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Psychiatry > Alcohol use disorder > Flashcards

Alcohol use disorder Flashcards

1
Q

Substance Abuse

A 
Acronym: WILD
Work, school, home obligation failure
Interpersonal or social consequences
Legal problems
Dangerous use
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2
Q

Substance Dependence

A

tolerance
withdrawal
increased use more than originally intended
persistent desire or unsuccessful attempts to cut down
significant time spent on obtaining, using, or recovering from the substance
decreased social, work, recreational activities
continued use despite physical and psychological consequences

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3
Q

What are the most commonly used substances?

A

Alcohol and Nicotine

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4
Q

How do you differentiate whether mood symptoms are primary or substance induced?

A

If symptoms improve with abstinence then mood is substance induced. If symptoms persist then mood disorder is primary.

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5
Q

What is the leading cause of mental retardation in the US?

A

Fetal Alcohol syndrome

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6
Q

Asian people often have a gene variant that affects alcohol use by……

A

often have less aldehyde dehydrogenase which then leads to flushing, headache, nausea/vomiting with alcohol use.

*serves as a protective factor against alcohol dependence

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7
Q

What is the most common co-ingestant in drug overdoses?

A

Alcohol

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8
Q

Most adults will show some signs of intoxication with BAL of:…….

A

> 100

Obvious signs of intoxication with BAL >150

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9
Q

Causes of metabolic acidosis with increased anion gap to consider….

A

Ethanol
Methanol
Ethylene glycol

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10
Q

What should a patient with alcohol intoxication, especially if chronic drinker, be supplemented with?

A

Thiamine (B1) and Folate

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11
Q

If alcohol intoxication also involves co-ingested opioids, this may be necessary to administer

A

Naloxone

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12
Q

What is more likely in a home with a ale who has a substance use disorder, especially alcoholism?

A

Spousal Abuse

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13
Q

What BAL is likely to induce coma in a novice drinker?

A

300 mg/dL

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14
Q

What BAL can cause respiratory depression and possibly death?

A

400 mg/dL

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15
Q

What is the most commonly abused substance in the U.S.?

A

Alcohol

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16
Q

Attempted suicide is associated commonly with these three factors:

A

psychiatric illness
young female
alcoholism

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17
Q

Withdrawal from which two substances can be deadly?

A

Alcohol and Barbiturates

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18
Q

When do earliest symptoms of EtOH withdrawal begin?

A

6-24 hours after last drink

Can last 2-7 days

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19
Q

Mild Alcohol Withdrawal Symptoms:

A

irritability
tremor
insomnia

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20
Q

Moderate Alcohol Withdrawal Symptoms:

A 
Diaphoresis
HTN
Tachycardia
Fever 
Disorientation
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21
Q

Severe Alcohol Withdrawal Symptoms

A

Tonic Clonic Seizures
Delirium Tremens
Hallucinations

22
Q

When do generalized tonic-clonic seizures occur in alcohol withdrawal?

A

6-48 hours after cessation of drinking

peak around 13-24 hours

23
Q

about 1/3 of patients with seizures in EtOH withdrawal will develop….

A

delirium tremens (DTs)

24
Q

What can predispose to seizures in EtOH withdrawal?

A

hypomagenesemia

25
Q

How are seizures in EtOH withdrawal treated?

A

Benzodiazepines

Long-term treatment with anticonvulsants is not recommended for withdrawal

26
Q

most serious form of EtOH withdrawal….

A

DTs

27
Q

Timeline for DTs

A

Usually begins 48-72 hours after alcohol cessations

90% happen within first 7 days

28
Q

What condition predisposes to DTs?

A

Physical Illness

**Remember 1/3 of seizures in alcohol withdrawal will develop DTs

29
Q

Symptoms of DTs

A 
Delirium
Hallucinations (most commonly visual)
Gross Tremor
Autonomic Instability
Fluctuating levels of psychomotor activity
30
Q

What is the drug of choice for treatment of EtOH with drawal

A

Chlordiazepoxide (librium)
Other benzodiazepines used:
Diazepam and Lorazepam

31
Q

How do you monitor withdrawal?

A

CIWA-A Scales Q4Hrs

32
Q

Signs of hepatic failure:

A

Ascites
Jaundice
Caput Medusae
Coagulopathy

33
Q

Confabulations

A

memories of events that never occurred

Patients are unaware that they are making these up

34
Q

If alcoholic starts to have confabulations what condition should you be worried about?

A

Korsakoff Syndrome (psychosis)

35
Q

Heavy drinking for men =

A

.4 drinks/day or >14/week

36
Q

Heavy drinking for women =

A

> 3 drinks/day or >7/week

37
Q

What labs suggest excessive alcohol use?

A 
AST:ALT ratio > 2:1
Increased GGT (GGT reflects recent alcohol use last 3-7 days)
38
Q

Alcohol can cause what type of anemia?

A

Macrocytic Anemia (increased MCV)

39
Q

What medication can be used to treat EtOH dependence?

A

Disulfiram

40
Q

Disulfiram mechanism of action?

A 
inhibits aldehyde dehydrogenase
causes adverse reaction to alcohol:
flushing
headache
N/V
palpitations
SOB
41
Q

Contraindications for Disulfiram?

A

severe heart disease
pregnancy
psychosis

42
Q

what medication would you consider in an alcoholic with family history of alcoholism?

A

Naltrexone

43
Q

Naltrexone mechanism of action

A

Opioid receptor blocker

decrease desire/craving and “high” associated with alcohol

44
Q

How would naltrexone affect a person with opioid dependence?

A

precipitate opioid withdrawal….they would feel awful

45
Q

which medication should be used for EtOH dependence in patients with severe liver disease?

A

Acamprosate

46
Q

Acamprosate mechanism of action:

A

structurally similar to GABA

Thought to inhibit glutamatergic system

47
Q

Contraindication of acamprosate

A

severe renal disease

48
Q

what anticonvulsant can be used to treat EtOH dependence and what is the mechanism of action?

A

Topiramate

potentiates GABA and inhibits Glutamate receptors, decreasing craving for alcohol

49
Q

Wernicke’s Encephalopathy features:

A

Ataxia (wide-based)
confusion
ocular abnormalities: nystagmus and gaze palsies

50
Q

If untreated Wernicke’s encephalopathy can progress to

A

Korsakoff’s syndrome

Psychiatry (6 decks)

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