Alcohol Use Disorder Flashcards
Like all other substance use disorders, alcohol use disorder is typically a ____ condition.
Chronic, relapsing condition
Consequences from AUD involve morbidity of multiple body systems such as…
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
Etiology of developing AUD is primarily…
Genetic
Theories include polymorphisms in GABA, dopamine, 5-HT receptors, ADH enzyme
When considering alcohol abstinence and medication use, the FIRST thing we should consider is…
Shared decision making - how does the patient feel about stopping?
Goals of therapy with AUD include…
Prolong survival
Decrease morbidity and AE’s
Abstinence (short + long-term)
Minimize AE’s from drug use
Improve daily functioning and quality of life
The definition of alcohol use disorder is…
Problematic pattern of drinking with clinically significant impairment or distress
Medical clinical markers that may suggest AUD include…
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
Mental clinical markers that may suggest AUD include…
Cognitive impairment/decline
Mood, anxiety, sleep disorders
SIgnificant behavioural/academic change
Other clinical markers that may suggest AUD include…
Unexplained time off
Frequent absences from appointments
Poor medication adherence
Recent/recurrent trauma
High-risk behaviours
Canada’s guidance on alcohol and health states that…
No amount of alcohol is a safe amount - increased amount of drinks increased risks of alcohol-related consequences
A simplified way to screen for AUD is to…
Ask if the individual drinks any alcoholic beverages - how many heavy drinking days, then determine average days a week they drink
This AUD screening tool may be helpful for patients that are challenging to engage…
AUDIT
Score of 8+ is considered to indicate hazardous or harmful alcohol use
The 4 C’s of addiction include…
Loss of control of amount/frequency of use (decreased functioning)
Use despite consequences
Compulsions to use
Cravings
What is considered a standard drink for Canada’s low-risk alcohol drinking guidelines?
12 oz of beer/cider/cooler with 5% alcohol
5 oz of 12% wine
Candidates for AUD treatment include…
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+
Goals of AUD pharmacotherapy include…
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)
1st line AUD pharmacotherapy agents include…
Naltrexone + Acamprosate
MOA of naltrexone is…
Full Mu-opioid antagonist
Blocks euphoric effects of alcohol to decrease rewarding alcohol effects + reduce cravings
“Prevents lapse from becoming a relapse”
Common AE’s with naltrexone include…
N/V/D
Dizziness, anxiety, insomnia
Increased LFTs
Doses are titrated to help with GI effects
Naltrexone cannot be used with…
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
MOA of acamprosate is…
Not fully understood, but thought to restore imbalance between glutamate and GABA to reduce general neuronal hyperexcitability
“Prevents lapse - more effective at supporting abstinence
Efficacy between 1st line agents for AUD can differ via…
Naltrexone being more effective for helping with cravings
Acamprosate helping more with maintaining abstinence
Common AE’s with acamprosate include…
Anxiety, diarrhea, insomnia
2nd line agents for AUD include ____, and are usually used when…
Topiramate, Gabapentin
Used when 1st line agents cannot be used, or patient is unresponsive to naltrexone/acamprosate
Topiramate may help with AUD via…
Decreasing cravings by decreasing dopamine release in response to alcohol ingestion, and enhancing inhibitory GABA
Gabapentin may help with AUD via…
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
Notable AE with the 2nd line agents is…
Cognitive dysfunction - topiramate
CNS depression - gabapentin
The medication for AUD that is CI in kidney impairment is…
Acamprosate
The medication for AUD that is CI in liver failure/hepatitis is…
Naltrexone
MOA of disulfiram is…
Inhibit aldehyde dehydrogenase enzyme, and blocks the metabolism of alcohol
Disulfiram is different from other pharmacotherapies for AUD because…
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
Due to the severity of the disulfiram reaction and the weak evidence of benefit, usage of disulfiram should…
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
