Alcohol and Addiction Flashcards
Functions of the liver
carbohydrate metabolism fat metabolism protein metabolism storage of glucose, iron, copper and vitamins synthesis - fibrinogen and thrombopoietin kuppfer cells - rubbish collectors production of bile metabolism of drugs and alcohol
How much alcohol does a healthy liver process?
1 unit of alcohol per hour
What is the breakdown product of alcohol which is a carcinogen?
Acetaldehyde
How many units of alcohol is recommended per week?
<14 units
When would some people have more damage to their liver than others?
poor dietary status - nutritional deficiencies
simultaneous exposure to other drugs (affects metabolism)
genetic variations/polymorphisms of enzymes
female gender more vulnerable
coexisting viruses e.g. Hep C
Causes of cirrhosis (highest to lowest)
Alcohol related liver disease fatty liver disease hepatitis C virus Other autoimmune causes
Progression of alcohol liver disease
- normal liver
- fatty liver (steatosis)
- REVERSIBLE or can go straight to fibrosis - steatohepatitis
- fibrosis
- liver cirrhosis
Indicators of chronic alcohol use
elevated gamma GT macrocytosis (large RBCs) Low platelets Elevated ferritin enlarged smooth edged liver on AUSS History
What is alcoholic hepatitis?
Fatty change within the liver and an inflammatory process
Pathology of alcoholic hepatitis
infiltration of leucocytes
hepatic necrosis
Results of alcoholic hepatitis
hepatomegaly jaundice abdominal pain fever hepatic decompensation
Treatment of alcoholic hepatitis
ABSTINENCE
steroids
management of infection and nutrition
renal impairment and coagulopathy
Pathology of liver fibrosis
Chronic inflammation
activation of stellate cells
Collagen production -> starts to produce scarring
fibrosis/cirrhosis
The 3 complications of cirrhosis
variceal haemorrhage
ascites
encephalopathy
effects of alcohol in low doses
euphoria
reduced anxiety
relaxation
sociability
effects of alcohol in higher doses
intoxication impaired attention and judgement unsteadiness flushing nystagmus mood instability disinhibition slurring stupor unconsciousness
diagnostic criteria of alcohol dependence by ICD-10
Increased tolerance
Physiological withdrawal
neglect of other interests
difficulty controlling use
Definition of intoxication
the pathological state produced by a drug, serum, alcohol or any other toxic substance; poisoning
symptoms of dependence
3 or more of the following >_ 1 month repeatedly over 12 months
- cravings / compulsions to take
- difficulty controlling use
- primacy
- increased tolerance
- physiological withdrawal on reduction/cessation
- persistence despite harmful consequences
- neglect
Definition of withdrawal state
group of symptoms of variable clustering and severity on complete/relative withdrawal of a psychoactive substance, after persistent use of that substance
Symptoms of alcohol withdrawal state
tremor weakness nausea/vomiting anxiety seizures confusion agitation palpitations death sweating delirium tremens
Symptoms of delirium tremens
profound confusion tremor agitation hallucinations delusions sleeplessness autonomic overactivity
alcohol problems
physical health mental health relationships employment financial legal
What is Othello’s syndrome?
delusional jealously or morbid jealously
How long of abstinence can it take until the long term effects of alcohol subside?
3 months
Impacts of alcohol on mental health
anxiety depression sleep disturbance - drink to sleep morbid jealously alcoholic hallucinations deliberate self injury suicidal thoughts/acts
impacts of alcohol on physical health
brain damage memory loss hallucinations fits dementia risk of chest infections swollen liver hepatitis/cirrhosis tremor tingling nerves/numbess risk of STIs and HIV/AIDs loss of muscle enlagrened heart high BP / irregular pulse ulcers gastritis/pancreatitis vomiting blood impotence/infertility accidental injury / violence cancer (mouth, oesophagus, liver) fits/confused state wernickes encephalopathy koraskoffs psychosis
symptoms of wernickes encephalopathy
confusion
ataxia
opthalmoplegia
nystagmus
symptoms of koraskoffs psychosis
prominent impairment of recent and remote memory preservation of immediate recall no general cognitive impairment retrograde and anterograde memory impaired learning and disorientation may exhibit nystagmus and ataxia
Screening tools for alcoholism
CAGE (2 or more = likely alcohol problem)
AUDIT
FAST (4 Qs)
PAT (used in A and E)
The 4 CAGE questions
Have you ever tried to Cut down?
Have you felt Annoyed by people critising your drinking?
Have you felt Guilty about your drinking?
Have you ever felt the need for an Eye opener?
Treatment/management of alcohol dependency
Hollistic approach - support - psychological help (CBT, Groups) - social work - skills training - community support (AA, ADA) - in patient/ residential treatment inpatient at risk of alcohol withdrawal - cholordiazepoxide (a benzodiazepine) prevention of Wernicke-Korsakoff syndrome - thiamine management of alcohol withdrawal - benzodiazepines, commonly chlordiazepoxide Aversion/deterrent medication - disulfiram (Antabuse) Anti-craving medication - Acamprosate (campral) - naltrexone
Offences of the licencing (Scotland) act 2005
not allowed to buy < 18
attempt to enter a liscensed premises while drunk
sell to a drunk person or try to obtain for a drunk person
disruption of the peace when drunk
refusal to leave
low level disposal
Vulnerability through intoxication
increased risk of committing a crime, becoming the victim of a crime of misadventure
Actions and decisions affected by alcohol
Adverse incidents - reactive measure
Two distinct mechanisms of the misuse of drugs
- Tolerance- the basis of physiological dependence
2. Reward centre - the basis of physiological craving due to stimulation of reward pathways in the brain
What is tolerance the basis of?
Physical dependence
What is the reward centre the basis of?
Physiological craving due to the stimulation of reward pathways in the brain
What is tolerance?
Reduced responsiveness to a drug caused by previous administration
What kind of drugs cause tolerance?
opioids
ethanol
barbituates
benzodiazepines
Mechanisms of tolerance
- DRUG IN - LESS DRUG REACHES THE ACTIVE SITE = dispositional tolerance
- less drug absorped
- drug metabolised faster
- more drug excreted - DRUG ACTION = DRUG HAS LESS ACTION AT ACTIVE SITE = pharmacodynamic tolerance
- fewer drug receptors
- down regulation/ internalisation of drug receptors
- reduced signalling down stream of drug receptors
- less efficient drug receptors
What is tolerance closely linked to and how?
Dependence
imbalance of drug affect and adaptive response
- more drug effect means that the body develops a tolerance to bring the body back to its normal state
- if stop taking the drug = still increased adaptivity with loads of receptors and increased sensitivity to receptors and therefore get body withdrawal responses. Therefore the body has become dependent
What is a withdrawal effect?
The reverse of the acute effect
How does the reward pathway work?
- when VTA neurones are stimulated, they release DOPAMINE
- this causes a sensation of pleasure/reward
Therefore encourages those “healthy” behaviours that lead to propagation of your genes
What is the reward pathway stimulated by?
Eating
drinking
sex
some drugs
How do drugs become craved and give some examples
Some drugs abuse tap into the reward pathway and increase dopamine levels
- heroin increases firing rate of dopaminergic neurones
- amphetamine increases dopamine release
- cocaine inhibits dopamine uptake so there is more around for longer
- alcohol indirectly
What is the psychological component of addiction?
Craving
How to calculate alcohol units
% x ml / 1000
What is the alcohol limit for men and women per week?
14 in BOTH
Treatment of alcohol craving
Disufram
Acamprosate
Naltrexone
Baclofen
What does disufram do?
Makes the body unable to break down the alcohol so makes the patient very unwell when they take alcohol (have to pick patients very specifically for this)
What symptoms do you get on alcohol withdrawal at 6 - 12 hours?
Alcohol withdrawal symptoms
What symptoms do you get on alcohol withdrawal at 36 hours?
Seizures
What symptoms do you get on alcohol withdrawal at 72 hours?
Delerim tremens
What scale is looked at to assess alcohol withdrawal severity?
Clinical Institute Withdrawal Assessment for Alcohol (CIWA)
Treatment of delirium tremens
Benzodiazepines
