Alcohol Dependency Flashcards
What is another term for alcohol dependence?
Alcoholism
What is alcohol dependence?
It is a condition in which individuals experience a strong, often uncontrollable, desire to drink
What is the recommended alcohol intake per week for both men and women?
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
What is the recommended maximum number of alcohol units consumed in one day?
5 units
What is the function of alcohol screening?
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
What are the five alcohol screening questionnaires?
CAGE Questionnaire
AUDIT Questionnaire
FAST Questionnaire
PAT Questionnaire
Tweak Questionnaire
What is the CAGE questionnaire?
It is a series of four questions used to check for features of alcohol dependency
What are the four questions in the CAGE questionnaire?
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)
When does the CAGE questionnaire indicate alcohol dependency?
When patients present with two positive answers
What is the AUDIT questionnaire?
It is a series of ten questions to check for features of alcohol dependency
What is the gold standard alcohol screening questionnaire?
AUDIT questionnaire
When does the AUDIT questionnaire indicate harmful alcohol intake?
When patients present with a score > 8
What is the FAST questionnaire?
It is a series of four questions to check for features of alcohol dependency
It is a subset of AUDIT questions
Where is the FAST questionnaire used?
Emergency departments,
However, it can be used in a variety of health and social care setting
When does the FAST questionnaire indicate alcohol dependency?
When patients present with a score > 3
How do we progress when individuals have a positive FAST questionnaire?
It is recommended that the remaining AUDIT questions are asked to identify dependency
Where is the PAT questionnaire used?
Emergency departments
What is the TWEAK questionnaire?
It is a series of five questions to check for features of alcohol dependency
When is the TWEAK questionnaire used?
In pregnant women
What two criteria are used to diagnose alcohol dependency?
ICD-10
DSM-5
What is the ICD-10 criteria for alcohol dependency?
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
What are the nine clinical features of alcohol dependency on examination?
Jaundice
Hepatomegaly
Spider Naevi
Palmar Erythema
Gynaecomastia
Caput Medusae
Ascites
Asterixis
Anorexia
What is asterixis?
A flapping tremor
What are the five blood tests used to diagnose alcohol dependency?
Gamma-Glutamyl Transferase (GGT)
Mean Corpuscular Volume (MCV)
AST:ALT Ratio
Carbohydrate-Deficient Transferrin (CDT)
Ethanol Levels
What is GGT?
A liver enzyme created when the liver is injured
What GGT result indicates alcohol dependency?
The GGT levels are elevated, usually > 40
What is the most reliable biochemical marker of alcohol dependency?
GGT
What is MCV?
A measure of the red blood cell size
What MCV result indicates alcohol dependency?
The MCV is increased, usually > 100 (macrocyte)
What will cause MCV values to return back to normal?
When there is alcohol abstinence for several weeks
What are AST & ALT?
They are liver enzymes created when the liver is injured
What AST:ALT ratio result indicates alcohol dependency?
It is elevated in alcohol dependency, usually > 2
What is CDT?
It is a molecule involved in iron transport in blood
What CDT result indicates alcohol dependency?
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
What do elevated ethanol levels indicate?
Isolated drinking episode
Chronic abuse
What ethanol level indicates that an individual is a chronic heavy drinker?
A blood alcohol level > 80mg per 100ml
What arterial pH result indicates alcohol dependency?
Low (<7.3)
What bicarbonate level result indicates alcohol dependency?
Low (<22)
What PaCO2 result indicates alcohol dependency?
Low (<35)
What chlorine level result indicates alcohol dependency?
Low (<95)
What potassium level result indicates alcohol dependency?
Low (<3.5)
Why are chlorine and potassium level low in alcohol dependency?
Vomiting
What sodium level result indicates alcohol dependency?
Low (<133)
What urea level result indicates alcohol dependency?
High (>7.8)
What creatinine level result indicates alcohol dependency?
High (>104)
What serum osmolality result indicates alcohol dependency?
High
Why are the sodium levels low and urea, creatinine and serum osmolarity levels high in alcohol dependency?
Dehydration
What anion gap result indicates alcohol dependency?
High (>18)
What is the anion gap?
It is e difference between the total concentration of cations (Na+ + K+) and anions (Cl- + HCO3-) in the blood
Why is the anion gap high in alcohol dependency?
Due to the low level of bicarbonate ions
What does a blood gas result of low PCO2, low bicarbonate levels and normal PO2 indicate?
Metabolic acidosis with respiratory compensation
What does a blood gas result of low PCO2, low bicarbonate levels and normal PO2 indicate when it is directly related to alcohol intake?
Alcoholic ketoacidosis (AKA)
When does alcoholic ketoacidosis tend to occur?
The day after a massive binge
How do we manage alcoholic ketoacidosis?
IV thiamine
AND
0.9% saline
How is alcohol dependency psychologically managed?
Psychoeducation
Cognitive Behaviour Therapy (CBT)
Community Support Groups
What is psychoeducation?
It involves providing patients with information about reducing alcohol intake
What website do we refer patients to for alcohol psychoeducation?
Drink aware
What is CBT?
It is a talking therapy used to manage the way in which patients think, feel and behave
What two community support groups are used to support alcohol dependent patients?
AA
ADA
What is the function of community support groups?
They help individuals deal with the challenges of getting sober, provide support to family members and friends and avoid relapses
What are the three pharmacological management options used in alcohol dependency?
Nutritional Support
Anti-Craving Medication
Aversion Therapy
What nutritional support is given to alcohol dependent patients? Why?
They are administered vitamins, such as thiamine
To prevent alcohol related complications
What is the first line pharmacological option used in alcohol dependency after successful withdrawal?
Anti-craving medication
What are the four types of anti-craving medications?
Acamprosate
Naltrexone
Nalmefene
Baclofen
What is the first line anti-craving medication?
Acamprosate
What is the second line anti-craving medication?
Naltrexone
What drug class do naltrexone and nalmefene belong to?
Opioid receptor antagonists
What drug is used in aversion therapy?
Disulfiram
What is an Antabuse reaction?
It is a reaction in which disulfiram interacts with alcohol to cause an accumulation of acetaldehyde
What are the six clinical features associated with Antabuse reactions?
Headache
Facial flushing
Palpitations
Dyspnoea
Tachycardia
Nausea
How long after alcohol consumption does disulfiram cause an Antabuse reaction?
Within 10 minutes
When is aversion therapy used?
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
What other drug can produce an Antabuse reaction, however is not routinely prescribed for this purpose?
Metronidazole
What are the three main complications of alcohol dependency?
Alcohol Liver Disease (ARLD)
Wernicke’s Encephalopathy
Korsakoff’s Syndrome
What is alcohol liver disease?
It is a condition resulting from the effects of long term excessive consumption of alcohol on the liver
What is the stepwise progression of alcohol liver disease?
Alcohol related fatty liver
Alcoholic hepatitis
Liver cirrhosis
What is alcohol related fatty liver?
It is a condition in which alcohol leads to a build-up of fat in the liver
Is alcohol related fatty liver a reversible condition?
Yes
It can be reversed after two weeks of alcohol abstinence
What is alcoholic hepatitis?
It is a condition in which excessive periods of alcohol consumption cause liver inflammation
Is alcoholic hepatitis a reversible condition?
Yes
However only in mild cases when alcohol abstinence is permanent
What is liver cirrhosis?
It is a condition in which chronic inflammation of the liver results in the replacement of hepatic tissue with scar tissue
What is a complication of liver cirrhosis? How does this occur?
Portal hypertension
The fibrosis affects the structure and blood flow through the liver, which causes increased resistance in the vessels supplying the liver
Is liver cirrhosis a reversible condition?
No
However, alcohol abstinence can prevent further damage
What is Wernicke’s encephalopathy?
It is a neurological emergency resulting from thiamine deficiency
What is thiamine?
Vitamin B1
What are the triad of clinical features associated with Wernicke’s encephalopathy?
Confusion
Ataxia
Nystagmus
How do we treat Wernicke’s encephalopathy?
We administer intravenous high-dose Pabrinex, which is a thiamine replacement therapy
This should be followed by regular lower doses of oral thiamine
What is Korsakoff’s syndrome?
It is a neurological emergency resulting from thiamine deficiency
It is a complication of Wernicke’s encephalopathy
What is the pathophysiological cause of Korsakoff’s syndrome?
It is due haemorrhage to the mammillary bodies of the hypothalamus and the medial thalamus
What are the three clinical features associated with Korsakoff’s syndrome?
Anterograde amnesia
Retrograde amnesia
Confabulation
What is anterograde memory impairment?
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.
What is retrograde amnesia?
This is when individuals can’t recall memories that were formed before the event that caused the amnesia
What is confabulation?
This is when patients create, often fantastical, answers to fill the gaps in their memory
How do we treat Korsakoff’s syndrome?
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
How does alcohol cause thiamine deficiency?
Poor thiamine absorption
Lack of thiamine diet intake
What is alcohol withdrawal syndrome (AWS)?
It occur when severely dependent individuals, who have been drinking excessively for a prolonged period of time, undergo an abrupt reduction in alcohol intake
When does AWS present?
Within 6-72 hours of abrupt alcohol withdrawal
What are the eight clinical features associated with AWS?
Tremors
Anxiety
Nausea
Headaches
Sweating
Confusion
Irritability
Insomnia
What are the eight clinical features associated with delirium tremens?
Confusion
Irritability
Fever
Seizures
Hallucinations
Tachycardia
Hypertension
Insomnia
What are the two pharmacological management options used to treat AWS?
Benzodiazepines
Anticonvulsants
What is the first line pharmacological option for treating AWS?
Benzodiazepines
What are the three benzodiazepines used to treat AWS?
Chlordiazepoxide
Lorazepam
Diazepam
What contraindicates the use of chlordiazepoxide? Why?
Hepatic failure
To avoid the risk of increased sedation
What is the second line pharmacological option for treating AWS?
Anticonvulsants
What anticonvulsant is used to treat AWS?
Carbamazepine
What drug regimen is used in AWS?
Fixed-dose regimen
What is a fixed dose regimen?
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
