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Substance Use Disorders > Alcohol Use Disorder > Flashcards

Alcohol Use Disorder Flashcards

1
Q

Like all other substance use disorders, alcohol use disorder is typically a ____ condition.

A

Chronic, relapsing condition

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2
Q

Consequences from AUD involve morbidity of multiple body systems such as…

A

CNS - cognitive impairment, dementia
PNS - neuropathy, myopathy
Psych - MDD, anxiety, eating disorders
CV - cardiomyopathy, AFib, arrhythmias, HTN
GI - hepatitis, cirrhosis, pancreatitis
Cancers
Fetal alcohol spectrum disorders, vitamin B12 deficiency

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3
Q

Etiology of developing AUD is primarily…

A

Genetic

Theories include polymorphisms in GABA, dopamine, 5-HT receptors, ADH enzyme

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4
Q

When considering alcohol abstinence and medication use, the FIRST thing we should consider is…

A

Shared decision making - how does the patient feel about stopping?

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5
Q

Goals of therapy with AUD include…

A

Prolong survival
Decrease morbidity and AE’s
Abstinence (short + long-term)
Minimize AE’s from drug use
Improve daily functioning and quality of life

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6
Q

The definition of alcohol use disorder is…

A

Problematic pattern of drinking with clinically significant impairment or distress

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7
Q

Medical clinical markers that may suggest AUD include…

A

MCV > 96
Elevated GGT, AST, ALT (AST:ALT >2:1)
Alcohol on breath
Chronic non-cancer pain

Chronic conditions are also common - GERD, HTN, diabetes, pancreatitis

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8
Q

Mental clinical markers that may suggest AUD include…

A

Cognitive impairment/decline
Mood, anxiety, sleep disorders
SIgnificant behavioural/academic change

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9
Q

Other clinical markers that may suggest AUD include…

A

Unexplained time off
Frequent absences from appointments
Poor medication adherence
Recent/recurrent trauma
High-risk behaviours

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10
Q

Canada’s guidance on alcohol and health states that…

A

No amount of alcohol is a safe amount - increased amount of drinks increased risks of alcohol-related consequences

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11
Q

A simplified way to screen for AUD is to…

A

Ask if the individual drinks any alcoholic beverages - how many heavy drinking days, then determine average days a week they drink

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12
Q

This AUD screening tool may be helpful for patients that are challenging to engage…

A

AUDIT

Score of 8+ is considered to indicate hazardous or harmful alcohol use

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13
Q

The 4 C’s of addiction include…

A

Loss of control of amount/frequency of use (decreased functioning)
Use despite consequences
Compulsions to use
Cravings

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14
Q

What is considered a standard drink for Canada’s low-risk alcohol drinking guidelines?

A

12 oz of beer/cider/cooler with 5% alcohol
5 oz of 12% wine

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15
Q

Candidates for AUD treatment include…

A

Any patient with moderate-severe AUD (and mild, if patient is interested)

Any patient who has undergone withdrawal management/stopped/reduced drinking but has ongoing alcohol cravings placing them at risk of relapse

Moderate = 4-5 sx’s on DSM, severe = 6+

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16
Q

Goals of AUD pharmacotherapy include…

A

Prevent return to any drinking/return to heavy drinking
Reduce number of heavy drinking days + Reduce number of drinks per drinking day (if cannot reach abstinence)

17
Q

1st line AUD pharmacotherapy agents include…

A

Naltrexone + Acamprosate

18
Q

MOA of naltrexone is…

A

Full Mu-opioid antagonist

Blocks euphoric effects of alcohol to decrease rewarding alcohol effects + reduce cravings

“Prevents lapse from becoming a relapse”

19
Q

Common AE’s with naltrexone include…

A

N/V/D
Dizziness, anxiety, insomnia
Increased LFTs

Doses are titrated to help with GI effects

20
Q

Naltrexone cannot be used with…

A

Concurrent opioids, due to blockage of Mu-opioid receptor
Patient should be opioid free for ~7 days before starting to avoid risk of precipitate withdrawal

21
Q

MOA of acamprosate is…

A

Not fully understood, but thought to restore imbalance between glutamate and GABA to reduce general neuronal hyperexcitability

“Prevents lapse - more effective at supporting abstinence

22
Q

Efficacy between 1st line agents for AUD can differ via…

A

Naltrexone being more effective for helping with cravings
Acamprosate helping more with maintaining abstinence

23
Q

Common AE’s with acamprosate include…

A

Anxiety, diarrhea, insomnia

24
Q

2nd line agents for AUD include ____, and are usually used when…

A

Topiramate, Gabapentin
Used when 1st line agents cannot be used, or patient is unresponsive to naltrexone/acamprosate

25
Q

Topiramate may help with AUD via…

A

Decreasing cravings by decreasing dopamine release in response to alcohol ingestion, and enhancing inhibitory GABA

26
Q

Gabapentin may help with AUD via…

A

Decreasing CNS excitation, decrease glutamate and increase GABA - helps lower subacute withdrawal symptoms and may help treat mild acute withdrawal

Likely more efficacious in patients with hx of alcohol withdrawal sx and high alcohol withdrawal scores

27
Q

Notable AE with the 2nd line agents is…

A

Cognitive dysfunction - topiramate
CNS depression - gabapentin

28
Q

The medication for AUD that is CI in kidney impairment is…

A

Acamprosate

29
Q

The medication for AUD that is CI in liver failure/hepatitis is…

A

Naltrexone

30
Q

MOA of disulfiram is…

A

Inhibit aldehyde dehydrogenase enzyme, and blocks the metabolism of alcohol

31
Q

Disulfiram is different from other pharmacotherapies for AUD because…

A

It results in severely unpleasant AE’s if the patient drinks alcohol (sweating, headache, dyspnea, flushing, N/V, sympathetic hyperactivity)

Or even using ethanol-containing products

32
Q

Due to the severity of the disulfiram reaction and the weak evidence of benefit, usage of disulfiram should…

A

Not be recommended for treatment of AUD and should only be considered for specific circumstances (highly motivated patients)

Does not treat underlying cravings/psych part of AUD

Substance Use Disorders (6 decks)

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