Alcohol Misuse

Question 1

1 unit is the equivalent of…

Answer 1

10ml alcohol

Question 2

increased risk drinking is drinking between _ and _ units a week

Answer 2

15 and 35

Question 3

higher risk drinking is drinking over _ units per week

Answer 3

35

Question 4

what tools can be used to screen for alcohol dependence?

Answer 4

AUDIT - alcohol user disorders identification test

CAGE - cut down, annoyed, guilty, eye opener

Question 5

alcoholism has what effect on MCV?

Answer 5

raises it

Question 6

what kind of alcohol dependent patients are managed as inpatients?

Answer 6

if they have comorbidities and are moderately dependent or over

Question 7

how should alcohol dependent patients be managed in the community

Answer 7

use FRAMES
Feedback to review problems experienced
Responsibility for change
Advise reduction
Menu- provide options for change
Empathy
Self efficacy - give them confidence

Question 8

what happens to the CNS when you withdraw alcohol?

Answer 8

excess glutamate activity and reduced GABA activity which is toxic to neurons which = CNS excitability and neurotoxicity

Question 9

first symptoms of alcohol withdrawal occur in what timeframe

Answer 9

1-2 days

Question 10

DT onset will be within _ hours of withdrawal

Answer 10

24

Question 11

most symptoms of alcohol withdrawal resolve within - days

Answer 11

5-7

Question 12

symptoms of alcohol withdrawal

Answer 12

restlessness
tremor
sweating
anxiety
N+V

Question 13

how do benzodiazepines work in alcohol withdrawal?

Answer 13

act on GABA A receptors

Question 14

DT peaks after how many days of withdrawal?

Answer 14

2

Question 15

how does DT present?

Answer 15

insidiously with nighttime confusion

Question 16

Tx of alcohol withdrawal

Answer 16

diazepam (benzodiazepine)
reduce dose over 7 days or more
hydrate
analgesia
antiemetics

Question 17

what is the main vitamin deficiency in alcohol withdrawal and what is the consequence?

Answer 17

not eating so use up all their thiamine causing wernickes encephalopathy

Question 18

how is prophylactic thiamine given?

Answer 18

parenterally

Question 19

when would you manage detoxification of a patient in hospital?

Answer 19

secere dependence
DT or recent withdrawal seizures
Hx of failed detoxifications
poor social support
cognitive impairment

Question 20

when should benzos be stopped in alcohol withdrawal?

Answer 20

once detoxification has been achieved

Question 21

what drugs are used as prophylaxis for a relapse?

Answer 21

disulfiram - CANT DRINK ON IT
acamprosate
naltrexone

Question 22

first line agent for relapse prevention? what kind of drug is it?

Answer 22

naltrexone

opioid antagonist

Question 23

wernickes syndrome is due to what vitamin deficiency?

Answer 23

B1