Alcohol Use disorder

Question 1

What are the signs of alcohol withdrawal?

Answer 1

Hallucinations
autonimic=sweating, HR
Seizures

Anxiety

Psychomotor agitation
insomnia
nausea
tremor

Question 2

When does AWS peak?

Answer 2

2-3 days

Question 3

When does delirium tremens happen?

Answer 3

48 hrs to 96 hours

Question 4

How can we predict alcohol withdrawal? What us a high risk score?

Answer 4

PAWSS score
>4

Question 5

What drug do we use for seizures and delirium?

Answer 5

benzos

Question 6

What can we do for the anxiety, hypertension and tachycardia?

Answer 6

clonidine

Question 7

What only other medication MAY help with alcohol withdrawal seizures?

Answer 7

Phenobarbital

Question 8

What drug for hallucinations?

Answer 8

haloperidol

Question 9

Differences between benzos?

Answer 9

Lorazepam-shorter acting, takes a bit longer to work better for hepatic issues
lorazepam can be given IM, subcut

Question 10

For CIWA what is moderate and severe?

Answer 10

> 10 needs treatment
Mod=>15
Severe=>20

Question 11

When must you hold the benzo?

Answer 11

if SBP<90 or RR <10

Question 12

What other supportive care for AWS?

Answer 12

thiamine- prevent wernicke
folate- anemia
multivitamin
electrolytes and fluids

Question 13

Long term complications of Alcohol use?

Answer 13

hepatic, arrhythmia, HTN

Question 14

Stages of thinking of quitting alcohol?

Answer 14

pre contemplation-no interest
contemplation-thinking
prep
Action
maintenance

Question 15

AUD clinical markers

Answer 15

MCV>96
AST:ALT >2:1
GERD,HTN
Cog issues

Question 16

Standard drink sizes?

Answer 16

can of beer
5 oz of wine
3 oz

Question 17

Canada guidlines for drinks?

Answer 17

0=best
<2=low risk

Question 18

How does naltrexone work?

Answer 18

blocks euphoric effects= prevents a lapse from relapse

Question 19

How does acamprosate work?

Answer 19

restore imbalance of GABA and glutamate

Question 20

When to use acamprosate over naltrexone?

Answer 20

bad liver or opioid use as well

Question 21

Which agent prevents lapse?

Answer 21

acamprosate

Question 22

Dose of acamprosate?

Answer 22

666mg

Question 23

How to dose naltrexone?

Answer 23

slowly due to gi upset

Question 24

Monitoring of naltrexone?

Answer 24

LFTs

Question 25

Monitoring of acamprosate?

Answer 25

renal

Question 26

IS combo effective for AUD?

Answer 26

not any evidence

Question 27

Duration of therapy for AUD?

Answer 27

Individualize

Question 28

Is topiramate useful?

Answer 28

decreases craving by decrease DA release
BUT
bad brain fog

Question 29

Is gabapentin useful?

Answer 29

lowers withdrawal symptoms

Question 30

How does disulfiram work?

Answer 30

stops aldehyde dehydrogenase and blocks metabolism= BAD sweating, headache, nausea

Question 31

Should we recommend disulfiram?

Answer 31

NO

Question 32

When do you start disulfiram?

Answer 32

abstain from alcohol for 12 hours minimum