alcohol + substance abuse Flashcards
diagnosis of substance use disorder
2 of following over 1 year:
1) tolerance: more drug to achieve same effect
2) withdrawal sx: sx opposite of intoxication
3) persistent desire or unsuccessful attempt to cut down
4) significant energy spent obtaining, using, recovering
5) social, occupational activities reduced
6) continued use in spite of knowledge
7) craving
8) recurrent use in dangerous situations: drink + drive
9) failure to fulfill obligations at work, school, home
10) social or interpersonal conflicts
stages of change in overcoming addiction
1) precontemplation: don’t acknowledge there is a problem
2) contemplation: acknowledge there is a problem, not ready/willing to change
3) preparation/determination: ready to make change
4) action/willpower: changing behavior
5) maintenance: of behavior change
6) relapse: return to old behaviors
alcohol effects: CNS depressant
mood elevation disinhibition ↓ anxiety sedation if severe: somnolence: sleepy resp depression
alcohol withdrawal sx
agitation anxiety insomnia tremor tachycardia
mechanism of action of alcohol
GABA R (like BZD, barbiturates)
treatment for alcohol intoxication
wait for it to get out - give fluids
life-threatening alcohol withdrawal syndrome
peaks at 2-3 days after last drink
initially: feel like ants crawling on them
then: autonomic system hyperactivity (tachycardia, tremors, fever, hypotension/hypotension, diaphoresis, anxiety, seizures)
pychotic: hallucinations (visual or auditory), nightmares
delirium tremens
2-3 days post op seizure
consider delirium tremens
treatment for delerium tremens
BZD: longer acting better to prevent withdrawal
alcohol
complications of alcoholism
liver damage: ↑ GGT, AST>ALT (>2:1)
alcoholic cirrhosis
hepatitis
pancreatitis (gallstone + alcohol 2 main causes)
peripheral neuropathy
testicular atrophy
“saturday night palsy”: compression of radial artery/nerve in spiral groove (when pass out on couch with arm overhanging)
aspiration pneumonia (anaerobes, klebsiella: alcoholics have weak IS)
screening for alcoholism
CAGE questionnaire Cut back - ever had need Annoyance - get annoyed when people ask Guilt Eye opener - had a drink in morning after waking up?
caused by thiamine deficiency (B1)
Wernicke-Korsakoff syndrome
characterized by
wernicke encephalopathy: acute, life-threatening neuropathology
Korsakoff syndrome: long-term consequence of wernicke encephalopathy
Wernicke-Korsakoff syndrome
confusion nystagmus opthalmoplegia ataxia coma, death if untreated
wernicke encephalopathy
anterograde amnesia: can’t form new memories
retrograde amnesia: loss of existing memories
confabulation: false perception
hallucinations
korsakoff syndrome
damage to:
medial thalamus
mammillary bodies of posterior hypothalamus
Wernicke-Korsakoff syndrome
treatment of Wernicke-Korsakoff syndrome
IV thiamine BEFORE glucose: resolve wernicke encephalopathy
alcohol impairs livers ability to undergo…
gluconeogenesis (and alcoholics don’t have good diet) → hypoglycemic
thiamine is a cofactor for glucose metabolism - but missing → if give glucose load in ER: become ueglycemic → comatose
always give THIAMINE before glucose for patient with AMS or malnourished or alcoholic
longitudinal laceration of GE junction caused by excessive vomiting
presenting sx: hematemesis
mallory-weiss syndrome
extremely dilated submucosal veins in lower third of esophagus
caused by portal HTN due to cirrhosis
“coffee ground” emesis
LIFE THREATENING
esophageal varices
long-term treatment of alcoholics: prevent relapse in recovering alcoholic
AA: DOC for relapse prevention
naltrexone: opioid antagonist, endogenous opioids are associated with + feelings that come with alcohol use → don’t feel as good when drink
disulfiram: take before party so not tempted to drink →↑ acetylaldehyde: N/V, flush
topiramate: affects glutamate R (migraines + seizures too)
acamprosate: modulate glutamate R
BZD and barbiturate effects
CNS depression ↓ anxiety disinhibition coma severe respiratory depression
