Alcohol Dependence Flashcards

1
Q

In a GP setting, what regimen should be used for assisted alcohol withdrawal?

A

Fixed-dose reducing regimens.
Use a standard initial dose, determined by the severity of alcohol dependence, or level of alcohol consumption, followed by dose reduction to zero, usually over 7-10 days.

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2
Q

In an inpatient or residential setting, what regimen should be used for assisted alcohol withdrawal?

A

A fixed-dose regimen or a symptom-triggered regimen can be used. A symptom-triggered approach involves tailoring the drug regimen according to the severity of withdrawal and any complications in an individual patient; adequate monitoring facilities should be available.

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3
Q

Which long acting benzodiazepines are recommended to attenuate alcohol withdrawal symptoms in MODERATE dependence?

A

Chlordiazepoxide hydrochloride

  • 10-30 mg 4 times a day
  • Dose reduction over 5-7 days
  • Oral

or

Diazepam

  • 10 mg, then 10 mg after at least 4 hrs if required
  • IV into a large vein
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4
Q

Which long acting benzodiazepine are recommended to attenuate alcohol withdrawal symptoms in SEVERE dependence?

A

Chlordiazepoxide hydrochloride

  • 10-50 mg 4 times a day
  • 10-40 mg as required for 1st 2 days
  • Dose reduced over 7-10 days
  • Max 250 mg per day
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5
Q

What the contraindications for Chlordiazepoxide hydrochloride?

A
  • Chronic psychosis

- Respiratory depression

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6
Q

What the contraindications for all benzodiazepines?

A
  • Acute pulmonary insufficiency
  • Marked neuromuscular resp weakness
  • Obsessional states
  • Phobic states
  • Sleep apnoea syndrome
  • Unstable myasthenia gravis
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7
Q

What are the most common side effects for Benzodiazepines?

A
Alertness decreased
Anxiety 
Ataxia (more common in elderly 
Depression 
Dizziness 
Drowsiness 
Dysarthria 
Hypotension 
Altered mood
Muscle weakness 
Respiratory depression 
Tremor 
Sleep disorders
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8
Q

What cautions should be taken for benzodiazepines?

A

Pregnancy:

  • High doses administered during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression.
  • Present in milk, should be avoided

Reduce dose in:

  • Debilitated patients
  • Elderly

Hx of alcohol dependance

Hx of drug dependance

Myasthenia gravis

Personality disorder

Respiratory disease

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9
Q

What drug can be used as an alternative treatment in acute alcohol withdrawal?

A

Carbamazepine

  • 800 mg initially in divided doses initially, then:
  • 200 mg daily for usual treatment duration of 7-10 days
  • Dose reduced gradually over 5 days
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10
Q

What drug can be used as an alternative treatment in acute alcohol withdrawal for carbamazepine or a benzodiazepine?

A

Clomethiazole

  • 2-4 capsules to be repeated if necessary after some hours
  • 9-12 capsules daily in 3-4 divided doses on day 1
  • 6-8 capsules daily in 3-4 divided doses on day 2
  • 4-6 capsules daily in 3-4 divided doses on day 3

Dose then to be gradually reduced over days 4-6

Total duration of treatment for no more than 9 days

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11
Q

What are the contraindications of Clomethiazole?

A

Acute pulmonary insufficiency

Alcohol dependent patients who continue to drink (cause fatal respiratory depression even with short term use)

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12
Q

What drug should be used if alcohol withdrawal seizures occur which would reduce the likelihood of further seizures?

A

Lorazepam

  • 4 mg for 1 dose
  • 4 mg after 10 minutes if required
  • Slow IV injection
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13
Q

What characterises Delirium tremens?

A

Agitation
Confusion
Paranoia
Visual and auditory hallucinations

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14
Q

What is the first line treatment of delirium tremens?

A

Oral Lorazepam
- Unlicensed

If symptoms persist:

Paraenteral Lorazepam
- Unlicensed

or

Haloperidol
- Unlicensed

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15
Q

In harmful drinkers or patients with mild alcohol dependence, what treatment should be offered before pharmacological treatment?

A

Psychological interventions e.g. CBD

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16
Q

In harmful drinkers or patients with mild alcohol dependence, what pharmacological treatment can be used?

A

Acamprosate calcium

or

Oral Naltrexone hydrochloride
(Opioid receptor antagonist)

17
Q

What are the cautions and side effects of acamprosate calcium?

A

Cautions:

  • Risk of treatment failure
  • Severe hepatic failure

Side effects:

  • Abdominal pain
  • Diarrhoes
  • Flatulence
  • Nausea
  • Sexual dysfunction
  • Skin reactions
  • Vomiting
18
Q

What are the cautions and side effects of Naltraxone hydrochloride?

A

Caution:
- Concomitant use of opioids

Side effects:

  • Abdominal pain
  • Chest pain
  • Dizziness
  • Eye disorder
  • Hyperhidrosis
  • Altered mood
  • Palpitations
  • Sexual dysfunction
  • Tachycardia
19
Q

What treatment regimen should be used for relapse prevention in patients with moderate to severe alcohol dependance after successful withdrawal?

A

Acamprosate calcium ​

or

Oral Naltrexone hydrochloride

with

Psychological intervention

20
Q

What drug can be used as an alternative to acamprosate and naltrexone hydrochloride?

A

Disulfiram

21
Q

What drug is recommended in for the reduction of alcohol consumption in patients with alcohol dependence who have a high drinking risk level, without physical withdrawal symptoms?

A

Nalmefene

- 18 mg daily if required, taken on each day there is a risk of drinking alcohol

22
Q

Contraindications of Nalmefene?

A
  • Acute withdrawal syndrome

- Recent or current opioid use

23
Q

Cautions and Side effects of Nalmefene?

A

Cautions:

  • Treatment for >1 year
  • Hx of seizure disorders
  • Psychiatric illness

Side effects:

  • Confusion
  • Hyperhidrosis
  • Libido decreased
  • Muscle spasms
  • Palpitations
  • Decreased weight
24
Q

What should a patient with chronic alcohol-related pancreatitis be given?

A

Nutritional support

25
Q

What should a patient who have symptoms of steatorrhoea or who have poor nutritional status due to Exocrine pancreatic insufficiency be prescribed?

A

Pancreatic enzyme supplements

- Not indicated when pain is the only symptom

26
Q

What should be given when a patient is suspected of Wernicke’s encephalopathy?

A

Paraenteral thiamine followed by oral thiamine

Harmful or dependent drinkers should be given this prophylactically.