Alcohol addiction Flashcards
What is hazardous/harmful/problem drinking? (interchangeable terms)
Excess intake causing actual or potential harm, but no dependence
What is alcohol abuse?
Repeated drinking causing harm to work or social life
What 5 things mean alcohol dependence/addiction?
Increased tolerance, narrowed repertoire, withdrawal, difficulty/failure of abstinence, priority to maintain alcohol intake
Give 3 screening tools. What are the first two’s main drawback?
CAGE (>2 implies problem drinking), TWEAK (modified CAGE that includes tolerance). These two do not assess dependence or abuse, just that there is problem drinking. AUDIT – used to identify risk and offer advice.
Give 2 blood tests to screen and 2 blood tests to look at in alcohol withdrawal.
Gamma GT, MCV (macrocytic anaemia)
When should alcohol withdrawal be considered? How long does it take to start?
In EVERY new patient who is confused. Takes around 3 days after stopping drinking
Give 5 features. When is withdrawal Delirium tremens?
Increased pulse, low BP, tremor, seizures, visual or tactile hallucinations (i.e. formication) – hallucinations = delirium tremens
What is treatment for alcohol withdrawal?
Chlordiazepoxide or diazepam (2nd line)
What is Wernicke’s encephalopathy? Asides from alcohol dependence, give 3 causes
Medical emergency caused by thiamine (B1) deficiency. Eating disorders, malabsorption, brain tumours.
What is the clinical triad of Wernickes?
Confusion, wide based gait ataxia, ophthalmoplagia (nystagmus, conjugate gaze, bilateral CNVI palsies)
Give 5 other potential clinical features of Wernickes
Clouding of consciousness, memory disturbance, peripheral neuropathy, hypotension, hypothermia, ptosis.
How is Wernickes treated and what is the prognosis?
High dose IV/IM thiamine then PO. Prognosis: 20% die untreated, 80% ish get Korsakoff’s
What is Korsakoff’s syndrome?
Long-term thiamine deficiency. Leads to hypothalamic damage and cerebral atrophy
Give 3 clinical features of Korsakoffs and the prognosis
Confabulation, inability to acquire new memories, lack of insight. ¼ are reversible but even so, a slow and often incomplete recovery
What therapy can help w alcohol dependence?
Group therapy.
Give 2 medications that can help with managing dependence?
Disulfiram, naltrexone (opioid antagonist, helps ½ relapse rates)
Give 5 lifestyle measures for alcohol dependence
Slow down how fast you drink, don’t buy yourself a drink at rounds, go to the pub later, rewards for sobriety, alcohol diary
What problems does alcohol cause to the liver? CNS? GI? CVS?
Liver: Normal in 50%! Fatty liver hepatitis (10% get liver failure) 80% get cirrhosis with hepatitis. 50% 5 year survival if keep on drinking, 80% if not.
CNS: Wernicke’s, Korsakoff’s, cortical and cerebellar atrophy, peripheral neuropathy.
GI: Pancreatitis, varices, ulcers
CVS: Arrhythmias, cardiomyopathy
Give 2 cancers linked to alcohol.
Breast and bowel
What is a unit? Give 3 examples.
8g pure ethanol. 25ml spirit, 1 glass of wine, ½ pint of standard strength beer
What is the recommended weekly limits for men and for women?
14
What is binge drinking? How many people does it affect?
> 8U/day or >6U/day for men and women respectively. Effects 20% of men, 10% women