Alcohol Symposium Flashcards
1
Q
What effects does alcohol have at low doses?
A
- euphoria
- reduced anxiety
- relaxation
- sociability
2
Q
What effects does alcohol have at higher doses?
A
- impaired attention and judgement
- unsteadineness
- flushing
- nystagmus
- mood instability
- disinhibition
- slurring
- stupor
- unconsciousness
3
Q
what is intoxication
A
the pathological state produced by a drug, serum, alcohol or any toxic substance; poisoning
4
Q
What is harmful use?
A
pattern of drinking causing damage to physical or mental health
-Use >1 month or repeatedly over 12 months
5
Q
What are the signs of dependence?
A
3 for > 1month or repeatedly over 12 months:
- cravings
- difficulty controlling use
- primacy
- increased tolerance
- physiological withdrawal on reduction/cessation
- persistence despite harmful consequences
6
Q
What is withdrawal state?
A
group of symptoms (variable clustering and severity) on complete/relative withdrawal of a psychoactive substance
7
Q
What are the signs and symptoms of alcohol withdrawal state?
A
- tremor, weakness, seizures
- nausea, vomiting, anxiety
- confusion, agitation
- death
8
Q
What is delirium tremens?
A
rapid onset of confusion usually caused by withdrawal from alcohol
9
Q
What are the signs and symptoms of delirium tremens (DT)
A
- profound confusion, tremor, agitation
- hallucinations, delusions, sleeplessness
- autonomic over-activity
10
Q
When do DTs usually occur?
A
48-72 hours after alcohol is stopped
11
Q
How can death occur due to DTs?
A
- cardiovascular collapse
- infection
- hyperthermia
- seizures
- self-injury
12
Q
What are the categories of alcohol related problems?
A
- physical health
- mental health
- relationships
- employment/ finances
- legal
13
Q
How can alcohol affect your mental health?
A
- anxiety
- depression
- sleep disruption
- morbid Jealousy
- alcoholic hallucinosis
- deliberate self-injury
- suicidal thoughts/acts
14
Q
how can alcohol affect your physical health
A
15
Q
What problems can occur due to thiamine deficiency?
A
- Wernicke’s encephalopathy
- Korsakoff’s psychosis
16
Q
How does Wernicke’s encephalopathy present?
A
- confusion
- ataxia
- ophthalmoplegia
- nystagmus
17
Q
How does Korsakoff’s psychosis present?
A
- impairment of recent and remote memory
- preservation of immediate recall
- no general cognitive impairment
- retrograde and anterograde memory
- impaired learning and disorientation
- may exhibit nystagmus and ataxia
18
Q
Why does thiamine deficiency occur with excessive alcohol consumption?
A
- poor intake and absorption
- poor hepatic function
- increased requirement for alcohol metabolism
19
Q
What screening tools are there?
A
- CAGE
- AUDIT
- FAST
- PAT
20
Q
What are the 4 components of the CAGE questionnaire?
A
- Have you tried to Cut down?
- Have you felt Annoyed by people criticising your drinking?
- Have you felt Guilty about drinking?
- Have you felt the need to have an Eye-opener?
21
Q
How can alcoholism be managed?
A
- practical advice: education, harm reduction
- holistic/bio-psycho-social support: skills training, medication, social work
22
Q
What medication can be used in the prevention of Wernicke-Korsakoff syndrome?
A
Thiamine
23
Q
What medication can be used in the management of alcohol withdrawal?
A
Benzodiazepines (commonly chlordiazepoxide)
24
Q
What medication can be used for aversion/deterrent?
A
Disulfiram (Antabuse)
25
What medications can be used to help fight cravings?
- acamprosate (Campral)
- naltrexone
- nalmefene
- (baclofen)
26
What are the top 5 causes of admission due to alcohol?
- unintentional injuries
- mental ill health and behavioural disorders
- heart conditions and strokes
- liver disease and pancreatitis
- cancer
27
What are the functions of the liver?
- Carbohydrate metabolism
- Fat metabolism
- Protein metabolism
- Storage
- Synthesis
- Kupffer cells collect rubbish (bacteria, old cells etc)
- Production of bile
- Metabolism of drugs and alcohol
28
What role does the liver play in carbohydrate metabolism?
- Excess glucose: glycogenesis (storage)
| - Low blood glucose: glycogenolysis to provide more
29
What role does the liver play in fat metabolism?
- Lipid metabolism predominantly within the liver
| - Breaks down fats to produce phospholipids and cholesterol
30
What role does the liver play in protein metabolism?
- Deamination (break down) and Transamination (make up) of amino acids
- Byproduct is Ammonia – liver synthesises urea to remove
- Albumin synthesis (main protein of blood plasma) almost exclusive to the liver
31
What substances does the liver store for when you need them?
- Glucose
- Iron
- Copper
- Vitamins
32
What does the liver synthesise?
- Fibrinogen (to Fibrin for clotting)
| - Thrombopeitin (platelet production in bone marrow)
33
How is alcohol metabolised?
- Alcohol consumed and absorbed into blood from mouth, oesophagus, stomach and intestines
- Blood arrives at the liver and is broken down to acetaldehyde and acetate by ADH and ALDH
- Acetate is converted to fatty acids, C2O and H2O
- Healthy liver can process 1 unit of alcohol per hour.
- Acetaldehyde is a carcinogen and so overload can predispose to pathology
34
What are the recommended alcohol consumption guidelines?
- <14 units per week
| - Spread over 3 days
35
Why does alcohol affect some people more than others?
- Poor dietary status – nutritional deficiencies
- Simultaneous exposure to other drugs (affects metabolism)
- Genetic variations/polymorphisms of enzymes (Fast acting ADH or slow acting ALDH (build-up of acetaldehyde))
- Dependence and progression
- Female gender more vulnerable
- Coexisting viruses eg hepatitis C
36
What causes of cirrhosis are there?
- Alcohol related liver disease
- Fatty liver disease
- Hepatitis C virus
- Autoimmune diseases
- Other
37
How does alcohol related liver disease progress?
- Normal liver
- Fatty liver (steatosis)
- Steatohepatitis
- Fibrosis
- Liver cirrhosis
(Step 1- 2 is reversible)
(Step 3 may be missed out)
38
Why does steatosis (fatty liver) occur?
- Alcohol is calorie rich
- Broken down to fatty acids which are deposited around the central veins then parenchyma
- Reversible as liver can return to normal through abstinence
39
What are the indicators of chronic alcohol use?
- Elevated gamma GT (liver enzyme)
- Macrocytosis (large red blood cells)
- Low platelets
- Elevated ferritin
- Enlarged smooth edged liver on AUSS
- POSITIVE HISTORY
40
Describe the structure of the liver.
Central vein is a branch of the hepatic vein whereas the interlobular vein is a branch of the portal vein next to branch of the hepatic artery and portal tract
41
What is alcoholic hepatitis?
Fatty change within the liver with infiltration of leucocytes and hepatic necrosis
42
What does alcoholic hepatitis result in?
- Hepatomegaly
- Jaundice
- Abdominal Pain
- Fever
- Hepatic decompensation
43
What system is used to predict 28 day survival for alcoholic hepatitis?
Glasgow Alcoholic Hepatitis Score
44
How is alcoholic hepatitis managed?
- Steroids
- Management of infection
- Nutrition
- Abstinence
45
How do liver fibroids occur?
- Chronic inflammation
- Activation of stellate cells
- Collagen production
- Makes liver stiff
46
What happens to the liver when fibrosis/cirrhosis occurs?
- Localised fibrosis around vein
- Collagen bridging between veins/tracts
- Loss of lobule structure
47
What are the complications of liver fibrosis/cirrhosis?
- Variceal haemorrhage
- Encephalopathy
- Ascites
48
What are the roles of the North East Division Licensing Team?
- Respond to the Licensing Board in respect of alcohol licensing applications
- Respond to the Licensing Committee in respect of civic licensing applications
- Represent the Chief Constable at sittings
- Monitor incidents at licensed premises
- Engage with premises licence holders through intervention – address issues
- Work in partnership – local authorities, health, the trade, security industry and many initiatives
49
What act provides regulation of the sale of alcohol?
Licensing (Scotland) Act 2005
50
Give examples of licensing offences.
- Sale to, on behalf of, allow consumption by (on premises) , under 18 and under 18 to buy, attempt to buy consume (on premises), give to under 18 (public place) ,deliver to, send for…
- Attempt to enter whilst drunk, or be drunk and incapable of taking care of self (on)
- Sell to drunk person, obtain or attempt to obtain for a drunk person (on)
- Whilst drunk, behave in disorderly manner or use obscene/indecent language to annoyance of others
- Allow drunkenness or disorderly conduct (on)
- Refuse to leave
51
What vulnerability is there through intoxication?
- Increased risk of committing a crime, becoming the victim of a crime or misadventure
- Actions and decisions are affected by alcohol
- Adverse incidents – reactive measure
52
What risk factors are important to consider in a bid to reduce intoxication?
- Private space consumption
- Longer and later hours
- Physiological factors
- How alcohol is consumed
- Are customers drinking rapidly
- Other substances involved
- Mix of types of alcohol
- Bottle sales - consider a policy
- ‘Shots’ drinks – consider a policy
53
How do I know if my patient is drinking above the low risk guidelines?
- Screening tools
- FAST, Paddington alcohol test etc
- Self -disclosure
54
What should I do if my patient is drinking more than the low risk guidance?
- Opportunity to reduce their risk of health harm
- If alcohol dependence is likely – refer to treatment services
- Offer feedback, assess how willing they are to change and offer support strategies
55
What social vulnerability factors are there in alcohol consumption?
- Alcohol pricing, availability, regulation
- Drinking context
- Socio-economic status
- Culture
56
What individual vulnerability factors are there in alcohol consumption?
- Mental health
- Homelessness
- Gender
- Age
