Alcohol Misuse Flashcards
What is alcohol dependence?
Excessive drinking over a prolonged period of time
What is alcohol often used as?
A coping mechanism
What can harmful drinking lead to?
- Depression
- Liver cirrhosis
- Cancer
- Heart disease
- Associated with criminal activity and domestic violence
What is one unit of alcohol?
10mls/8g of pure alcohol
How many units of alcohol are recommended per week?
14 units/week
What are alcohol-dependent patients at risk of if they stop drinking suddenly?
Alcohol withdrawal
What does alcohol cause?
Down-regulation in inhibitory GABA receptors & up-regulation of excitatory neurotransmitter receptors
How long for symptoms to occur?
6-12 hrs after last drink and more severe 48-72hrs later
What are the symptoms of alcohol withdrawal?
- Tremor
- Sweating
- Confusion
- Seizures
- Headache
- Death
How do we assess alcohol dependence?
- AUDIT (10 qs)
- AUDIT-C (3 qs)
- SADQ > determine severity
- CIWA-AR (Clinical Institute Withdrawal Assessment of Alcohol scale revised)
Which benzodiazepine is used 1st line in management of alcohol withdrawal?
Chlordiazepoxide
How to manage alcohol withdrawal plan?
Community
-Planned detoxification with support in place
- Fixed-dese regiment with diazepam or chlordiazepoxide
- Monitor
- No more than 2 days medication supplied at any time
- Do not offer clomethiazole due to risk of overdose
Inpatient
- Can be planned/unplanned
- Used to prevent complications as often these patients do not want to stop drinking
How does the CIWA-Ar tool work?
- Scores patients depending on their symptoms
- Triggers a dose of benzodiazepines to be administered when required
What are the advantages and disadvantages of regimens?
+
Effective treatment
Avoids over/under sedation
-
Requires trained staff
Time consuming
What are alcohol dependent patients deficient in and what happens?
B vitamins
Thiamin (B1) can cause Wernicke’s Encephalopathy which is reversible but can progress to Korsakoff’s psychosis which is irreversible
- Confusion, ataxia, nystagmus
Parenteral thiamine (IV pabinex) given for 5 days followed by oral thiamine
What is the most severe form of alcohol withdrawal?
Delirium Tremens (DTs)
- Requires specialist management and in severe cases admission to critical care for sedation and ventilation
How to manage DTs
Oral lorazepam (1st line)
If symptoms persist/patient declines treatment
Offer IV/IM lorazepam/haloperidol
If a patient develops alcohol withdrawal seizures what should be used?
IV Lorazepam NOT phenytoin
What should be used to maintain abstinence?
Acamprosate/oral naltrexone
2nd line: Dilsulfiram
All these with CBT
What is the MOA of acamprosate?
Dose?
SEs?
Not fully known
Promotes a balance between excitatory and inhibitory neurotransmitters, glutamate and GABA
Dose of 666mg TDS, reduced if below 60kg
SEs: nausea, sexual dysfunction, skin reactions, flatulence
What is naltrexone, the dose and monitoring requirements?
Opioid receptor antagonist
25mg OD if tolerated 50mg OD
Measure LFTs before & during
Only suitable if not on opioids
What is disulfiram?
DAR symptoms?
Dose?
Counselling?
Alcohol deterrent
Irreversible inactivation of liver enzyme ALDH
- Mechanism of ethanol is blocked and ALDH conc rises
Flushing, increased body temp, nausea, vomiting, sweating, urticaria, headache, dizziness
Develop after 15 mins, peak at 30-60 mins and subside over next few hours
Can be severe & life-threatening
200mg daily, increased to 500mg daily
No alcohol 24hrs before or 14hrs after discontinuation
Reactions after exposure
Awareness of hepatoxicity
What is alcohol fatty liver disease?
Build up of fats in liver
Can develop over a few days
Reversible if stop drinking - no treatment required
What is alcohol hepatitis?
Inflammation of the liver caused by alcohol
Can be reversible if stop drinking depending on severity but can be serious & life-threatening
