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alcohol interventions Flashcards

1
Q

what is an example of a key policy in treatment of drug and alcohol dependency?

A

MoCAM - Models of care for alcohol misusers

put in place by the department of health

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2
Q

what did MoCAM talk about?

A
  1. screening and assessment
  2. the four tired framework
  3. care planning and coordination
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3
Q

What are the four tiers?

A
  1. non-substance misuse specific services - eg social services or GP where a pt can make first contact
  2. open access drug/alcohol services - run by the third sector ie volunteer groups like Turning Point
  3. specialist community based clinics eg alcohol and opiate clinics
  4. specialist in-pt services - eg detox treatments and residential rehab programmes
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4
Q

what did the government’s alcohol strategy in 2012 focus on?

A
  1. minimum pricing for a unit of alcohol
  2. licensing - reduce the density of licensed premises
  3. law - challenge alcohol related offending
  4. lower risk limits - < 14 units per week and if you drink 14 units a week, spread this out evenly over ≥3 days and have several alcohol free days a week to reduce the amount of alcohol you drink
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5
Q

define substance misuse

A

recurrent substance use resulting in a failure to fulfil major role obligations such as work, school or home life
recurrent substance misuse in which it is physically hazardous eg driving or operating machinery
recurrent substance misuse despite persistent or recurrent social or interpersonal problems caused

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6
Q

How can we tell when someone’s drinking needs treating?

A

screening tools eg AUDIT - Alcohol Use Disorders Identification Test

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7
Q

what are the questions of AUDIT C?

A
  1. how OFTEN do you have a drink containing alcohol?
  2. how MANY UNITS of alcohol do you drink on a typical day when you are drinking
  3. how often have you had ≥6 units per day if female or ≥8 units per day if male?
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8
Q

what score in indicates risky drinking in AUDI C and what happens if someone hits the cut off?

A

≥ 5 - AUDIT C positive, then move on to the longer version AUDIT

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9
Q

can AUDIT be done by GPs and what is this type of screening called?

A

yes

brief interventions

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10
Q

give examples of extended brief interventions

A
  1. behavioural change - CBT
  2. motivational enhancement therapy
  3. Motivational Interviewing
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11
Q

how long are extended brief interventions?

A

20-30 min sessions with a follow up - 1-4 sessions

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12
Q

who can deliver extended brief interventions?

A

GP
specialist service
third sector eg Turning Point

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13
Q

what are the two types of brief intervention?

A

brief advice - a few minutes

Extended Brief Intervention

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14
Q

what tool do we use to measure the severity of alcohol dependence?

A

SADQ - Severity of Alcohol Dependence Questionnaire

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15
Q

What investigation would you do if someone go a score of ≥20 on AUDIT

A
  1. SADQ
  2. MMSE
  3. Beck’s depression index
  4. blood tests - FBC and LFTs

assess alcohol withdrawal symptoms using SADQ
assess for cognitive issues using MMSE
assess mental health - risk to self/others, low mood anxiety with Beck’s DI

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16
Q

give examples of two cognitive conditions caused by alcohol

A

Wenike’s encephalopathy

Dementia

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17
Q

what topics does SADQ cover?

A 
physical withdrawal symptoms 
affective withdrawal symptoms 
relief drinking
frequency of alcohol consumption
speed on onset of withdrawal symptoms
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18
Q

what doe the score mean in SADQ?

A

below 16 = mild physical dependency
16 - 30 = moderate dependence
≥ 31 = severe depedence

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19
Q

What should someone be offered if they they have a score of ≥ 16 on the SADQ?

A

Chlordiapoxide detoxification regime (a benzodiazepine)

20
Q

what is dependence?

A

a state in which an organism functions normally only in the presence of a drug and gets withdrawal symptoms when the drug is withdrawn

21
Q

How does alcohol affect the CNS whist the person is drinking alcohol?

A

potentiates GABA, so inhibits electrical impulses

inhibits the major excitatory neurotransmitter glutamate

22
Q

what is tolerance?

A

a state in which an organism requires a higher dose to achieve the same effect

23
Q

what would you offer a pt who has had tremors or a seizure from alcohol withdrawal before?

A

alcohol detox as an in-pt (in this case they need to be in hospital)

24
Q

what is the main drug used in both community and in-pt alcohol detox programmes?

A

Chlordiazepoxide as it has a long half life and can be given every 4 hours

25
what is chlordiazepoxide indicated for?
symptomatic relief of anxiety muscle spasm symptomatic relief of acute alcohol withdrawal
26
what is the maximum length of time you can use chlordiazepoxide for?
4 weeks including a 2 week tapering off period as it is addictive
27
how does alcohol cause withdrawal symptoms?
1. number of presynaptic calcium channels increases 2. chloride ion flow is reduced 3. so electrical impulses in the nerves increase 4. and the excitability of the nerve is enhanced this is what causes tremor this is also behind tolerance
28
what are the pharmacokinetics properties of chlordiazepoxide relating to absorption?
``` well absorbed in the small intestine highly lipophilic so gets across the BBB absorption is delayed in the elderly and on those with reduced liver function half life is 6-30 hours highly protein bound ```
29
what are the pharmacokinetics properties of chlordiazepoxide relating to distribution and metabolism?
extensively metabolised by the liver, so causes problems in people with reduced liver function crosses BBB - works in the grey matter active metabolite is desmethyl-chlordiazepoxide
30
how does Chlordiazepoxide work?
binds to GABA receptors on the post synaptic neurone is a GABA agonist so causes Cl- ions to flow in inhibits nerve impulses
31
what are the contraindications of Chlordiazepoxide?
``` hypersensitivity to benzodiazepines phobic and obsessional states chronic psychosis severe hepatic insufficiency - can cause encephalopathy pregnancy myasthenia gravis ```
32
why do we taper off treatment with Chlordiazepoxide?
can cause withdrawal effects (NB it is addictive too if used over a long time)
33
what are the withdrawal effects of Chlordiazepoxide
``` headache muscular pain anxiety hallucinations epileptic seizures ```
34
what are the interactions with Chlordiazepoxide?
1. alcohol - causes additive depressive effects so can get respiratory depression 2. centrally acting drugs eg antipsychotics, analgesics and sedative antihistamines 3. anti-epileptic drugs 4. CYP450 inhibitors increase the effect of Chlordiazepoxide as it depends on CYP450 for elimination
35
when is Disulfiram given?
post-detox as it cannot be given with Chlordiazepoxide as it reduces the clearance rate of Chlordiazepoxide
36
what are the side effects of chlordiazepoxide?
``` drowsiness ataxia aggression/disinhibition headache amnesia respiratory depression impaired liver function ```
37
which liver enzymes are usually affected by alcohol?
serum AST - aspartate aminotransferase | serum GGT - Gamma-glutamyltransferase
38
Which is more specific to the liver ALT or AST?
ALT - L for Liver | AST is present elsewhere
39
What drug is given as an alternative to Chlordiazepoxide for people who have hepatic impairment?
Lorazepam
40
What is Wernike's encephalopathy caused by?
Thiamine deficiency - due to poor diet and poor intake of vitamins and poor gastro-intestinal absoprtion due to gastritis
41
How does thiamine interact with alcohol?
metabolism of alcohol depends on thiamine as a co-enzyme
42
How is Wernicke's encephalopathy treated?
treated initially with Pabrinex - a compound preparation of B and C vitamins then oral thiamine is started
43
What drugs are given for relapse prevention?
Acamprosate Disulfiram Nalmefine
44
What effects does Acamprosoate have on the pt?
stops cravings for alcohol
45
What effect does Disulfiram have on the | body and so on the pt?
``` it prevents oxidation of alcohol into acetic acid, so acetyaldehyde builds up and causes an anaphylaxis type reaction with: flushing of the skin tachycardia SOB nausea vomiting this happens if the pt drinks alcohol ```
46
What are the cautions with Disulfiram
dietary caution - foods containing alcohol cosmetics containing alcohol hepatic impairment
47
How does Nalmefine work?
opioid receptor antagonist modifies activity at dopamine receptor sites linked to reward so there is a reduced feeling of reward from drinking alcohol

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