Alcohol and Drug addiction Flashcards
What are the symptoms of (alcohol) intoxication?
Impaired attention and judgements Unsteadiness Flushing Nystagmus Mood instability Disinhibition Slurring Stupor Unconsciousness
Define “harmful use”
pattern of use causing damage to physical or mental health. Use >1 month or repeatedly over 12 months
What features constitute “dependence” on a substance?
Cravings/compulsions to take
- Difficulty controlling use
- Primacy
- Increased tolerance
- Physiological withdrawal on reduction/cessation
- Persistence despite harmful consequences
Describe the features of alcohol withdrawal
STAND mnemonic
Seizures Tremor and weakness Anxiety/Agitation Nausea and vomiting Death
What is delirium trements?
An acute alcohol withdrawal state that comes on 24-72 hours after alcohol is stopped
Hyperadrenergic state
–> Medical emergency
Describe the features of delirium tremens
Features of alcohol withdrawal PLUS altered mental status:
- confusion
- altered level of consciousness
- sleepiness
- tremor
- agitation
- hallucinations
- delusions
What is the mortality rate of delirium tremens?
5%
How can delirium tremens be fatal?
Cardiovascular collapse Infection Hyperthermia Seizures Self-injury
Give four problems caused by alcohol
- Liver disease (and other physical health problems)
- Lover (relationships)
- Livelihood – ability to work
- Legal aspects
Give two neurological conditions linked to alcoholism. What causes these?
Wernicke’s encephalopathy
Korsakoff’s psychosis
–> Thiamine deficiency
What is the main difference between Wernicke’s encephalopathy and Korsakoff’s psychosis?
Wernicke’s is reversible whereas Korsakoff’s is irreversible
Describe the CAGE screening tool for alcoholism
2 or more = likely alcohol problem
- Have you tried to Cut down?
- Have you felt Annoyed by people criticising your drinking?
- Have you felt Guilty about drinking?
- Have you felt the need to have an Eye-opener?
Give four screening tools available to screen for alcoholism
CAGE
AUDIT (Alcohol Use Disorders Identification Test)
FAST
PAT (Paddington Alcohol Test)
What treatment is used to prevent Wernicke-Korsakoff syndrome?
Thiamine
Which drugs can be used to manage alcohol withdrawal?
Benzodiazepines, commonly Chlordiazepoxide
What is Disulfiram?
An aversion/deterrent medication used to help reduce alcohol consumption
Give three examples of anti-craving medications
Acamprosate (Campral)
Naltrexone, Nalmefene – long acting opioid antagonists
(Baclofen)
How long does it take for fatty liver to return to normal after abstinence?
Up to 6 weeks
What percentage of patients with fatty liver will go on to develop cirrhosis?
20%
What is the most common precipitant of decompensated liver disease?
Infection
Give three manifestations of decompensated liver disease
GI bleed
Encephalopathy
Ascites
Among cirrhosis patients, what is the mortality rate from hepatocellular cancer?
20 - 25%
Define tolerance
Reduced responsiveness to a drug caused by previous administration
Give four examples of drugs which people develop tolerance to
Alcohol
Opioids
Barbiturates
Benzodiazepines
