Alcohol dependence

Question 1

Acamprosate

Answer 1

Unknown mechanism of actions, is thought to bind and block NMDA receptors in the brain, preventing excitation by glutamate.
Reduces cravings.

Adverse effects are nausea, vomiting and headache

Contraindicated with renal impairment as it is renally excreted

Question 2

Opioid side effects

Answer 2

Repiratory depression
Nausea and vomiting (antiemetic)
Constipation (laxative)
Cough suppression
Miosis
Urinary retention
Pruritis/ histamine release
Euphoria

Question 3

Short term management of alcohol withdrawal symptoms

Answer 3

Benzodiazepines

• Diazepam
• Oxazepam if hepatic impairment

Thiamine IM given before correcting hypoglycaemia - glucose can precipitate wenicke’s encepathalopathy

Question 4

Wernicke’s encephalopathy

Answer 4

Short term memory loss
Ataxia
Nystagmus
Ophthalmoplegia

Question 5

Korsakoff’s psychosis

Answer 5

Anterograde and retrograde amnesia
Confabulation
Apathy

Question 6

Alcohol withdrawal symptoms

Answer 6

Anxiety
Tremor
Headache
Tachycardia and palpitations
Perceptual disturbances
Delirium tremens (severe)
- confusion and hallucinations (formication - sensation of bugs crawling)

Question 7

Disulfiram use

Answer 7

Only in fit healthy, young patients willing to comply, and understanding effects of taking alcohol while on disulfiram

Question 8

Acamprosate use

Answer 8

One week after alcohol withdrawal
Indicated for protracted withdrawal symptoms e.g. insomnia, cravings
Best effects with psychosocial treatment and naltrexone

Question 9

Naltrexone effects, CI and SE

Answer 9

mu opioid receptor antagnoist preventing euphoric effects associated with endogenous opioids released with alcohol consumption

Side effects
- insomnia, nausea, diarrhoea, mydriasis

CI in patients with chronic pain - interferes with opioid analgesic effects

Question 10

Disulfiram side effects and CI

Answer 10

Inhibits acetylaldehyde dehydrogenase

With alcohol - flushing, palpitations, tachycardia, headache, sweating, nausea and vomiting

Otherwise SEs = Nausea, headache

Contraindicated in people on metronidazole (combination can induce CNS toxicity)
and in people who are not committed to abstinence.