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Therapeutics 1 > Alcohol Use Disorder > Flashcards

Alcohol Use Disorder Flashcards

1
Q

Define: Delirium Tremens (DTs)

A

disturbances in attention, awareness, memory, orientation, language, and hallucinations along with tremors or even seizures

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2
Q

When would you expect your patient to experience delirium tremens (DTs)?

A

-2-4 days after last drink
-developes abruptly and ends abruptly
-can occur several days later

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3
Q

Define: Wernicke-Korsakoff Syndrome

A

vitamin B1 (thiamine) deficiency caused by long-term alcohol use

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4
Q

What are the symptoms of wernicke-korsakoff syndrome?

A

confusion. ataxia (trouble walking), eye muscle weakness or paralysis, hypothermia

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5
Q

What are the goals of treatment for alcohol withdrawal?

A

-prevent and treat withdraw symptoms and severe complications
-correct electrolyte imbalances
-promote long-term abstinence
-encourage treatment of alcohol-dependence

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6
Q

What can be use to assess a patient in alcohol withdraw?

A

CIWA

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7
Q

Describe: CIWA

A

symptom monitoring protocol and allows for intermittent symptom-triggered use of withdrawal medications (not valid in ICU pt)

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8
Q

What is the first line treatment for alcohol withdraw?

A

benzodiazepines

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9
Q

What is the mechanism of action of benzodiazepines?

A

GABA agonist, same MOA as alcohol

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10
Q

How can benzodiazepines be given to the patient?

A

-symptom triggered using CIWA (preferred)
-scheduled dosing (may be helpful for pt that have history of seizures)
either way they must be tapered

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11
Q

What does the CIWA score determine for the patients treatment?

A

-dose of benzodiazepines
-frequency of future assessments

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12
Q

What are the adverse effects of benzodiazepines?

A

dizziness, sedation, hypotension, respiratory depression, delirium

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13
Q

What is the preferred benzodiazepine to treat alcohol withdrawal and why?

A

lorazepam because it can be used in liver dysfunction

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14
Q

What is the mechanism of action of phenobarbital?

A

increases GABA activity, same MOA as alcohol

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15
Q

What drugs can only be used in ICU settings for alcohol withdrawal?

A

propofol(only for patients requiring mechanical ventilation) and dexmedetomidine

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16
Q

What is the use of Gabapentin in alcohol withdrawal?

A

increases GABA activity, could provide a bridge from withdrawal -> maintenance (mostly recommended outpatient)

17
Q

What is the use of clonidine in alcohol withdrawal?

A

controls BP, HR, tremor, and sweating

18
Q

What is the use of antipsychotic agents in alcohol withdrawal?

A

controls severe agitation and delirium

19
Q

What are common electrolyte abnormalities due to alcohol use disorder?

A

-hypokalemia (low K+)
-hypophosphatemia (low PO4-)
-hypomagnesemia (low Mg+)

20
Q

How can supplemental Thiamine (vitamin B1) be dosed for a patient?

A

-preventative dose for Wernicke-Korsikoff (100mg/day for 3-5days)
-treatment dose for Wernicke-Korsikoff(500mg TID)

21
Q

What are the goals of treatment for alcohol use disorder(AUD)?

A

-appropriately manage acute withdrawal
-successfully initiate maintenance treatment
-sustain/prolong abstinence
-alleviate stigma

22
Q

What is the first-line therapy for treatment of alcohol use disorder (AUD)?

A

acamprosate or naltrexone

23
Q

What is the mechanism of action of acamprosate?

A

increases GABA, decrease glutamate

24
Q

How does acamprosate treat AUD?

A

reduces cravings and prevents delayed withdrawal symptoms

25
Q

What is the dosing of acamprosate?

A

-333-666mg TID
-333mg for CrCl 30-50 mL/min
do not use if CrCl <30 mL/min
-but OKAY for liver dysfunction
monitor renal function while taking this medication!

26
Q

What are the patient counseling points for acamprosate?

A

pt may continuing taking in relapse

27
Q

What is the mechanism of action of naltrexone?

A

opioid antagonist

28
Q

How does naltrexone treat AUD?

A

decreases cravings and pleasurable effects of alcohol due to decreased reward

29
Q

What are cautions to be aware of when a patient is using Naltrexone for AUD?

A

-do not use in patients who use opioids or may
-risk of hepatoxicity (do not exceed 50 mg/daily)
-increased liver function tests(LFTs)

30
Q

How can Disulfiram treat AUD?

A

it is a deterrent and must not be used with alcohol (even alcohol containing products) or side effects will occur (wait 12h since last ingestion for 1st dose)

Therapeutics 1 (16 decks)

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