Alcohol and substance misuse Flashcards
What does CAGE stand for
Have you tried to Cut down
Have you been Annoyed by people talking about your drinking
Have you felt guilty about your drinking
Have you ever needed an eye opener
What does thiamine deficiency cause (3 steps)
Mamillary body damage -> Wernickes encephalopathy -> Korsakoff’s psychosis
Condition resulting from sudden alcohol withdrawal
Delirium tremens
3 key medications to help maintain abstinence of alcohol
Disulfiram - blocks OH- metabolism -> sudden hangover
Acamprosate - acts on GABA to reduce cravings
Naltrexone - opioid receptor antagonist
What is naltrexone used for
Alcohol and drug dependance
Opioid receptor antagonist
Reduce cravings once stopped
UK gov max drinking recommendation
14 units men and women
1 pint = 2 units
1 glass of wine = 2 units
UK gov max drinking recommendation
14 units men and women
1 pint = 2 units
1 glass of wine = 2 units
What does DT incidence peak following last drink
72 hours
1-3 days after
Untreated DT mortality rate
10%
DT key symptoms
Confusion Memory loss Fear, agitation and restlessness Hallucinations Autonomic disturbances (tachycardia, hypertension, hyperthermia) SEIZURES
Classic triad of Wernicke’s encephalopathy
Confusion, ataxia, ocular palsy
3 key ddx to Wernicke’s encephalopathy
Hypoglycemia
Hepatic encephalopathy
Subdural hemorrhage
Wernicke’s encephalopathy prognosis
20% recover
10% die from haemorrhages in brainstem and hypothalamus
Remainder develop Korsalov’s
What are symptoms and pathology by Korsakov’s
Haemorrhages in mamillary bodies
Neuronal loss
Impairment of recent memory
(+ features of Wernicke’s)
Which common biochemical marker is most sensitive for heavy long term alcoholics
MCV - long half life of RBC
Better than GGT and ALP
Detoxification from alcohol drug course
Chloradiazepoxide 20m QDS slowly reducing over 7 days
Thiamine 200mg OD
Why is chlordiazepoxide used instead of other benzos
Longer half life
When may chlorodiazepoxide not be used and lorazepam indstead
Severe liver cirrhosis
May lead to over sedation
3 drugs used to maintain alcohol abstention
Naltrexone - opioid receptor antagonist
Acamprosate - GABA analogue
Disulfram - inhibits aldehyde dehydrogenase (early hangover)
How many grams of alcohol is 1 unit
8g
