Alcohol addiction and withdrawal Flashcards
criteria of dependency
strong desire to take substance difficulties in controlling substance abuse withdrawal state increased tolerance neglect of alternative pleasures persistence despite harm
screening tool to assess dependency
CAGE felt should Cut down? felt Annoyed at criticism? Guilty? Eye opener - eg used it to get rid of nerves
what neurotransmitter is involved in the reward and addition pathway
dopamine
why does tolerance occur
functional decrease in D2 receptors - synaptic plasticity
role of striatum
habit learning
role of hippocampus
declarative learning - learning information you can speak
neurotransmitter released in stress and its effect in addiction
dopamine - can motivate drug seeking behaviour in times of stress
high risk occupations for alcoholism
bartenders itinerant workers (travelling place to place) professional autonomy (eg doctors)
how to calculate no. of units
(% x volume in ml) / 10
how many units in bottle of wine
8-10
how many units do high risk drinkers consume
> 35/week
how many units do increased risk drinkers consume
15-35/week
UK alcohol recommendation of u/week
14u/week spread across three of more days
what lab tests can be used to screen for alcohol related problems
GGT - indication of liver injury
carbohydrate deficient transferrin - men drinking 5+ units/day for >2weeks
raised MCV
what intervention tool is used in alcohol dependency
FRAMES Feedback (problems caused by alcohol) Responsibility Advice (reduction and abstinence) Menu (options) Empathy Self-efficiency
what receptors does alcohol inhibit
excitatory NMDA (glutamate) receptors
effect of chronic alcohol use on these receptors
upregulation of NMDA receptors
down regulation of GABAa receptors
what receptors does alcohol stimulate
GABAa receptors (inhibitory neurotransmitter)
what does alcohol withdrawal cause in terms of receptors
increased glutamate action
decreased GABA action
when do first symptoms occur in alcohol withdrawal
occur within hours
peak at 24-48 hours
symptoms of alcohol withdrawal
restlessness tremor sweating anxiety nausea/vomiting loss of appetite insomnia generalised seizures delirium tachycardia postural hypotension
how long do alcohol withdrawal symptoms take to resolve
5-7 days
presentation of delirium tremens
insidious onset night time confusion/disorientation agitation hypertension fever visual/auditory hallucinations paranoid ideation
management of alcohol withdrawal
long acting benzodiazepines (diazepam, chlordiazepoxide)
parenteral thiamine as prophylaxis against Wernicke’s encephalopathy
antiemetics
what is Wernicke’s encephalopathy
used up all of vit B (particularly vit B1/thiamine)
presentation of wenicke’s encephalopathy
nystagmus
ataxia
opthalmoplegia
what medications can be used for relapse prevention
disulfiram (Antabuse)
naltrexone
acamprosate
how does disulfiram work
inhibits acetaldehyde dehydrogenase - accumulation of acetaldehyde if alcohol ingested
causes flushed skin, tachycardia, nausea vomiting and hypotension
when should disulfiram be used
motivated individuals only (as an extra deterrent)
how does naltrexone work
opioid antagonist - reduces reward of alcohol
when should naltrexone be used
first line
how does acamprosate work
acts on central glutamate/GABA systems to reduce cravings
SE acamprosate
headaches
diarrhoea
nausea
