Alcohol abuse and cirrhosis review article Flashcards
What are the 3 benzo regimens for AWS
Fixed schedule: Same dose of benzos regardless of symptoms (easy to use, possible to over or under treat; generally not recommended)
Front loading: Frequent high benzo dose until patient symptoms are controlled or lightly sedated (quick improvements of symptoms, requires close monitoring)
Symptom-triggered: Uses physical exam to determine the severity of withdrawal (lower total benzo use, may be difficult to determine severity from physical exam)
Which pharmacological characteristic determines onset for the benzo class of medications
Lipophilicity. The more lipophilic the drug, the faster the onset.
Which 2 benzos have the fastest onset (< 30 min)
Xanax and Valium
Which 3 benzos take effect within an intermediate amount of time (30-60 mins)
Librium, Klonopin, Ativan
Which 2 benzos have a slow onset (>60 min)
Tranxene (chlorazepate), Serax (oxazepam)
Rank the benzos used in alcohol withdrawal from shortest to longest half life
Shortest: Xanax
Intermediate: Ativan, Serax
Long: Librium, Klonopin, Tranxene, Valium
Describe the relationship between half-life and withdrawal symptoms severity with benzos
Benzos associated with a greater potential for withdrawal symptoms include those with a short-intermediate half life. Benzos with a long half life have a decreased severity of withdrawal symptoms.
When is benzo tapering necessary
Patients who require high doses of benzos for extended periods of time should receive a taper. (> 2 weeks)
How do we taper benzos?
Reduce the dose by 10-25% Q 1-2 weeks as tolerated. Benzos with long half life can be tapered more rapidly. Shorter half life requires a slower taper.
Identify alternative therapies for patients with severe/refractory alcohol withdrawal
Anti-epileptic drugs: Phenobarb,
Antipsychotics: Haldol
Propofol and dexmedetomidine
