Alcohol Dependence

Question 1

What could happen to a severely dependent patient who has been drinking excessively for a long time, if he just stops?

Answer 1

Could develop alcohol withdrawal syndrome, which without medical management can lead to seizures, delirium tremens and death

Question 2

What is recommended to attenuate alcohol withdrawal symptoms?

Answer 2

A long acting benzodiazepine

• Chlordiazepoxide
• Diazepam

Question 3

Alcohol withdrawal regimen in primary care

Answer 3

Fixed-dose reducing regimen.

• Start dose determined by severity of alcohol dependence/level of alcohol consumption
• Dose reduction to 0, over 7-10 days

Question 4

Carbamazipine

Answer 4

[Unlicenced Indication] Can be used as an alternative treatment in acute alcohol withdrawal

Question 5

Clomethiazole

Answer 5

Alternative to benzodiazepine or carbamazepine.
Only used on inpatients.
Not to be prescribed if the patient is likely to continue drinking.
As can lead to fatal respiratory depression even with short term use.

Question 6

Managing Co-existing benzodiazepine and alcohol dependence

Answer 6

Increase the dose of benzodiazepine used for withdrawal. (Requirements for alcohol withdrawal + equivalent daily dose of benzodiazepine)
In patient withdrawal regimens should last 2-3 weeks or longer.

Question 7

If alcohol withdrawal seizures occur, what should be prescribed to reduce the likelihood of further seizures?

Answer 7

a fast acting benzodiazepine such as lorazepam [unlicensed indication]

Question 8

Delirium Tremens

Answer 8

A medical emergency that requires specialist in patient care.
Characterised by:
- Agitation - Confusion - Paranoia - Visual and Auditory hallucinations -

Question 9

Treatment of Delirium tremens

Answer 9

FIRST LINE - Oral Lorazepam

if sysmptoms persist or oral medication is declined parenteral lorazepam [unlicenced] or haloperidol [unlicensed] can be given as adjunctive therapy.

Question 10

Recommended for harmful drinkers or mild alcohol dependence

Answer 10

a psychological intervention (such as cognitive behavioural therapy)

Question 11

Drinkers who have not responded to psychological interventions alone or if they request pharmacological treatment

Answer 11

Acamprosate or oral naltrexone in combination with psychological intervention

Question 12

Recommended for relapse prevention in patients with moderate and severe alcohol dependence

Answer 12

Acamprosate or oral naltrexone

Question 13

Patients who can’t take acamprosate or oral naltrexone

Answer 13

Disulfiram

Question 14

Use of Nalmefene

Answer 14

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

Question 15

Can patients with severe alcohol-related hepatitis be given corticosteroids?

Answer 15

yes but only after any active infection or GI bleeding is treated, any renal impairment is controlled

Question 16

Does corticosteriod treatment in patients with severe alcohol-related hepatits have any benefits?

Answer 16

Yes it has been shown to improve survival in the short term (1 month)
but it can increase the risk of serious infections within the first 3 months of starting treatment.

Question 17

Wernicke Encephalopathy

Answer 17

A neurological emergency resulting from thiamine deficiency.
Typically seen as: alterations of consciousness, eye movement abnormalities and gait and balance disorders.

Patients with alcohol dependence are at risk of developing Wernicke’s encephalopathy
(patients at risk include those who are malnourished, at risk of malnourishment, or have decompensated liver disease)

Question 18

Treatment of Wernicke Encephalopathy

Answer 18

Parenteral thiamine (vitamin B1), followed by oral thiamine.

Prophylactic oral thiamine should also be given to harmful or dependent drinker if they are in acute withdrawal, or before and during assisted alcohol withdrawal