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PBL SEM 4 > alcohol use and abuse : clinical perspective > Flashcards

alcohol use and abuse : clinical perspective Flashcards

1
Q

epidemiology of alcohol abuse

A
  • 3 million deaths a year worldwide
  • 7th leading cause of death
  • pea incidence age 35-54
  • only 18% of those with alcohol dependence receive treatment in the UK, 25% worldwide
  • 1.3% prevelance in adult UK population
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2
Q

how long does it take to metabolise 1 unit of alcohol?

A

1 hour

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3
Q

how is alcohol dependence diagnosed according to the ICD-11?

A
  • disorder of regulation of alcohol use
  • repeated or continuous use of alcohol
  • strong internal drive to use alcohol
  • present for 12 months or 1 month if continuous
  • chronically relapsing disorder
  • internal drive, compulsion, desire, urge or craving to use alcohol
  • impaired control
  • prioritisation of alcohol over other activities
  • persistent use despite its harms
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4
Q

what does alcohol dow regulate?

A

GABAa

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5
Q

describe the CAGE alcohol questionnaire

A

C - have you ever felt you needed to CUT down on your drinking?
A - have people ANNOYED you by criticising your drinking?
G - have you ever felt GUILTY about drinking?
E - have you ever felt you needed a drunk first thing in the morning (EYE-OPENER) to steady your nerves or to get rid of a hangover

2+ requires further questionning
old, not sensitive or specific

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6
Q

what is the gold standard questionnaire for alcohol screening?

A
  • AUDIT screening tool
  • FAST version
  • an overall total score of 3 or more on the first or all 4 questions is FAST +ve. if positive complete remaining AUDIT alcohol screening questions
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7
Q

what are the 3 main patterns for alcohol dependence/use?

A
  • withdrawal, negative affect
  • preoccupation, anticipation
  • binge intoxication
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8
Q

describe reward

A
  • ventral and dorsal striatum to basal ganglia
  • lack of control from prefrontal cortex
  • emotional response — amygdala and hippocampus
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9
Q

describe the addiction as a brain disease model positives and negatives

A
  • disorder of reward systems, impulse control

positives:
- reduce the stigma they experienced by framing their behaviour as a medical vs. moral issue
- could poss reduce fluid, increase insight into drug use, and increase treatment-seeking behaviour

negatives:
- increasing stigma eg. by characterising people as dangerous or out of control
- undermining a client’s sense of personal responsibility
- increasing their sense of helplessness in recovery

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10
Q

what are the UK guidelines for safe drinking?

A
  • 14 units/week
  • spread use over 3 days if drinking 14 units week
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11
Q

what is 1 unit of alcohol?

A

10ml or 8g of pure ethanol

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12
Q

how to calculate units from ABV?

A

ABV in 1000mls = units

1000mls of 5% beer = 5 units
1000mls of 12% wine = 12 units

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13
Q

what is binge drinking for men and women?

A

> 8 units for men
6 units for women

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14
Q

how many calories are there in a gram of pure alcohol? vs carbohydrate?

A

7.1

vs only 4.1 calories in a gram of carbohydrate

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15
Q

what are the potential effects of alcohol on the oesophagus?

A
  • carcinoma of oesophagus, especially squamous carcinoma
  • oesophageal varices, associated with chronic liver disease — watch out for Hb drops, raised urea, coffee ground vomit
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16
Q

what are the potential effects of alcohol on the stomach?

A
  • acute gastritis
  • acute ulceration
  • chronic peptic ulceration
  • portal gastropathy
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17
Q

what are the potential effects of alcohol on the pancreas?

A
  1. acute pancreatitis
    - severe abdominal pain
    - radiating to the back
    - nausea and vomiting
    - greatly elevated serum amylase
  2. chronic pancreatitis (due to chronic inflammation from sustained alcohol use)
    - intermittent severe upper abdominal and back pain
    - weight loss
    - exocrine tissue replaced by fibrosis
    - leads to pancreatic malabsorption (steatorrhoea and reduced vitamins A/D/E/K)
    - relative preservation of endocrine tissue
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18
Q

what are the mechansims of alcohol related liver disease?

A
  • direct toxic effect
  • indirect metabolite effect eg. acetaldehyde (one of the breakdown products of alcohol that builds up)
  • activation of free radicals
  • induction of enzyme systems esp cytochrome p450
  • nutritional deficiencies esp B group vitamins
  • liver function impairment
19
Q

do men or women have a greater risk of alcoholic liver disease? what doubles the risk?

A

women have a greater risk even at lower amounts

obesity doubles risk

20
Q

what may be raised in liver disease?

A
  • ALT (alanine transaminase)
  • AST (aspartate aminotransferase)
  • bilirubin
  • gamma GT (gamma-glutamyl transferase)

NOTE! can have extensive liver disease but normal bloods

21
Q

describe the progression of alcoholic liver disease

A
  1. acute fatty change - reversible
  2. acute alcoholic hepatitis - reversible
  3. hepatic fibrosis - reversible
  4. cirrhosis - irreversible
  5. hepatic decompression - fatal
22
Q

what are 2 classic signs of liver disease?

A

jaundice, ascites

23
Q

what are the potential effects of alcohol on the heart?

A
  • atrial fibrillation
  • myocardial infarction
  • congestive heart failure - cardiomyopathy
24
Q

what neuropsychiatric disorders are there in alcohol dependence ?

A
  1. seizures
  2. delirium tremens (DTs)
  3. Wernicke’s encephalopathy (WE)
  4. Korsakoff’s psychosis
  5. polyneuropathy
25
Q

why do you get seizures in withdrawal and delirium tremens?

A
  • alcohol inhibits NDMA neuroreceptors
  • therefore suddenly stopping exposure to alcohol results in the brain going into a state of hyperexcitability dye to the receptors that were being obstructed by alcohol no longer being obstructed
26
Q

what is delirium tremens?

A

delirium with hallucinations and autonomic disturbances in alcohol withdrawal

27
Q

what are Wernicke’s encephalopathy and korsakoff’s psychosis due to?

A

due to thiamine deficiency and neurotoxic effects of glutamatergic overdrive

both secondary to effects of alcohol and B1 (thiamine) deficiency

28
Q

describe wernicke’s encephalopathy

A
  • acute
  • delirium
  • ataxia
  • ophthalmoplegia
29
Q

describe Korsakoff’s psychosis

A
  • chronic (later complication of WE)
  • triad of short term memory loss, confabulation and ataxia
30
Q

what is confabulation?

A

refers to the production or creation of false or erroneous memories without the intent to deceive, sometimes called “honest lying”

31
Q

when do seizures and DTs present?

A

peak seizure incidence 1-2 days after 1st drink
DTs can present late

32
Q

how do the severity of withdrawal symptoms change with repeated cycles of alcohol intoxication and withdrawal?

A
33
Q

what leads to seizure susceptibility?

A

downregualtion of GABAa receptors and upregulation of NMDA receptors

34
Q

what medications are given to prevent seizures in alcohol withdrawal?

A

benzodiazepines such as chlordiazepoxide or diazepam

35
Q

who are high dose B vitamins given to?

A

to prevent the damage to neurons due to the excitatory effects of Glu and people deficient in B vitamins (esp thiamine)

36
Q

what is Acamprosate?

A
  • relapse prevention medication
  • works on calcium channels to help reduce the excitatory overdrive, and helps with cravings, anxiety and sleep
37
Q

what other disorders can you get in alcohol abuse?

A
  1. myopathy — typically wasting of proximal muscles in the pelvic girdle - poor mobility
  2. thrombocytopenia and bleeding
    - alcohol is toxic to bone marrow - leads to reduced normal cell levels
    - due to effects on the liver leads to folate deficiency and other effects on RBCs
    - can progress all the way to pancytopenia
    - see low platelets to begin with - so always do clotting as part of treatment (INR and platelets)
38
Q

the build up of what chemical gives us the horrible hangover effect?

A

alcohol dehydrogenase

39
Q

what is disulfiram?

A

prevents the conversion of acetaldehyde to acetate by aldehyde dehydrogenase

  • when taking this medication and you drink, you get flushing, sweating, nausea, tachycardia, palpitations
  • aim to put people off from drinking through these adverse effects
  • can have cardaic and hepatic effects
40
Q

safe alcohol advice

A
41
Q

units equation

A

units = (vol (mls) x ABV (%) ) / 1000

42
Q

CMO guidance - units per week?

A

14 for men and women

43
Q

describe the WHO safer alcohol control initiative

A
44
Q
A

PBL SEM 4 (50 decks)

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