Alcohol & SA Flashcards
Alcohol withdrawal: onset, sx, mx
Onset: within 4-12 hrs of cessation
Sx: tremulousness, sweating, N/V, mood, hyperacusis, ANS hyperactivity, sleep, psychomotor agitation
Mx: IM lorazepam or chlordiazepoxide
Alcoholic hallucinosis: onset, sx, mx
Onset: within 12 hrs of cessation
Sx: hallucination (visual > auditory & tactile), secondary delusions
Mx: antipsychotics e.g. haloperidol x6m
Alcohol withdrawal seizures: onset, RF
GTC
Onset: within 24 hrs of cessation
RF: previous hx, concurrent epilepsy, low K or Mg
Delirium tremens: sx, mx
Sx: vivid hallucinations, altered LOC & cognitive impairment, tremor, ANS arousal (sweating, tachycardia, HT, fever), paranoid delusions
Mx: large dose BZD (chlordiazepoxide or lorazepam), antipsychotic (haloperidol), large dose parenteral thiamine
Wernicke encephalopathy: cause, sx, mx
Thiamine deficiency (malabsorption -> acute brain damage) Clinical triad: delirium, ophthalmoplegia, ataxia Mx: parenteral thiamine BEFORE glucose
Korsakoff’s syndrome: sx, mx
Chronic state after Wernicke (irreversible)
Sx: amnesia, confabulation, poverty of speech, frontal lobe dysfunction, psychotic symptoms
Mx: lifelong oral thiamine
Alcoholic dementia / amnesic syndrome: epidemiology, sx
10% of all dementia
Sx: disoriented to time, confabulation, impaired short term memory
How to diagnose alcohol use disorder?
3 in past 12m
1) Craving
2) x control
3) Primacy
4) Tolerance
5) Withdrawal
6) Knowledge of harmful consequences (health, physical hazards)
How to manage alcohol use disorder?
Controlled drinking VS abstinence
Detox: chlordiazepoxide (taper down in 1st week)
Thiamine BEFORE glucose
Optional: disulfaram, naltrexone
Psychotherapy: CBT, motivational interviewing, AA
Cannabis intoxication
Physical: tachycardia, dry mouth, conjunctival injection, increased appetite
Psychological: euphoria, sedation, impaired judgment / memory / motor performance, distorted sensory perception, sensation of slowed time, asocial
Functional: amotivational syndrome
Cannabis withdrawal
Mood: irritable, anxious, depressed, restless
Poor sleep & appetite
Physical: abdominal pain, tremor, sweating/chills, headache
Examples of psychostimulants
Cocaine, meth, ecstasy
Examples of CNS depressants
Alcohol, BZD, Z drugs, heroin
What are the sx of psychostimulant intoxication?
Increased excitement, talkativeness, confidence Hand tremor Tachycardia, HT, palpitation Dilated pupils Sweating
What are the sx of psychostimulant withdrawal?
Depression
Psychomotor retardation
What are the sx of CNS depressant intoxication?
Constricted pupil
Euphoria, relaxation, disinhibition
Dulling of pain
What are the sx of CNS depressant withdrawal?
Withdrawal seizure
Restless, agitated, irritated
Insomnia
What are the specific sx of heroin?
Thrombophlebitis
Pinpoint pupil
What are the specific sx of ice?
Fornication -> festering, painful-looking sores
Meth mouth
What are the specific sx of ketamine?
LUTS
Cholangiopathy
Perforation of nasal septum
Long pinky nail
What are the sx of cough mixture?
Dental caries
What are the sx of cannabis?
Conjunctival injection (hyperemia & vasodilation)
What are the physical cx of SA?
Malnutrition, anemia, jaundice, hepatitis, DVT, IE, OD, accident
Alcohol: HI, liver disease, pancreatitis, cerebellar pathology
Ketamine: LUTS, nasal symptoms, cholangiopathy
What are the components and effects of cough mixture?
Codeine / dextromethorpan: relax
Ephedrine: euphoria
Promethazine: sedate
How to manage SA patient?
Admit for high risk
Inpatient detox
Psychotherapy: motivational abstinence, psychoeducation
Harm reduction advice
How to quit BZD?
Switch to single prescription (lorazepam)
Taper off gradually (1/8th fortnightly)
Manage sleep problem
What are the Cx of alcoholic cirrhosis?
Portal HT: esophageal varices, ascites, hypersplenism (splenomegaly, anemia, thrombocytopenia)
Renal dysfunction
Liver dysfunction: hypogly, low alb, coagulopathy, encephalopathy, jaundice
Respi: intrapulmonary vasodilation -> hypoxemia -> dyspnea
HCC
What are the stigmata of CLD?
Asterixis, ascites, ankle edema, x axillary hair Bruise, spider nevi, caput medusa Clubbing, color of nails (leukonychia) Dupuytren’s contracture Encephalopathy, palmar erythema Fetor hepaticus Gynecomastia, hypogonadism Hepatosplenomegaly Increased size of paotid Jaundice
How to investigate delirium tremens?
r/o other cx of alcohol e.g. GIB
r/o organic cause of delirium
LRFT, electrolyte, CBC, Ca, B12/folate, TFT, septic workup
