Alcohol Use Disorder Flashcards
which of the following is true about binge drinking
1. binge drinking can have the same effect as having the same amount over a longer period of time
2. it is linked with higher rates of behaviours that put people’s health at risk
3. is never safe
4. all of the above
4
Among healthy individuals, there is a continuum of risk for alcohol related harms where the risk is
Negligible to low for individuals who consume __ standard drinks or less / wk
Mod for ____ standard drinks/wk
Increasingly high for ____ standard drinks/ wk
2
3-6
>6
On any occasion, any level of consumption has risks, and with more than ____ standard drinks, most individuals will have an increased risk of______________
2
injury or other problems
which of the following statistics is true
1. Disproportionately more injuries, violence, and deaths result from men’s drinking
2. Above low levels of alcohol consumption, the health risks increase more steeply for women than for men
3. Having <2 drinks per week is safe in breastfeeding, but is strongly recommended against
4. any level of alcohol consumption is associated with some risk
3
how often should you screen for alcohol use disorder
annually and with major life events
name 2 tools used to screen for AUD
CAGE
AUDIT-C
what are 2 pros of CAGE
easy Y/N questions, doesn’t require quantification of alcohol (tends to underreport)
what is a con for CAGE
less sensitive than AUDIT-C for detecting high risk drinking patterns
what is a con for AUDIT-C
may be less sensitive for specific groups like women, older adults, other ethnicities, etc
T or F: screening alone is enough to improve AUD outcomes
F
A variety of approaches exist for brief interventions- what is consistent is that they include a ________________
brief variant of motivational interviewing
what is the 5 A model for delivering alcohol use brief interventiosn
ask, advise, assess, assist, arrange
what is included in the “assess” piece of alcohol use brief interventions
is the pt willing to make a change rn
what is included in the “advise” piece of alcohol use brief interventions
advising pts in a clear, strong, and personalized manner that they may be at risk of alcohol related harms
define alcohol use disorder + how long the time period must be
a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least 2 of the designated criteria, occurring within a 12mth period
define the following
clinically significant problematic behavioural or psychological changes that develop during, or shortly after alcohol ingestion
alcohol intoxication
T or F: a person may have BAD of >40 but still be functional if they have been a heavy user
T
T or F: a patient may undergo alcohol withdrawal even if they still have alcohol in their blood
T- is a relative change
what would we expect to see at 5mg/dL
legally impaired
what would we expect to see at 10mg/dL
significantly impaired
what would we expect to see at 20mg/dL
impaired ability to walk
what would we expect to see at 30mg/dL
loss of consciousness
what would we expect to see at 40mg/dL
respiratory arrest, coma, death
define alcohol withdrawal
cessation of (or reduction in) alcohol use that has been heavy and prolonged (hangover = mild sx of alcohol withdrawal)
when is alcohol withdrawal expected to set in
48-72hrs up to 5 days
sx expected <6-12hrs from alcohol cessation
Hand tremors, N/V, mild agitation, anxiety, insomnia, HA, diaphoresis
sx expected 12-24hrs after alcohol cessation
Alcohol hallucinosis: transient tactile disturbances (pruritus, pins and needles, burning, numbness), transient auditory and visual hallucinations
when does alcohol hallucinosis usually resolve
after 48hrs
sx expected 24-48hrs after alcohol cessation
Tachycardia, HPTN, marked agitation, withdrawal seizures
sx expected 48-72hrs after alcohol cessation
delirium tremens, seizures, hallucinations, profuse diaphoresis , tachycardia, tremors
depending on tolerance, people can go into severe withdrawal early than ____
48hrs
if a patient has stopped alcohol 50 hours ago and has not had a seizure, is it likely that they will have one?
no- if >48hrs
T or F: alcohol withdrawal is fatal
T
how dose alcohol withdrawal result in seizures
With chronic alcohol use, brain and body adapts so GABA mediated systems becomes less sensitive and GLU systems become hypersensitive- sudden stop = increased sensitivity to excitation (hypersensitive glutamate system) = lowers seizure threshold
list 3 factors that increase withdrawal
seizure withdrawal, previous tremens, + hx for impatient residential tx programs, blacked out, use of other CNS depressants or illicit substances, evidence of increased autonomic activity (if HPTN + HR already high)
T or F: delirium tremens can be fatal
T
what are some lab liver function test findings with alcohol use disorder
increased GGT + increased AST, ALT, bilirubin
lab findings of complete blood count in AUD
increased MCV, macrocytic anemia
lowered folate and thiamine
electrolyte changes in AUD
disturbances in phosphate, potassium, magnesium
changes in blood glucose with AUD
decreased BG
ketoacidosis possible
which tool helps identify pts who may be msot at risk for developing severe alcohol withdrawal sx
PAWSS
waht is a tool used to assess level of withdrawal
CIWA-Ar
list 4 complications from alcohol withdrawal
seizures, delerium tremens, Wernicke’s encephalopathy, korsakoff’s dementia
what is Wernicke’s encephalopathy
complication from alcohol withdrawal secondary to severe thiamine deficiency
what causes wernicke’s encephalopathy
decreased food consumption and absorption + storage in liver = less thiamine
sx of wernicke’s encephalopathy
CNS depression, wide ataxic gait, pupil abnormality, nystagmus, hemorrhage, decreased BP and temp
sx of korsakoff’s dementia
persistent psychosis, confabulation, retrograde and anterograde amnesia
T or F: most people with korsakoff’s dementia do not recover
T
tx for korsakoff’s dementia
prevention is essential as most do not recover
AP, cholinesterase inhibitors, thiamine replacement
how to prevent Wernicke’s encephalopathy
thiamine vit B1, then give glucose
describe the pathology of Wernicke’s
alcohol metabolism increases demand for thiamine, but poor nutrition decreases supply = decreased coenzyme thiamine pyrophosphate required for glucose metabolism in the brain = no glucose available for brain = WK encephalopathy
1st line for alcohol withdrawal tx
benzodiazepines
3 most common BZDs used for alcohol withdrawal tx
lorazepam, diazepam, chlordiazepoxide
what type of BZDs are preferred for alcohol withdrawal
longer acting agents for seizure prevention and less breakthrough sx
there is an increased risk of addiction with the 3 following BZDs due to their fast onset
diazepam, alprazolam, lorazepam
BZDs in alcohol withdrawal should be dosed ___
PRN by sx
which BZD is preferred in elderly
lorazepam
lorazepam is the preferred BZD in
elderly, those with respiratory depression, hepatic disease
why is lorazepam the preferred BZD in elderly, resp dep, and hepatic disease
no active secondary metabolites
T or F: BZDs in alcohol withdrawal are dosed very conservatively to avoid respiratory depression
F- aggressive dosing, but is still limited by sedation, confusion, and resp dep
T or F: LDs may be used for BZDs in alcohol withdrawal
T
how long is the length of BZD therapy for AW
usually <7d
list the 3 on label anticraving meds for AW
acamprosate
naltrexone
disulfiram
acamprosate MOA
may restore balance between glutamate mediated excitation and GABA mediated inhibition of neural activity + decrease neuronal hyperexcitability
with acamprosate, there is a significant decrease in _____ and an increase in ____________ compared to placebo
decrease in returning to drinking
increase cumulative duration of abstinence by 11 days compared to placebo
describe the typical dosing of acamprosate
333mg PO TID F3D, then increase to 666mg PO TID
when should acamprosate be started
4 days after last alcohol consumption
when should acamprosate dosing be adjusted
CrCL 30-50 = decrease 50%
avoid if CrCL <30
wt <60kg = use BID dosing
can acamprosate by used in pregnancy
yes- must use risk /benefit analysis
not much evidence for risks, much evidence for risks of alcohol
what is a major pro for acamprosate
no drug interactions
which of the following has no drug intx
1. acamprosate
2. naltrexone
3. disulfiram
4. topiramate
1
acamprosate is preferred in
opioid users, those not at risk of polypharmacy
acamprosate AE
GI upset
naltrexone MOA
mu opioid receptor antagonist that blocks euphoria associated with alcohol
naltrexone is effective in preventing/ lowering (3)
relapse rates, # of drinking days, cravings,
naltrexone is dosed
1. daily
2. PRN
3. either
3
naltrexone CIs
acute hepatitis, severe liver dysfunction, those requiring/ taking concurrent opioids
naltrexone SEs
GI upset, mood, hepatotoxicity
naltrexone is preferred in
renal dysfunction, struggles with polypharmacy, nonopioid users
disulfiram works as an
alcohol deterrent tx
disulfiram MOA
inhibits metabolism of alcohol by blocking acetaldehyde dehydrogenase = acetaldehyde build up and causes disulfiram reaction
how soon does the reaction start after disulfiram + how long does it last
can happen right after alcohol ingestion + last for several hours up to 2wks
what are some severe reactions to disulfiram
MI, CHF, arrhythmias, resp dep, seizures, death
T or F: there is no advantage of disulfiram over placebo in achieving abstinence or decreasing relapse
T
disulfiram should be started at least ____ after last drink
36hrs
what is important to counsel the patient on if they start disulfiram to stop alcohol
hidden forms of alcohol in mouthwashes, cough syrup, etc
disulfiram SEs
poor after taste, dermatitis, hepatitis, N/V, HA
what are 2 off label treatments for AW
gabapentin
topiramate
how might topiramate decrease AW
decreases dopamine release and alcohol cravings = decreases heavy drinking days
may alter GABA function at a nonBZD site on the GABAA receptor + antagonize glutamate activity
topiramate SEs
paresthesias, anorexia, pruritis, difficulty concnetrating, somnolence, fatigue, confusion
what are managed alcohol programs? who are they targeted towards
provides prescribed doses of alcohol at regular intervals
done in acute care to support those in hospital where forced detox is harmful and abstinence is not a realistic ST goal while admitted
there are now also some community programs
