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BB Test 4 > Alcohol & Sedative Use Disorder > Flashcards

Alcohol & Sedative Use Disorder Flashcards

1
Q

What is the most common form of excessive alcohol consumption?

A

Binge drinking

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2
Q

For women, binge drinking is defined as ___ or more drinks during a single occasion.

A

4 or more drinks

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3
Q

For men, binge drinking is defined as ___ or more drinks during a single occasion.

A

5 or more drinks

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4
Q

For women, heavy drinking is defined as more than ___ drink(s) per day.

A

More than 1 drink

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5
Q

For men, heavy drinking is defined as more than ___ drink(s) per day.

A

More than 2 drinks

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6
Q

A standard drink is a drink that contains ____ oz. of pure alcohol.

A

0.6 oz

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7
Q

Sedative and hypnotic abuse is more common in (males/females).

A

Females

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8
Q

Alcohol abuse is more common in (males/females).

A

Males

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9
Q

What are the most common symptoms of intoxication?

A
  • Slurred speech
  • Loss of coordination
  • Unsteady gait
  • Nystagmus
  • Impairment in attention or memory (blackout)
  • Disinhibition
  • Stupor or coma
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10
Q

(T/F) Barbiturates have little effect on respiratory drive unless combined with other sedatives or used by someone with preexisting respiratory compromise.

A

False. Benzodiazepines have little effect on respiratory drive unless combined with other sedatives.

  • Barbiturates do cause respiratory depression
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11
Q

What is Wernicke Encephalopathy and whare are the early symptoms?

A
  • Atrophy of mammillary bodies that results from thiamine deficiency due to alcholism
  • Symtpoms:
    • Decreased concentration
    • Apathy
    • Mild agitation
    • Depressed mood
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12
Q

(T/F) When treating a patient suspected of Wernicke encephalopathy, glucose must be given prior to thiamine in an acute setting such as an ER.

A

False. Thiamine must be given first to glucose in an acute setting.

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13
Q

What is the “triad” of symptoms in Wernicke encephalopathy?

A
  • Confusion
  • Ataxia
  • Nystagmus (something with the eyes: ophthalmoplegia, anisocoria, sluggish pupillary reflexes)

“CAN”

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14
Q

_______________ is a condition that results from Wernicke encephalopathy. It is characterized by amnesia, confabulation (fill in blanks with random information), and hallucinations.

A

Korsakoff’s Psychosis

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15
Q

What are some of the common signs seen in fetal alcohol syndrome (FAS)?

A
  • Mental retardation (44% have an IQ < 79)
  • Wide-set eyes
  • Short palpebral fissure
  • Short and broad-bridged nose
  • Hypoplastic (smooth) philtrum
  • Thinned upper lip
  • Flattened midface
  • Epicanthal folds at medial portion of eyes
  • “Railroad track” ears
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16
Q

There is a(n) (increase/decrease) in GABA functioning within the brain during intoxication.

A

Increase

17
Q

GABAA receptors are (increased/decreased) with chronic alcohol use.

A

Decreased

18
Q

There is a(n) (increase/decrease) in glutamate functioning within the brain during intoxication.

A

Decrease

19
Q

NMDA receptors (glutamate receptors) are (increased/decreased) with chronic alcohol use.

A

Increased

20
Q

The heritability rate for alcoholism is ___-___%.

A

50-65%

21
Q

What factors may make alcohol withdrawal worse?

A
  • Older age
  • Severity of use
  • Prior withdrawals (referred to as “kindling)
  • Major medical/surgical problems
  • Sedative/hypnotic use
22
Q

Describe Stage I of alcohol withdrawal (AW).

A
  • Occurs 24-48 hours after cessation
  • Characterized by:
    • Hypertension
    • Increased pulse
    • Increased heart rate
    • Sweating
    • Shaking
    • Seizures occur in this phase
23
Q

Describe Stage II of alcohol withdrawal (AW).

A
  • Occurs 48-72 hours after cessaition
  • Characterized by:
    • Wosened Stage I symptoms (hypertension, heart rate, sweating, shaking, etc)
24
Q

Describe Stage III of alcohol withdrawal (AW).

A
  • Occurs 72-105 hours after cessation
  • Characterized by:
    • Increased Stage I & II symptoms (hypertension, increased heart rate, sweating, shaking, etc)
    • Delirium Tremens (acute episode of delerium)
25
Q

Describe Stage IV of alcohol withdrawal (AW).

A
  • Occurs 7 days after cessation
  • Characterized by:
    • Protracted withdrawal (depressed, irritable)
26
Q

The first line pharmacotherapy agent for use in alcohol withdrawals is the _____________ group of drugs

A

Benzodiazepine

27
Q

______________ and ______________ are longer half life benzodiazepines used in withdrawal cases. Physicians should never use these in the elderly.

A

Chlordiazepoxide and Diazepam

  • Decreased risk of seizures
  • Decreased distress (smoother detox)
28
Q

______________ and ______________ are shorter half life benzodiazepines used in withdrawal cases. These are safe to use in the elderly.

A

Lorazepam and Oxazepam

  • Decreased oversedation
  • Good for patients with liver impairment
29
Q

A Clinical Institute Withdrawal Assessment (CIWA) score of ___ or greater usually warrants intervention with benzodiazepines in alcohol withdrawal cases. What are the scors for moderate and severe withdrawal?

A

Mild: 8 or greater

Moderate: 10 - 15

Severe: >15

30
Q

What is the mechanism of action, daily dose, and side effects for Disulfiram?

A
  • MAO: Inhibition of acetaldehyde dehydrogenase (results in accumulation of acetaldehyde and increases hangover symptoms)
  • Daily Dose: 250mg daily
  • Side Effects:
    • Drowsiness
    • Fatigue
    • Optic neuritis
    • Neuropathy
    • Hepatotoxicity (LFTs must be monitored every three months)
31
Q

What is the mechanism of action, daily dose, and side effects for Naltrexone?

A
  • MAO: Opioid antagonist (so if injured, opioids won’t help for pain)
  • Daily Dose: 50mg daily
  • Side Effects:
    • Nausea
    • Headaches/diziness
    • Weakness and other flu-like symptoms
    • Decreases liver function (so must check LFTs to rule out preexisting hepatic dysfunction
32
Q

What is the mechanism of action, daily dose, and side effects for Acamprosate?

A
  • MAO: Inhibition of glutamate response at NMDA receptor; NMDA antagonist (but also enhances NMDA receptor function) - Decreases anxiety-related drinking
  • Dose: 666mg three times daily
  • Side Effects:
    • Diarrhea
    • Bloating
    • Rash
    • Excreted unchanged so kidney function should be tested before beginning it
33
Q

What is the mechanism of action for disulfiram?

A

Disulfiram acts as an inhibitor of aldehyde dehydrogenase, causing the accumulation of acetaldehyde upon alcohol ingestion. This elicits a severe “hangover” reaction within 30 minutes of alcohol ingestion.

34
Q

What is the mechanism of action for acamprosate?

A

Acamprosate modulates the release of glutamate, an excitatory neurotransmitter. Glutamate is often overproduced in alcoholics and over time may elicit symptoms such as shaking, hypertension, or seizures. Acamprosate prevents this by competing for glutamate receptors (NMDA receptors).

35
Q

What is the mechanism of action for naltrexone?

A

Naltrexone acts as an opioid inhibitor and antagonist. By occupying the opioid receptor, naltrexone decreases the endogenous “reward” elicited by substances such as alcohol. This prevents cravings and alcoholics seeking “just one more drink”.

36
Q

(T/F) Naltrexone may be injected in a once-monthly dosage to eliminate the need for daily compliance.

A

True.

37
Q

What is Delirium Tremens?

A
  • Severe, compliacted alcohol withdrawal
  • Symptoms:
    • Marked, autonomic arousal
    • Shakes, sweats, hypertension, tachycardia
    • Usually 3 - 5 days but may last longer
    • Delirium (frequent tactile & visual hallucinations)
    • If untreated, there is a 20% mortality

BB Test 4 (14 decks)

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