Alcohol Misuse

Question 1

What are the alcohol dependence criteria?

Answer 1

1. Physiological evidence of tolerance
2. Physiological evidence of withdrawal
3. Recurrent use of alcohol which prevents completion of obligations
4. Use of alcohol in situations where it is potentially harmful
5. Continued use of alcohol despite social or interpersonal problems (overwhelming craving)

Question 2

How does acamprosate work in reducing alcohol intake?

Answer 2

Weak antagonism of NMDA receptors, which reduces alcohol cravings.

NMDA = N-methyl-D-aspartate

Question 3

How does naltrexone work in reducing alcohol intake?

Answer 3

Antagonistic effect on mu-opioid receptors, which suppresses associated euphoria

Question 4

How does disulfiram work in treating alcohol misuse?

Answer 4

Inhibition of acetaldehyde dehydrogenase, i.e. blocks breakdown of alcohol in body. This promotes abstinence by producing effects of a hangover immediately after alcohol consumption.

Question 5

How does thiamine supplementation help patients with alcohol misuse?

Answer 5

People who excessively drink alcohol commonly have thiamine deficiency, which can lead to Wernicke-Korsakoff syndrome. Thiamine supplements therefore help prevent this.

Thiamine = vitamin B1

Question 6

What are the features 6-12 hours post alcohol withdrawal?

Answer 6

1. Tremor
2. Sweating
3. Tachycardia
4. Anxiety

Question 7

What is most likely to occur in 36 hours post alcohol withdrawal?

Answer 7

Seizures

Question 8

What is most likely to occur in 48-72 hours post alcohol withdrawal?

Answer 8

Delirium tremens

Question 9

What are the signs and symptoms of delirium tremens?

Answer 9

1. Coarse tremor
2. Confusion
3. Delusions
4. Hallucinations
5. Fever
6. Tachycardia

Question 10

What is the first line management of alcohol withdrawal features?

Answer 10

Long-acting benzodiazepines

Question 11

If long-acting benzodiazepines are used for alcohol withdrawal, at what point should they be stopped?

Answer 11

When CIWA-Ar score is <10

Question 12

What is the triad of Wernicke’s encephalopathy?

Answer 12

1. Ataxia
2. Confusion
3. Ophthalmoplegia

Ataxia = disorders of balance, movement and coordination.

Question 13

What often follows Wernicke’s encephalopathy?

Answer 13

Korsakoff’s syndrome

Question 14

What are the features of Korsakoff’s syndrome?

Answer 14

1. Confabulation
2. Anterograde amnesia (unable to form new memories)

Confabulation = creation of false memories without intent to deceive