Alcohol Misuse Disorders Flashcards
what screening tool is used to assess for alcohol dependence?
CAGE
what screening tool is used to assess for harmful and hazardous drinking?
AUDIT
what management is indicated by each result of the AUDIT test?
0-7 = none 8-19 = brief intervention 20+ = specialist referral
what alcohol screening tool can be done in A+E?
FAST
how do you calculate units of alcohol?
strength x volume/1000
what seven types of cancer are associated with alcohol?
mouth/throat larynx oesophagus breast liver bowel
what is hazardous drinking?
a pattern of alcohol consumption that increases someones risk of harm
over the recommended limit
what amount of alcohol consumption is considered harmful drinking?
regular consumption of >35 units in a week
what acronym represents the elements of a brief intervention?
FRAMES
what does FRAMES stand for?
feedback responsibility advice menu empathy self efficacy
what does the feedback section of the FRAMES model involve?
reviewing the problems experienced because of alcohol
what does the responsibility section of the FRAMES model involve?
explaining that the patient is responsible for change
what does the advice section of the FRAMES model involve?
advise reduction or abstinence
what does the menu section of the FRAMES model involve?
providing options for changing behaviour
what does the empathy section of the FRAMES model involve?
use an empathic approach
what does the self efficacy section of the FRAMES model involve?
encourage optimism about changing behaviour
what is the general pathophysiology behind alcohol withdrawal?
chronic CNS depression from alcohol results in increased CNS excitation
this is unopposed when alcohol is removed
when do the symptoms of alcohol withdrawal syndrome begin?
within hours
peak at 24-48 hours
what are the symptoms of alcohol withdrawal syndrome?
restlessness tremor sweating anxiety N+V loss of appetite insomnia
what serious symptom can occur in the first 24 hours of alcohol withdrawal syndrome?
generalised seizures
what medical emergency can alcohol withdrawal syndrome progress to?
delirium tremens
how long does it usually take for the symptoms of alcohol withdrawal syndrome to resolve?
5-7 days
when is the peak onset of delirium tremens?
within 2 days of abstinence
how does delirium tremens often present?
insidiously, with night time confusion
what are the symptoms of delirium tremens?
confusion agitation hypertension hallucinations paranoid ideation
how can delirium tremens result in death?
CV collapse
infection
what medication can be given to manage alcohol withdrawal syndrome?
benzodiazepines
what benzodiazepines should be used for alcohol withdrawal syndrome?
long acting agents
diazepam, chloriazepoxide
why is thiamine given in alcohol withdrawal syndrome?
as prophylaxis against Wernicke’s encephalopathy
why is thiamine given in alcohol withdrawal syndrome?
as prophylaxis against Wernicke’s encephalopathy
what are the possible psychosocial interventions for relapse prevention?
CBT MET 12 step behavioural self control family/couple therapy
what three medications can be used to prevent alcohol relapses?
disulfiram
acamprosate
naltrexone
what is another name for disulfiram?
Antabuse
how does disulfiram work?
inhibits acetaldehyde dehydrogenase leading to accumulation of acetylhyde if alcohol consumed
causes unpleasant side effects
what are the side effects of taking disulfiram and consuming alcohol?
flushing tachycardia N+V arrhythmia hypotension
what is one negative to using disulfiram?
relies on the patients compliance
how does acamprosate work?
acts centrally on glutamate and GABA systems
reduces cravings
when should acamprosate be started?
as soon as the detox is complete
what are the possible side effects of acamprosate?
headache
diarrhoea
nausea
what should acamprosate be prescribed alongside?
psychological intervention
what is the first line drug for alcohol relapse prevention?
naltrexone
what type of drug is naltrexone?
opioid antagonist
how does naltrexone prevent a relapse?
reduces the reward a patient experiences from alcohol
