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PSYCH Therapeutics > Alcohol Use Disorder > Flashcards

Alcohol Use Disorder Flashcards

1
Q
  1. Whats the definition of 1 standard drink ?
  2. Whats considered binge drinking in men and women ?
  3. Heavy drinking?
A
  1. 12 fl oz of regular beer . 8-9 fl oz of malt liquor 7% alc , 5 fl oz of table wine (12% alc), 1.5 fl oz shot of 80 proof spirits (hard liquor! about 40% alc)
  2. > = 5 drinks for men >= 4 drinks for women , on the same occasion on at least 1 day in the past 30 days
  3. Heavy drinking : binge drinking >= 5 days in the past 30 days
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2
Q

TX of Alcohol Intoxication : For the following sx’s, state the treatment

  1. Hypotension (5)
  2. Hypoglycemia
  3. Respiratory Acidosis (2)
  4. Coma (3)
A
  1. IV fluids w/electrolytes, MVI, thiamine 100mg, and folic acid 1mg, antiemetics
  2. 50% glucose (50 mL) IV push, give thiamine first
  3. Endotracheal intubation , Narcan
  4. Naloxone 0.4mg q2-3 mins, max 10mg
    gastric lavage, hemodialysis
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3
Q

Alcohol Withdrawal Sx’s :
1. >=2 within several hours to a few days
- Name 8 sx’s

Withdrawal sx timeline :
For each phase, state sx’s and the time of appearance after ETOH cessation

  1. Phase 1
  2. Phase 2
  3. Phase 3
  4. Phase 4
A
  1. Autonomic hyperactivity
    incr hand tremor
    insomnia
    N/V
    Transient hallucinations or illusions
    Psychomotor agitation
    Anxiety
    Gen Tonic CLonic seizures
  2. Insomnia, tremors, anxiety, GI uspet, HA, sweating, palpitations, anorexia
    -6-12 hrs
  3. Hallucinations (visual, tactile, auditory)
    -12-24 hrs. resolve within 48 hrs
  4. Seizures . 24-48 hrs. , may occur as early as 2hrs
  5. Delirium Tremens (DTs)
    -hallucinations, disorientation, Tachycardia/HTN, fever/sweating, agitation
    -48-72 hrs, sx’s peak at 5 days
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4
Q

TX of withdrawal :
1. What are the 3 med classes?

  1. Whats the gold standard to treat withdrawal?
  2. Name 4 benzos and their onset of action for PO route
  3. Which 2 have active metabolites?
  4. Which 3 are metabolized outside the liver?
  5. Which BZD’s would you choose for a patient that DOES NOT HAVE SIGNIF HEPATIC DYSFUNCTION?
  6. Which two would u choose if ur patient had signif hepatic dysfunction, is elderly, or had delirium?
A
  1. BZD’s, ANTI hypertensives(CLonidine), Anticonvulsants (Carbam, VPA, Gabapentin, phenobarb)
  2. BZD’s
  3. Chlordiazepoxide (Librium) – Intermediate
    Diazepam (valium) - Very fast
    Lorazepam (Ativan) – Intermediate
    Oxazepam (Serax) – Slow
  4. Chlordiazepoxide , and Diazepam
  5. Lorazepam, Oxazepam, Temazepam
  6. Chlordiazepoxide, Diazepam
  7. Lorazepam, Oxazepam
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5
Q

BDZ’s : Patient COunseling Points
1. Should only be used?
2. Common ae’s?
3. Dont take with __ or __ due to decr respiration
4. Risk for ? (3)
5. Elderly ?
6. What agent can u use for severe withdrawal, in bzd refractory withdrawal, or patients with CI for bzd’s?

A
  1. Short term
  2. Dizzy, confusion, memory loss, drowsy or blurred vision, dont drive after taking
  3. Alc, opiates,
  4. abuse, dependence, withdrawal
  5. Incr risk of ae’s
  6. Phenobarb
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6
Q

Phenobarbital :
1) AE’s?
2) CI?s
3) Induces which CYPS?

GABAPENTIN :
1. need to dose adjust for?

A
  1. Bradycardia, hypotension, confusion, drowsy, syncope
  2. Barbiturate hypersensitivity, porphyria, severe respiratory depression/pulm insufficiency, RENAL AND HEPATIC IMPAIRMENT
  3. 450, 2c9, 2c19, 3a4, , UGT, PGP
  4. CrCL < 60
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7
Q

ADJUNCTIVE THERAPY FOR WITHDRAWAL:
1. Assess for ? (3)
2. 30 days of? (3)

PREVENTING WERNICKE-KORSAKOFF :
1. Caused by ?
2. Wernicke’s enceph sx’s? (Reversible)
3. How do we prevent this?

A
  1. Hydration , electrolytes, nutrtition
  2. MVI daily, folic acid 1 mg daily , thiamine 100mg daily
  3. Thiamine deficiency
  4. confuson, ataxia, nystagmus (pupil abnorms)
  5. Thiamine 100mg IM or slow IV push before IV fluids containing dextrose for 3-5 days
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8
Q

Signs/Sx’s of ALc Use Disorder :
-Problematic pattern of use leading to clinically signif impairment or distress within 12 months with >=2
1. drinking ___ or over ___
2. Persistant ___ efforts to cut down
3. Much time spent in activities to ?
4. C__
5. Recurrent use when ___
6. T
7. W
8. continued use despite knowing its causing or worsening a __

Pharmacotherapy for ALCOHOL ABSTINENCE :

  1. These are used in addition to ?
  2. First line ?
  3. 2ND LINE?
A
  1. larger amounts, longer period than intended
  2. desire/unsuccessful
  3. obtain, use or recover from effects
  4. craving
  5. physically hazardous
  6. tolerance
  7. withdrawal
  8. recurrent medical or mental health prob
  9. Psychosocial interventions (CBT,MET, Support groups, behavioral couples therapy )
  10. Naltrexone, Topiramate
  11. Acamprosate, gabapentin, disulfiram
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9
Q

Naltrexone : (Revia, Vivitrol)
1. Mu opioid receptor antag that blocks ___, reduces __ and decreases? (2)

  1. Do not initiate until ?
  2. AE’s?
  3. CI’s? (4)
  4. DDI’s? (3)
  5. Monitoring? (2 for efficacy and toxicity)
A
  1. pleasurable effects of alcohol, cravings, heavy drinking + drinking frequency
  2. opioid free for 7-10 days
  3. GI UPSET, HA, Sedation, INSOMNIA, depression, anxiety, HEPATOTOXIC, Inj site rxns (IM formulation )
  4. Naltrexone hypersensitivity, concurrent use of opioids or in opioid withdrawal, acute hepatitis or liver failure
  5. Opioids, Disulfiram (Hepatotoxicity), Anticoags (specific to naltrexone IM)
  6. Efficacy : alc cravings, intake
    Toxicity : LFTS, psych sx’s
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10
Q

NALTREXONE : COUNSELING
1. Must be ___ free for how long ?
2. Opioid pain meds will not be ?
3. Carry ___
4. Take with ___
5. report changes in mood or signs of __
6. Recc in addition to ?

A
  1. opioid free, 7-10 days
  2. effective while on naltrexone (may need to discontinue med prior to painful procedure x 3 days)
  3. wallet card indicating usage of naltrexone
  4. food if GI upset
  5. Jaundice
  6. Psychosocial interventions
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11
Q

Topiramate (TOPAMAX)
1. Common ae’s?
2. Rare ae’s?
3. CI”s?
4. DDI’s?
5. Monitoring ?
6. Patient counseling on ae’s? (7)
7. DO NOT ____ , and report changes in ?
8. Has __ dosing adjustments if you’re > 60 and CrCl < 70

Recc in ADDITION to psychosocial interventions

A
  1. Nystagmus, increased eye pressure, paresthesias, sedation, dizziness, memory impairment, GI upset, anorexia, taste abnormalities, wt loss, metabolic acidosis, oligohydrosis, Nephrolithiasis!!!, elevated LFTs!
  2. AV block, pancytopenia, psychosis, suicidal ideations
  3. Abrupt discontinuation
  4. Metformin, HCTZ, CNS depressants, Induces CYP 3a4 (Contraceptives, amlodipine, lurasidone)
  5. Efficacy : alc cravings,, intake
    Toxic : Renal function!!, LFTS, Psychosis, SI
  6. Sedation , poor mem, mental slowing, changes in vision, weight loss, numbness/tingling, KIDNEY STONES so stay well hydrated
  7. abruptly stop, mood or SI
  8. renal dose adjutsments
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12
Q

Acamprosate (Campral):
-Better for pt’s who are abstinent, mainly just reduces cravings*
1. Has ___
2. AE’s?
3. CI’s? (2)
4. DDI’s?
5. Monitoring Efficacy vs toxicty
6. Counseling points for patients?
-Dont ___, take with __, report changes in __
7. ACcording to conference, this is the preferred agent in ?
8. Do not initiate until ___

A
  1. renal dose adjustments if CrCL 30-50 , and if < 60kg
  2. Diarrhea, nausea, bloating, insomnia, anxiety, depression
  3. Acamprosate hypersensitivity, renal impairment of <30 mL/min
  4. Naltrexone INCR AUC of acamprosate (not rlly signif)
  5. Effic : alc intake, Toxicity : renal function, psych sx’s
  6. crush tabs, food if GI upset occurs, mood
  7. Pt’s with Liver dysfunction
  8. Achieved abstinence
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13
Q

Gabapentin (neurontin) :
1. WHen is it used?
2. has ___
3. AE’s?
4. CI’s?
5. DDI’s? (2)
6. Monitoring ?

COunseling :
7. Dose is titrated in order to ?
8. Dont ____ after taking
9. DO not abruptly ___
10. DONT TAKE WITH ? (2)
11. RIsk for ?
12. report presence of?

  1. Can be used in ?
A
  1. when 1st line meds are CI or ineffective
  2. Renal dose adjustment < 60 mL
  3. Common : drowsy, dizzy, ataxia, HA, periph edema, wt gain
    rare : SJS, respir depression, depression, SI
  4. Abrupt discontinuation
  5. CNS depressants (BZD’s, opioids, barbiturates, muscle relaxers)
    Antacids!!!
  6. Efficacy : Alc intake
    Toxic : Renal function, depression , SI
  7. Devel tolerance to sedation
  8. drive
  9. stop taking it
  10. alcohol or opiates
  11. abuse, dependence, withdrawal
  12. rash, changes in mood or SI
  13. Hepatic dysfunction (no adjustment needed)
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14
Q

DISULFIRAM : ANTABUSE
1. Acetaldehyde accumulation can cause which sx’s?
2. Do not initiate until ?
3. Ae’s ? common vs rare
4. CI’s? (5)
5. DDI’s?
6. MOnitoring

PATIENT COUNSELING
7. Little effect on body ___
8. Does not decr ___, but may decr overall __
9. U may get ___ if drinking while using this med
10. Avoid alc containing products ___ before initiation , while taking, and up to ___ after discontinuation
11. reports signs of ? (2)

A
  1. Flushing, HA, N/V, Palpitations, hypotension
  2. Alc free x 12-24 hrs
  3. Rash ,sedation, metallic/garlic taste, smell disturbance
    Rare : blurred vision, hepatitis, neuropathy, psychosis
  4. Ethanol ingestion, cardiac/cerebrovasc disease, coronary occlusion, renal/hepatic failure, pyschosis
  5. Products w/alcohol (mouthwash, cough syrup), Metronidazole or omeprazole
    Inhibits CYP 2E1 : warfarin, phenytoin, isoniazid, BZD’s except for OTL bzd’s
  6. Efficacy: alc intake
    Toxic : LFTS and psychosis
  7. without alc
  8. alc cravings, alc intake
  9. ill
  10. 12-24 hrs , 14 days
  11. psychosis or jaundice
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PSYCH Therapeutics (11 decks)

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