIWA-Ar - Clinical Institute Withdrawal Assessment for Alcohol Scale
Benzodiazepines - chlordiazepoxide or diazepam
Oxazepam
Lorazepam
Thiamine Folate Correction of any deficiencies in glucose Potassium Magnesium Phosphate
Alcohol misuse results in reduced thiamine (Vit B1) intake from poor nutrition and impaired GI absorption. What 2 things does it cause?
Wernicke’s encephalopathy and Korsakoff’s syndrome
Wernicke’s encephalopathy:
What is the classic triad:
- Eyes
- Gait
- Mind
CAN BE MISTAKEN FOR INTOXICATION!!
Ophthalmoplegia - nystagmus, lateral rectus palsy
Ataxia with wide-gait
Confusion
Korsakoff’s syndrome:
What is it?
Define:
- anterograde amnesia
- retrograde amnesia
- confabulation
The chronic manifestation of thiamine deficiency.
Can’t form new memories
Can’t remember the past - RETRO 80’S PAST
False memories - believed to the true - to fill the memory blanks
Wernicke’s encephalopathy and Korsakoff’s syndrome:
Management
Why do you have to be careful with glucose for correcting hypoglycaemia?
Thiamine replacement - IM or IV as an inpatient
THEN PO long term
Thiamine must be given if glucose is given as glucose depletes remaining thiamine.
