Alcohol & drugs

Question 1

What are some of the physical health problems that can occur with alcoholism?

Answer 1

Alcoholic liver disease - Cirrhosis
Acute + Chronic Pancreatitis
Wernicke’s/Korsakoff’s syndrome - lack of thiamine (B1)
Alcohol related malignancies
Mallory weiss tear/Gastritis/Oesophagitis
Cardiomyopathy
Peripheral neuropathy - lack of B12

Question 2

What are some of the risk factors for alcohol misuse?

Answer 2

Genetics
Culture
Religion
FH
Male
Availability + cost of alcohol

Question 3

What are some of the signs of alcoholic liver disease?

Answer 3

Palmar erythema
Oedema
Ascites
Spider naevi
Gynaecomastia (oestrogen normally broken down in liver)
Hepatic flap

Question 4

What is the management of alcohol dependency?

Answer 4

Detoxification
Motivational interviewing
12 step groups
Address social issues
Treat any underlying psychiatric disorders
Medications

Question 5

What medication is involved in detoxification of alcohol dependency?

Answer 5

BDZs - Chlordiazepoxide V long acting. (Prevent seizures + reduce withdrawal symptoms)
Correction of electrolyte disturbances
Vitamin supplements

Question 6

Why are patients undergoing alcohol withdrawal at a higher risk of seizures?

Answer 6

Alcohol is a CNS depressant therefore over time the seizure threshold is lowered. Once alcohol is removed, there is no longer depression of neurones causing threshold to be reached

Question 7

What medications can be used in alcoholism?

Answer 7

Disulfiram

Acamprosate

Question 8

What medications an be used in opiate overdose?

Answer 8

Naltrexone - opiate antagonist

Question 9

What is the mode of action of Disulfiram?

Answer 9

Aldehyde dehydrogenase inhibitor leading to build up of acetaldehyde causing fatigue, GI upset, headaches, general malaise

Question 10

What is the mode of action of Acamprosate?

Answer 10

Restores chemical balances within the brain. Pts need to be abstinent when beginning treatment

Question 11

What are some of the complications of substance misuse?

Answer 11

Anxiety
Depression
Relapse
DSH/Suicide
Memory loss

Question 12

What is delirium tremens?

Answer 12

MEDICAL EMERGENCY
Hyperadrenergic state
Happens when withdrawing from alcohol - usually around day 3

Question 13

What are the symptoms/signs of delirium tremens?

Answer 13

Hallucinations
Confusion
Delusions
Severe agitation
Seizures
Tachycardia/Tachypnoea
Hyperthermia
HTN
Tremor
Mydriasis
Ataxia
CVS collapse

Question 14

What is the management of delirium tremens?

Answer 14

A-E assessment
Correct any hypoglycaemia
Sedate with BDZs
IV thiamine if suspecting Wernicke’s

Question 15

What is Mydriasis?

Answer 15

Dilation of pupils

Question 16

What are the signs of opiate overdose?

Answer 16

Pinpoint pupils
Respiratory depression
Low GCS/Unconscious

Question 17

What is Wernicke’s triad?

Answer 17

Confusion
Opthamoplegia (Paralysis of muscles within or surrounding the eye)
Ataxia
Due to thiamine deficiency, reversible with treatment

Question 18

What is Korsakoff’s syndrome?

Answer 18

Amnesic disorder with confabulation
Irreversible
Occurs if chronic thiamine deficiency

Question 19

What is confabulation?

Answer 19

A memory disturbance - production of fabricated, distorted or misinterpreted memories about oneself or the world, without the conscious intention to deceive

Question 20

What is the management of opiate addiction?

Answer 20

Detoxification
Motivational interviewing
Substitution - methadone/subutex (buprenorphine) Helps prevent withdrawal symptoms by binding receptors
Harm minimisation
Treat any psychiatric co morbidities

Question 21

What are the complications of substance misuse?

Answer 21

Crime
Debt
Isoaltion
Infection/BBV
Worsening of psychiatric conditions