Alcohol Dependence

Question 1

What is the mechanism of action of alcohol?

Answer 1

Stimulates GABA receptors which are inhibitory

Inhibits glutamate receptors (NMDA receptors) which are excitatory

Causing a relaxing effect on the brain

Question 2

What does long-term alcohol use do to receptors in the brain?

Answer 2

Upregulation of glutamate receptors because they are inhibited

Downregulation of GABA receptors because they are stimulated

Patient must continue drinking alcohol to prevent detrimental effects

Question 3

How do you calculate alcohol units?

Answer 3

Volume x % / 1000

e.g.

750mls of 12% wine

750 x 12 /1000 = 9 units

Question 4

What is the recommended alcohol consumption?

Answer 4

Not more than 14 units per week
Spread evenly over 3 days or more
Not more than 5 units in a single day

Question 5

What is binge drinking?

Answer 5

Drinking 6 or more units for women in a single session

8 or more for men

Question 6

What does drinking alcohol in pregnancy lead to?

Answer 6

Miscarriage
Small for dates
Preterm delivery
Foetal alcohol syndrome

Question 7

What are the complications of alcohol excess?

Answer 7

Alcohol related liver disease
Cirrhosis
Alcohol dependence
Wernicke-Korsakoff syndrome
Pancreatitis
Alcoholic cardiomyopathy
Increased cancer risk
Increased CVD risk

Question 8

What is used to screen for harmful alcohol use?

Answer 8

AUDIT Questionnaire

Score of 8 or more indicates harmful use

Question 9

What are CAGE questions?

Answer 9

Cut down
Annoyed (at others commenting on your drinking)
Guilty about drinking
Eye opener- ever drink in the morning to help hangover or nerves

Question 10

What are the examination findings of excess alcohol?

Answer 10

Smelling of alcohol
Slurred speech
Bloodshot eyes
Telangiectasia
Tremor

Question 11

What happens at different times with alcohol withdrawal?

Answer 11

6-12 hours- tremor, sweating, headache, craving

24 hours- hallucinations

36 hours- seizures

72 hours- delirium tremens

Question 12

What happens in delirium tremens?

Answer 12

Long-term alcohol use

Upregulated glutamate and downregulated GABA

So increased excitatory and decreases inhibitory causing extreme excitability and excessive adrenergic activity

Question 13

What is used in treatment of delirium tremens?

Answer 13

Chlordiazepoxide or diazepam

Question 14

When is lorazepam used in treatment of delirium tremens?

Answer 14

When there is significant hepatic impairment

Lorazepam undergoes less significant metabolism by the liver and has a shorter half-life than other benzodiazepines

Question 15

What is used to identify symptoms of alcohol withdrawal?

Answer 15

CIWA-Ar

Used to score withdrawal symptoms and guide treatment

Question 16

What can be given for alcohol withdrawal effects?

Answer 16

Librium (benzodiazepine)

High-dose B vitamins (Pabrinex) IM or IV followed by long-term oral thiamine to prevent Wernicke-Korsakoff syndrome

Question 17

What drug is given following detoxification?

Answer 17

Acamprosate

Anti-craving medication

Question 18

What interventions are used in long-term management of alcohol dependence?

Answer 18

Specialist alcohol service
Alcohol detoxification
Oral thiamine
Psychological therapy
Disulfiram
Inform the DVLA

Question 19

What causes Wernicke-Korsakoff syndrome?

Answer 19

Alcohol excess causes Vitamin B1 deficiency (thiamine)

B1 poorly absorbed in presence of alcohol

Alcoholics typically have poor diets and get many calories from alcohol

Question 20

What are the features of Wernicke’s encephalopathy?

Answer 20

Confusion
Oculomotor disturbances
Ataxia

Question 21

What are the features of Korsakoff syndrome?

Answer 21

Memory impairment (retrograde and anterograde)
Behavioural changes