Alcohol Misuse Flashcards
What are the methods used in motivational enhancement therapy?
- Reflective listening and expression of empathy.
- Developing a discrepancy between the patients most deeply held values and their current behaviour.
- Sidestep resistance by responding with empathy.
- Building confidence and helping the patient see that change is possible.
What score in the audit questionnaire suggests hazardous drinking?
8 - 14
What score in the audit questionnaire suggests harmful drinking?
15 - 19
What score in the audit questionnaire suggests possible dependence on alcohol?
20+
What should you do if a patient has an audit score of 11 and you are worried they have hazardous drinking?
Deliver a brief intervention.
What should you do if a person scores 21 on the audit drinking questionaire?
Comprehensive assessment of their drinking
What does FRAMES mean in therms of an alcohol brief intervention?
Feedback Responsibility Advice Menu of options Empathy Self efficacy
What number of units per day is it safe for men to drink?
3 - 4, with 2 alcohol free days (21 units per week)
What number of units per day is it safe for women to drink?
2 - 3, with 2 alcohol free days (14 units per week)
How many unite counts as a bing drink?
8 units for men
6 units for women
What does a comprehensive assessment of someones alcohol use cover?
- Consumption - pattern and daily unit intake.
- Dependence
- Alcohol related problems
- Treatment history
- Comorbidity (physical, psychological, social)
- Other substance use.
- Cognitive function (MMSE)
- Readiness and belief in ability to change.
How long into alcohol withdrawal might seizures occur?
0 - 48 hours
How long into alcohol withdrawal might the DTs occur?
48 - 72 hours.
What happens in the delirium tremens?
Course tremor
Confusion
Delusions
Hallucinations
What drug is used to in assisted alcohol withdrawal in a fixed dose regime?
Chlordiazepoxide
What drug is used in assisted alcohol withdrawal in a flexible dose regimen?
Diazepam
A patient who has a significant alcohol dependence problem is staggering and confused. You also notice that his eye movements are very restricted.
Wernicke’s encephalopathy
What causes wernicke’s encephalopathy?
Thiamine deficiency (vitamin B1)
A patient who has a significant alcohol dependence problem is having short term memory problems, appears to be confabulating and is acting strangely. What is this and what is the cause?
Korsakoff’s syndrome caused by a thiamine deficiency.
What is the treatment for Wernicke’s encephalopathy?
Thiamine
A patient with a history of alcohol dependence present with nummbess and pain in his hands and feet?
Peripheral neuropathy
What causes the peripheral neuropathy seen in alcohol dependency?
Thiamine deficiency
What part of the brain starts to degenerate as a result of thiamine deficiency?
Cerebellum
What drug do you start FIRST in patientss with overt symptoms of wernicke’s encephalopathy or korsakoff syndrome?
Pabrinex. Patient is on this for 7 days then thiamine is started.
What drug, prescribed for those with alcohol dependance reduces glutaminergic activity which reduces alcohol cravings, acting as an adjunct to maintain abstinence?
Acamprosate
What drug, prescribed for those with alcohol dependance is an opioid receptor antagonist that reduces the pleasure which reinforces alcohol use meaning there is less chance of a lapse becoming a relapse?
Naltrexone
What drug, prescribed for those with alcohol dependance is an opioid receptor agonist which reduces alcohol consumption?
Nalmefene
What class of drug is used in medically assisted alcohol withdrawal?
Benzodiapzapine
What drugs, used to help with withdrawal are not given in the community due to risk of overdose?
Clomethiazole
What benzodiazepine is best to use in alcohol withdrawal if the person have liver impairement?
lorazepam
What is the first line treatment for the DTs?
Oral lorazepam
A person in the DTS has had some oral lorazepam but there has been no significant improvement. What drug should be given next?
Parenteral lorazepam, haloperidol or olanzapine.
What part of the brain is there haemmorhage into in Wernicke’s encephalopathy?
Mamillary bodies
What is the classic triad of symptoms seen in Werneike’s encephalopathy?
Encephalopathy
Ataxic gait
Oculomotor disfunction
What are the symptoms of chronic Werneike;s?
Retrograde and Anterograde amnesia
