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afsha - substance dependence > alcohol dependence > Flashcards

alcohol dependence Flashcards

1
Q

what is it

A
  • cluster of behavioural, cognitive and physiological factors that typically include:
  • strong desire to drink, tolerance to its effects, difficulties controlling its use
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2
Q

in severely dependent pt who have been drinking excessively for a prolonged period of time, abrupt reduction in alcohol intake may result in …

A

may result in development of an alcohol withdrawal syndrome
in the absence of medical management can lead to seizures, delirium tremens, death

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3
Q

do patients with mild alcohol dependence need assisted alcohol withdrawal

A

not usually

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4
Q

do patients with moderate dependence need associated alcohol withdrawal

A

can generally be treated in community setting unless at high risk of developing alcohol withdrawal seizures or delirium tremens

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5
Q

do pt with severe alcohol dependence need assisted alcohol withdrawal

A

will need to undergo withdrawal in an in-pt setting

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6
Q

who should treat patients with decompensated liver disease

A

under specialist supervision

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7
Q

what is recommended to attenuate alcohol withdrawal symptoms (2 examples)

A

long acting BZDPN e.g. chlordiazepoxide or diazepam
follow local clinical protocols

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8
Q

in primary care, which regimen is used for assisted alcohol withdrawal

A

fixed dose reducing regimen
- involved standard, initial dose (determined by severity of alcohol dependence or level of alcohol consumption)
- followed by dose reduction to 0, usually over 7-10 days

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9
Q

in in-pt or residential settings, what regimens can be used (2)

A

fixed dose
symptom triggered

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10
Q

what does a symptom triggered approach involve

A
  • tailoring drug regimen according to severity of withdrawal and any complications in an individual patient
  • adequate monitoring facilities needed
  • monitor pt on regular basis and only continue treatment as long as there are withdrawal symptoms
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11
Q

what does a fixed dose reducing regimen involve

A
  • using standard, initial dose - determined by severity of alcohol dependence or level of alcohol consumption
  • followed by dose reduction to 0, usually over 7-10 days
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12
Q

this anti epileptic drug can be used as an alternative treatment in acute alcohol withdrawal

A

carbamazepine

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13
Q

this drug may be considered as an alternative to a LA BZDPN or carbamazepine for alcohol withdrawal symptoms. discuss its use e.g. when it can be used, which setting it can be used in, and the danger of it being taken with alcohol

A

chlomethiazole
- only use in in-pt setting
- do not prescribe if pt is liable to continue drinking alcohol
- alcohol combined with chlomethiazole, esp in pt with cirrhosis, can lead to fatal respiratory depression even with short term use

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14
Q

alcohol combined with this drug, particularly in pt with cirrhosis, can lead to fatal respiratory depression even with short term use. hence it should only be prescribed in an in patient setting and should not be prescribed if pt is liable to continue drinking.

A

chlomethiazole

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15
Q

name the 4 drugs that can be used to attenuate alcohol withdrawal symptoms

A
  1. LA BZDPN e.g. diazepam, chlordiazepoxide
  2. carbamazepine
  3. chlomethiazole (in patient setting only! & only if pt not liable to drinking alcohol!)
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16
Q

when managing withdrawal from CO-EXISTING benzodiazepene and alcohol dependence, the BZDPN used for withdrawal …

A

should be increased

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17
Q

explain how you would calculate the dose BZDPN for managing withdrawal from co-existing BZDPN + alcohol dependence

A

initial daily dose is calculated based on requirements for alcohol withdrawal + equivalent regularly used daily dose of BZPN

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18
Q

single BZDPN or multiple BZDPNs - which should be used for managing withdrawal from co-existing BZDPN + alcohol dependence?

A

single should be used e.g. chlordiazepoxide or diazepam

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19
Q

how long does in patient withdrawal regimens last for when managing co-existing benzodiazepine and alcohol dependence

A

should last for 2–3 weeks or longer, depending on the severity of benzodiazepine dependence

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20
Q

When managing withdrawal from co-existing benzodiazepine and alcohol dependence in the community, or where there is a high level of BZDPN dependence, or both, the regimen should last for a minimum of ….

A

3 weeks (according to pt symptoms)

21
Q

if alcohol withdrawal seizures occur when managing withdrawal from co-existing benzodiazepine and alcohol dependence, what type of BZDPN (+ example) should be prescribed to reduce the likelihood of further seizures?

A

fasting acting one e.g. lorazepam (unlicensed indication)

22
Q

If alcohol withdrawal seizures develop in a person during treatment for acute alcohol withdrawal, what should you do

A

review their withdrawal drug regimen.

23
Q

what is delirium tremens

A
  • medical emergency
  • require specialist inpatient care
24
Q

what is delirium tremens characterised by

A

agitation, confusion, paranoia, and visual and auditory hallucinations

25
Q

a patient who is undergoing alcohol withdrawal is displaying signs of confusion and hallucinations. what are they suffering from and what do you need to do?

A

delirium tremens
medical emergency
requires specialist inpatient care
1st line: oral lorazepam

26
Q

1st line for delirium tremens

A

oral lorazepam

27
Q

oral lorazepam should be used as first-line treatment in delirium tremens. if symptoms persist or oral medication is declined, what should you give ad adjunctive therapy (2)

A

parenteral lorazepam [unlicensed], or haloperidol [unlicensed]

28
Q

If delirium tremens develops during treatment for acute alcohol withdrawal what should you do

A

the withdrawal drug regimen should also be reviewed
(in addition to giving treatment)

29
Q

in harmful drinks or pt with mild alcohol dependence, what intervention should be offered?

A

psychological intervention e.g. CBT

30
Q

which patients can have psychological intervention (e.g. CBT) in combination with a drug (naltrexone or acamprosate)?

A

harmful drinks or pt with mild alcohol dependence who have not responded to psychological interventions alone
or who have specifically requested a pharmacological treatment

31
Q

Acamprosate calcium or oral naltrexone hydrochloride in combination with a psychological intervention are recommended for relapse prevention in patients with ….

A

moderate and severe alcohol dependence, to start after successful assisted withdrawal.

32
Q

Acamprosate calcium or oral naltrexone hydrochloride in combination with a psychological intervention are recommended for relapse prevention in patients with moderate and severe alcohol dependence. They should be started once…

A

To start after successful assisted withdrawal

33
Q

alternative in pt for whom acamprosate or oral naltrexone are not suitable, of if the pt just prefers to have this drug and understands the risks of taking it

A

disulfuram

34
Q

this drug is recommended for the reduction of alcohol consumption in patients with alcohol dependence who have a high drinking risk level, without physical withdrawal symptoms, and who do not require immediate detoxification

A

nalmefene

35
Q

patients with severe alcohol related hepatitis with a discriminant function of 32 or more can be given ….. but only after …..

A

CCs
(but only after any active infection or GI bleeding is treated, any RI is controlled, and following discussion of potential benefits and risks of treatment)

36
Q

Patients with severe alcohol-related hepatitis with a discriminant function of 32 or more can be given corticosteroids but only after any active infection or gastro-intestinal bleeding is treated, any renal impairment is controlled, and following discussion of the potential benefits and risks of treatment. What are the advantages + disadv of CC treatment?

A

CC treatment has been shown to improve survival in the short term (1 month) but not over a longer term (3 months to 1 year)
Also been shown to increase risk of serious infections within the first 3 months of starting treatment

37
Q

Who should be offered nutritional support

A

chronic alcohol-related pancreatitis

38
Q

patients with chronic alcohol related pancreatitis should be offered …

A

nutritional support

39
Q

patients who have symptoms of steatorrhoea (excessive fat in poo) or who have poor nutritional status due to exocrine pancreatic insufficiency should be prescribed…
(but not indicated when …. is the only symptom)

A

pancreatic enzyme supplements
(not indicated when pain is the only symptom)

40
Q

What is Wernick encephalopathy

A
  • acute neurological condition
  • characterised by clinical trio of nystagmus, ataxia and confusion)
  • life threatening illness caused by thiamine deficiency
41
Q

3 main symptoms of Wernick encephalopathy

A
  • nystagmus
  • ataxia
  • confusion
42
Q

Patients at high risk of developing Wernick’s encephalopathy

A
  • malnourished
  • at risk of malnourishment
  • decompensated liver disease
43
Q

Treatment for pt with suspected Wernick’s encephalopathy, those who are malnourished or at risk of malnourishment, those who have decompensated liver disease or who are attending hospital for acute treatment

A
  • parenteral thiamine
  • followed by oral thiamine
44
Q

this prophylactic vitamin should be given to harmful or dependent drinkers if they are in acute withdrawal, or before and during assisted alcohol withdrawal

A

oral thiamine prophyactically

45
Q

parenteral thiamine is available as part of a ….

A

vitamin B substances with ascorbic acid preparation

46
Q

Summarise what drugs are given for the maintenance of abstinence in alcohol-dependent patients (after they have successfully undergone assisted withdrawal)

(3)

A
  • acamprosate
  • naltrexone oral (initated under specialist supervision)
  • Alternative if above not suitable, or if pt wants this and understands risks: disulfuram
47
Q

Summarise what drugs are used for alcohol withdrawal (3)

A
  • LA BZDPN e.g. diazepam, chlordiazepoxide
  • Alt: carbamazepine
  • Alt: chlomethiazole (restrictions to use!! in pt setting only, do not prescribe if pt liable to start drinking again)
48
Q

What are the restrictions to the use of chlomethiazole and why

A

Clomethiazole may be considered as an alternative to a benzodiazepine or carbamazepine for alcohol withdrawal symptoms.
It should only be used in an inpatient setting and should not be prescribed if the patient is liable to continue drinking alcohol.
Note: Alcohol combined with clomethiazole, particularly in patients with cirrhosis, can lead to fatal respiratory depression even with short-term use.

49
Q

when is nalmefene given

A

recommended for the reduction of alcohol consumption in patients with alcohol dependence who have a high drinking risk level, without physical withdrawal symptoms, and who do not require immediate detoxification

afsha - substance dependence (8 decks)

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