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Psychiatry HK > Alcohol addiction and withdrawal > Flashcards

Alcohol addiction and withdrawal Flashcards

1
Q

criteria of dependency

A 
strong desire to take substance 
difficulties in controlling substance abuse 
withdrawal state
increased tolerance 
neglect of alternative pleasures 
persistence despite harm
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2
Q

screening tool to assess dependency

A 
CAGE 
felt should Cut down?
felt Annoyed at criticism?
Guilty?
Eye opener - eg used it to get rid of nerves
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3
Q

what neurotransmitter is involved in the reward and addition pathway

A

dopamine

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4
Q

why does tolerance occur

A

functional decrease in D2 receptors - synaptic plasticity

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5
Q

role of striatum

A

habit learning

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6
Q

role of hippocampus

A

declarative learning - learning information you can speak

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7
Q

neurotransmitter released in stress and its effect in addiction

A

dopamine - can motivate drug seeking behaviour in times of stress

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8
Q

high risk occupations for alcoholism

A 
bartenders 
itinerant workers (travelling place to place)
professional autonomy (eg doctors)
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9
Q

how to calculate no. of units

A

(% x volume in ml) / 10

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10
Q

how many units in bottle of wine

A

8-10

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11
Q

how many units do high risk drinkers consume

A

> 35/week

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12
Q

how many units do increased risk drinkers consume

A

15-35/week

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13
Q

UK alcohol recommendation of u/week

A

14u/week spread across three of more days

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14
Q

what lab tests can be used to screen for alcohol related problems

A

GGT - indication of liver injury
carbohydrate deficient transferrin - men drinking 5+ units/day for >2weeks
raised MCV

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15
Q

what intervention tool is used in alcohol dependency

A 
FRAMES
Feedback (problems caused by alcohol)
Responsibility 
Advice (reduction and abstinence)
Menu (options)
Empathy
Self-efficiency
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16
Q

what receptors does alcohol inhibit

A

excitatory NMDA (glutamate) receptors

17
Q

effect of chronic alcohol use on these receptors

A

upregulation of NMDA receptors

down regulation of GABAa receptors

18
Q

what receptors does alcohol stimulate

A

GABAa receptors (inhibitory neurotransmitter)

19
Q

what does alcohol withdrawal cause in terms of receptors

A

increased glutamate action

decreased GABA action

20
Q

when do first symptoms occur in alcohol withdrawal

A

occur within hours

peak at 24-48 hours

21
Q

symptoms of alcohol withdrawal

A 
restlessness
tremor
sweating 
anxiety
nausea/vomiting
loss of appetite 
insomnia 
generalised seizures
delirium
tachycardia
postural hypotension
22
Q

how long do alcohol withdrawal symptoms take to resolve

A

5-7 days

23
Q

presentation of delirium tremens

A 
insidious onset
night time confusion/disorientation
agitation 
hypertension 
fever
visual/auditory hallucinations 
paranoid ideation
24
Q

management of alcohol withdrawal

A

long acting benzodiazepines (diazepam, chlordiazepoxide)
parenteral thiamine as prophylaxis against Wernicke’s encephalopathy
antiemetics

25
Q

what is Wernicke’s encephalopathy

A

used up all of vit B (particularly vit B1/thiamine)

26
Q

presentation of wenicke’s encephalopathy

A

nystagmus
ataxia
opthalmoplegia

27
Q

what medications can be used for relapse prevention

A

disulfiram (Antabuse)
naltrexone
acamprosate

28
Q

how does disulfiram work

A

inhibits acetaldehyde dehydrogenase - accumulation of acetaldehyde if alcohol ingested
causes flushed skin, tachycardia, nausea vomiting and hypotension

29
Q

when should disulfiram be used

A

motivated individuals only (as an extra deterrent)

30
Q

how does naltrexone work

A

opioid antagonist - reduces reward of alcohol

31
Q

when should naltrexone be used

A

first line

32
Q

how does acamprosate work

A

acts on central glutamate/GABA systems to reduce cravings

33
Q

SE acamprosate

A

headaches
diarrhoea
nausea

Psychiatry HK (21 decks)

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