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Year Three - Psychiatry > Alcohol Dependency > Flashcards

Alcohol Dependency Flashcards

1
Q

What is another term for alcohol dependence?

A

Alcoholism

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2
Q

What is alcohol dependence?

A

It is a condition in which individuals experience a strong, often uncontrollable, desire to drink

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3
Q

What is the recommended alcohol intake per week for both men and women?

A

14 units

In cases where individuals drink 14 units a week, this should be spread evenly over 3 or more days and not more than 5 units in a single day

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4
Q

What is the recommended maximum number of alcohol units consumed in one day?

A

5 units

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5
Q

What is the function of alcohol screening?

A

It is a systematic process of identifying individuals whose alcohol consumption places them at increased risk of physical, psychological or social problems, thus who would benefit from preventative intervention

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6
Q

What are the five alcohol screening questionnaires?

A

CAGE Questionnaire

AUDIT Questionnaire

FAST Questionnaire

PAT Questionnaire

Tweak Questionnaire

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7
Q

What is the CAGE questionnaire?

A

It is a series of four questions used to check for features of alcohol dependency

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8
Q

What are the four questions in the CAGE questionnaire?

A

Have You Ever Felt You Should Cut Down Your Drinking?

Have People Annoyed You By Criticising Your Drinking?

Have You Ever Felt Bad Or Guilty About Your Drinking?

Have You Ever Had A Drink First Thing In The Morning To Steady Your Nerves or Get Rid Of A Hangover? (Eye Opener)

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9
Q

When does the CAGE questionnaire indicate alcohol dependency?

A

When patients present with two positive answers

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10
Q

What is the AUDIT questionnaire?

A

It is a series of ten questions to check for features of alcohol dependency

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11
Q

What is the gold standard alcohol screening questionnaire?

A

AUDIT questionnaire

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12
Q

When does the AUDIT questionnaire indicate harmful alcohol intake?

A

When patients present with a score > 8

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13
Q

What is the FAST questionnaire?

A

It is a series of four questions to check for features of alcohol dependency

It is a subset of AUDIT questions

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14
Q

Where is the FAST questionnaire used?

A

Emergency departments,

However, it can be used in a variety of health and social care setting

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15
Q

When does the FAST questionnaire indicate alcohol dependency?

A

When patients present with a score > 3

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16
Q

How do we progress when individuals have a positive FAST questionnaire?

A

It is recommended that the remaining AUDIT questions are asked to identify dependency

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17
Q

Where is the PAT questionnaire used?

A

Emergency departments

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18
Q

What is the TWEAK questionnaire?

A

It is a series of five questions to check for features of alcohol dependency

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19
Q

When is the TWEAK questionnaire used?

A

In pregnant women

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20
Q

What two criteria are used to diagnose alcohol dependency?

A

ICD-10

DSM-5

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21
Q

What is the ICD-10 criteria for alcohol dependency?

A

It states that at least 3 of the following criteria should be present for more than 1 month…

  • Compulsions To Drink
  • Difficulties In Controlling Use
  • Neglect of Alternative Interests (Primacy)
  • Tolerance Increase
  • Physiological Withdrawal Upon Cessation
  • Persistence Despite Harmful Consequences
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22
Q

What are the nine clinical features of alcohol dependency on examination?

A

Jaundice

Hepatomegaly

Spider Naevi

Palmar Erythema

Gynaecomastia

Caput Medusae

Ascites

Asterixis

Anorexia

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23
Q

What is asterixis?

A

A flapping tremor

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24
Q

What are the five blood tests used to diagnose alcohol dependency?

A

Gamma-Glutamyl Transferase (GGT)

Mean Corpuscular Volume (MCV)

AST:ALT Ratio

Carbohydrate-Deficient Transferrin (CDT)

Ethanol Levels

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25
Q

What is GGT?

A

A liver enzyme created when the liver is injured

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26
Q

What GGT result indicates alcohol dependency?

A

The GGT levels are elevated, usually > 40

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27
Q

What is the most reliable biochemical marker of alcohol dependency?

A

GGT

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28
Q

What is MCV?

A

A measure of the red blood cell size

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29
Q

What MCV result indicates alcohol dependency?

A

The MCV is increased, usually > 100 (macrocyte)

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30
Q

What will cause MCV values to return back to normal?

A

When there is alcohol abstinence for several weeks

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31
Q

What are AST & ALT?

A

They are liver enzymes created when the liver is injured

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32
Q

What AST:ALT ratio result indicates alcohol dependency?

A

It is elevated in alcohol dependency, usually > 2

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33
Q

What is CDT?

A

It is a molecule involved in iron transport in blood

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34
Q

What CDT result indicates alcohol dependency?

A

The CDT levels are elevated, usually > 60

It is not useful as a screening test for alcohol abuse, however, may be useful in detecting those who have relapsed

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35
Q

What do elevated ethanol levels indicate?

A

Isolated drinking episode

Chronic abuse

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36
Q

What ethanol level indicates that an individual is a chronic heavy drinker?

A

A blood alcohol level > 80mg per 100ml

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37
Q

What arterial pH result indicates alcohol dependency?

A

Low (<7.3)

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38
Q

What bicarbonate level result indicates alcohol dependency?

A

Low (<22)

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39
Q

What PaCO2 result indicates alcohol dependency?

A

Low (<35)

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40
Q

What chlorine level result indicates alcohol dependency?

A

Low (<95)

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41
Q

What potassium level result indicates alcohol dependency?

A

Low (<3.5)

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42
Q

Why are chlorine and potassium level low in alcohol dependency?

A

Vomiting

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43
Q

What sodium level result indicates alcohol dependency?

A

Low (<133)

44
Q

What urea level result indicates alcohol dependency?

A

High (>7.8)

45
Q

What creatinine level result indicates alcohol dependency?

A

High (>104)

46
Q

What serum osmolality result indicates alcohol dependency?

A

High

47
Q

Why are the sodium levels low and urea, creatinine and serum osmolarity levels high in alcohol dependency?

A

Dehydration

48
Q

What anion gap result indicates alcohol dependency?

A

High (>18)

49
Q

What is the anion gap?

A

It is e difference between the total concentration of cations (Na+ + K+) and anions (Cl- + HCO3-) in the blood

50
Q

Why is the anion gap high in alcohol dependency?

A

Due to the low level of bicarbonate ions

51
Q

What does a blood gas result of low PCO2, low bicarbonate levels and normal PO2 indicate?

A

Metabolic acidosis with respiratory compensation

52
Q

What does a blood gas result of low PCO2, low bicarbonate levels and normal PO2 indicate when it is directly related to alcohol intake?

A

Alcoholic ketoacidosis (AKA)

53
Q

When does alcoholic ketoacidosis tend to occur?

A

The day after a massive binge

54
Q

How do we manage alcoholic ketoacidosis?

A

IV thiamine

AND

0.9% saline

55
Q

How is alcohol dependency psychologically managed?

A

Psychoeducation

Cognitive Behaviour Therapy (CBT)

Community Support Groups

56
Q

What is psychoeducation?

A

It involves providing patients with information about reducing alcohol intake

57
Q

What website do we refer patients to for alcohol psychoeducation?

A

Drink aware

58
Q

What is CBT?

A

It is a talking therapy used to manage the way in which patients think, feel and behave

59
Q

What two community support groups are used to support alcohol dependent patients?

A

AA

ADA

60
Q

What is the function of community support groups?

A

They help individuals deal with the challenges of getting sober, provide support to family members and friends and avoid relapses

61
Q

What are the three pharmacological management options used in alcohol dependency?

A

Nutritional Support

Anti-Craving Medication

Aversion Therapy

62
Q

What nutritional support is given to alcohol dependent patients? Why?

A

They are administered vitamins, such as thiamine

To prevent alcohol related complications

63
Q

What is the first line pharmacological option used in alcohol dependency after successful withdrawal?

A

Anti-craving medication

64
Q

What are the four types of anti-craving medications?

A

Acamprosate

Naltrexone

Nalmefene

Baclofen

65
Q

What is the first line anti-craving medication?

A

Acamprosate

66
Q

What is the second line anti-craving medication?

A

Naltrexone

67
Q

What drug class do naltrexone and nalmefene belong to?

A

Opioid receptor antagonists

68
Q

What drug is used in aversion therapy?

A

Disulfiram

69
Q

What is an Antabuse reaction?

A

It is a reaction in which disulfiram interacts with alcohol to cause an accumulation of acetaldehyde

70
Q

What are the six clinical features associated with Antabuse reactions?

A

Headache

Facial flushing

Palpitations

Dyspnoea

Tachycardia

Nausea

71
Q

How long after alcohol consumption does disulfiram cause an Antabuse reaction?

A

Within 10 minutes

72
Q

When is aversion therapy used?

A

It is the second line pharmacological management option used in cases where anti-craving medications are unsuitable

It should only be used when individuals have stopped their consumption of alcohol

73
Q

What other drug can produce an Antabuse reaction, however is not routinely prescribed for this purpose?

A

Metronidazole

74
Q

What are the three main complications of alcohol dependency?

A

Alcohol Liver Disease (ARLD)

Wernicke’s Encephalopathy

Korsakoff’s Syndrome

75
Q

What is alcohol liver disease?

A

It is a condition resulting from the effects of long term excessive consumption of alcohol on the liver

76
Q

What is the stepwise progression of alcohol liver disease?

A

Alcohol related fatty liver

Alcoholic hepatitis

Liver cirrhosis

77
Q

What is alcohol related fatty liver?

A

It is a condition in which alcohol leads to a build-up of fat in the liver

78
Q

Is alcohol related fatty liver a reversible condition?

A

Yes

It can be reversed after two weeks of alcohol abstinence

79
Q

What is alcoholic hepatitis?

A

It is a condition in which excessive periods of alcohol consumption cause liver inflammation

80
Q

Is alcoholic hepatitis a reversible condition?

A

Yes

However only in mild cases when alcohol abstinence is permanent

81
Q

What is liver cirrhosis?

A

It is a condition in which chronic inflammation of the liver results in the replacement of hepatic tissue with scar tissue

82
Q

What is a complication of liver cirrhosis? How does this occur?

A

Portal hypertension

The fibrosis affects the structure and blood flow through the liver, which causes increased resistance in the vessels supplying the liver

83
Q

Is liver cirrhosis a reversible condition?

A

No

However, alcohol abstinence can prevent further damage

84
Q

What is Wernicke’s encephalopathy?

A

It is a neurological emergency resulting from thiamine deficiency

85
Q

What is thiamine?

A

Vitamin B1

86
Q

What are the triad of clinical features associated with Wernicke’s encephalopathy?

A

Confusion

Ataxia

Nystagmus

87
Q

How do we treat Wernicke’s encephalopathy?

A

We administer intravenous high-dose Pabrinex, which is a thiamine replacement therapy

This should be followed by regular lower doses of oral thiamine

88
Q

What is Korsakoff’s syndrome?

A

It is a neurological emergency resulting from thiamine deficiency

It is a complication of Wernicke’s encephalopathy

89
Q

What is the pathophysiological cause of Korsakoff’s syndrome?

A

It is due haemorrhage to the mammillary bodies of the hypothalamus and the medial thalamus

90
Q

What are the three clinical features associated with Korsakoff’s syndrome?

A

Anterograde amnesia

Retrograde amnesia

Confabulation

91
Q

What is anterograde memory impairment?

A

This is a loss in the ability to create new memories after the event that caused amnesia, leading to a partial or complete inability to recall the recent past, while long-term memories from before the event remain intact.

92
Q

What is retrograde amnesia?

A

This is when individuals can’t recall memories that were formed before the event that caused the amnesia

93
Q

What is confabulation?

A

This is when patients create, often fantastical, answers to fill the gaps in their memory

94
Q

How do we treat Korsakoff’s syndrome?

A

It is an irreversible condition and results in patients requiring full time institutional care

The treatment involves administration of intravenous high-dose Pabrinex, which is a thiamine replacement therapy

This should be followed by regular lower doses of oral thiamine

95
Q

How does alcohol cause thiamine deficiency?

A

Poor thiamine absorption

Lack of thiamine diet intake

96
Q

What is alcohol withdrawal syndrome (AWS)?

A

It occur when severely dependent individuals, who have been drinking excessively for a prolonged period of time, undergo an abrupt reduction in alcohol intake

97
Q

When does AWS present?

A

Within 6-72 hours of abrupt alcohol withdrawal

98
Q

What are the eight clinical features associated with AWS?

A

Tremors

Anxiety

Nausea

Headaches

Sweating

Confusion

Irritability

Insomnia

99
Q

What are the eight clinical features associated with delirium tremens?

A

Confusion

Irritability

Fever

Seizures

Hallucinations

Tachycardia

Hypertension

Insomnia

100
Q

What are the two pharmacological management options used to treat AWS?

A

Benzodiazepines

Anticonvulsants

101
Q

What is the first line pharmacological option for treating AWS?

A

Benzodiazepines

102
Q

What are the three benzodiazepines used to treat AWS?

A

Chlordiazepoxide

Lorazepam

Diazepam

103
Q

What contraindicates the use of chlordiazepoxide? Why?

A

Hepatic failure

To avoid the risk of increased sedation

104
Q

What is the second line pharmacological option for treating AWS?

A

Anticonvulsants

105
Q

What anticonvulsant is used to treat AWS?

A

Carbamazepine

106
Q

What drug regimen is used in AWS?

A

Fixed-dose regimen

107
Q

What is a fixed dose regimen?

A

This involves titrating the initial dose of medication to the severity of alcohol dependence and/or regular daily level of alcohol consumption

This dose is then gradually reduced over 7-10 days to avoid alcohol withdrawal recurring

Year Three - Psychiatry (23 decks)

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