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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
Q

what is chlordiazepoxide indicated for?

A

symptomatic relief of anxiety
muscle spasm
symptomatic relief of acute alcohol withdrawal

26
Q

what is the maximum length of time you can use chlordiazepoxide for?

A

4 weeks including a 2 week tapering off period as it is addictive

27
Q

how does alcohol cause withdrawal symptoms?

A
  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
Q

what are the pharmacokinetics properties of chlordiazepoxide relating to absorption?

A 
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
Q

what are the pharmacokinetics properties of chlordiazepoxide relating to distribution and metabolism?

A

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
Q

how does Chlordiazepoxide work?

A

binds to GABA receptors on the post synaptic neurone
is a GABA agonist so causes Cl- ions to flow in
inhibits nerve impulses

31
Q

what are the contraindications of Chlordiazepoxide?

A 
hypersensitivity to benzodiazepines 
phobic and obsessional states 
chronic psychosis 
severe hepatic insufficiency - can cause encephalopathy 
pregnancy 
myasthenia gravis
32
Q

why do we taper off treatment with Chlordiazepoxide?

A

can cause withdrawal effects (NB it is addictive too if used over a long time)

33
Q

what are the withdrawal effects of Chlordiazepoxide

A 
headache 
muscular pain 
anxiety 
hallucinations 
epileptic seizures
34
Q

what are the interactions with Chlordiazepoxide?

A
  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
Q

when is Disulfiram given?

A

post-detox as it cannot be given with Chlordiazepoxide as it reduces the clearance rate of Chlordiazepoxide

36
Q

what are the side effects of chlordiazepoxide?

A 
drowsiness
ataxia 
aggression/disinhibition
headache 
amnesia
respiratory depression 
impaired liver function
37
Q

which liver enzymes are usually affected by alcohol?

A

serum AST - aspartate aminotransferase

serum GGT - Gamma-glutamyltransferase

38
Q

Which is more specific to the liver ALT or AST?

A

ALT - L for Liver

AST is present elsewhere

39
Q

What drug is given as an alternative to Chlordiazepoxide for people who have hepatic impairment?

A

Lorazepam

40
Q

What is Wernike’s encephalopathy caused by?

A

Thiamine deficiency - due to poor diet and poor intake of vitamins and poor gastro-intestinal absoprtion due to gastritis

41
Q

How does thiamine interact with alcohol?

A

metabolism of alcohol depends on thiamine as a co-enzyme

42
Q

How is Wernicke’s encephalopathy treated?

A

treated initially with Pabrinex - a compound preparation of B and C vitamins
then oral thiamine is started

43
Q

What drugs are given for relapse prevention?

A

Acamprosate
Disulfiram
Nalmefine

44
Q

What effects does Acamprosoate have on the pt?

A

stops cravings for alcohol

45
Q

What effect does Disulfiram have on the

body and so on the pt?

A 
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
Q

What are the cautions with Disulfiram

A

dietary caution - foods containing alcohol
cosmetics containing alcohol
hepatic impairment

47
Q

How does Nalmefine work?

A

opioid receptor antagonist
modifies activity at dopamine receptor sites linked to reward so there is a reduced feeling of reward from drinking alcohol

GI (15 decks)

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