Alcohol Misuse Flashcards
What is the recommended alcohol limits for both men and women?
14 units
Why do men metabolise alcohol faster?
They have lower percentage of body fat
What is the legal limit to drive after alcohol?
<80mg of alcohol/100ml of blood
Can still be above 80% in the morning after
Why are women drinking more?
More socially acceptable
More disposable income
More drinks marketed at women
More drinking places aimed at women customers
What are the risk factors for drinking?
Drinking within the family Childhood behavioural problems Early use of alcohol, nicotine and drugs Poor coping responses to life events Depression as a cause
What are the common causes of death due to alcohol?
Accidents and violence
Malignancies
Cerebrovascular disease
Coronary heart disease
What are the effects of alcohol on pregnancy?
Increased risk of miscarriage, low birth weight, fetal alcohol syndrome
What is the management for people requesting help with alcohol problem?
- Investigations
Physical and mental examination
Assess IHD, osteoporosis risk - Screening questions
CAGE questionnaire
AUDIT questionnaire - Treatment
Referral to appropriate services
Offer vitamin supplements
Benzodiazepines for acute withdrawal
Disulfiram (Antabuse): promotes abstinence - alcohol intake causes severe reaction due to inhibition of acetaldehyde dehydrogenase. Patients should be aware that even small amounts of alcohol (e.g. In perfumes, foods, mouthwashes) can produce severe symptoms. Contraindications include ischaemic heart disease and psychosis
Acamprosate: reduces craving, known to be a weak antagonist of NMDA receptors, improves abstinence in placebo controlled trials
What are the questions asked in CAGE questionaire?
Have you ever felt you should Cut down on your drinking?
Have people Annoyed you by criticising your drinking?
Have you ever felt bad or Guilty about your drinking?
Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?
A total score of 2 or greater is considered clinically significant.
What are the dangers of alcohol withdrawal?
Wernicke’s encephalopathy
Korsakoff’s syndrome
Delirium tremens
How is Korsakoff’s diagnosed?
CT head
How is delirium tremens managed?
1st line: benzodiazepines e.g. chlordiazepoxide. Lorazepam may be preferable in patients with hepatic failure. Typically given as part of a reducing dose protocol
carbamazepine also effective in treatment of alcohol withdrawal
phenytoin is said not to be as effective in the treatment of alcohol withdrawal seizures
What is alcohol harm paradox?
People with lower income who drinks less have higher risks of hospitalisations/conditions caused by alcohol
This is may be due to higher stress levels, limited social support, poor diet/exercise.
What is prevention paradox?
A prevention measure that brings a large benefit to the community confers little benefit to each individual.
Define at risk drinking.
Pattern of drinking which brings about risk of physical or psychological harm.