Alcohol use disorder

Question 1

Risky use

Answer 1

Risky use of alcohol or other drugs are consumption amounts that increase the likelihood of health consequences (eg, injury, interpersonal problems, medical consequences).

Question 2

Risky amount of alcohol ingestion?

Answer 2

Men under age 65 – More than 14 standard drinks per week on average

       or   More than 4 drinks on any day

Women and adults 65 years and older – More than 7 standard drinks per week on average
or More than 3 drinks on any day

Question 3

List four screening test for alcohol use disorder?

Answer 3

1. single-item screening test (“How many times in the past year have you had five (four for women) or more drinks in a day?”) 2. AUDIT-C 3. AUDIT 4. CAGE

Question 4

What is CAGE?

Answer 4

Have you ever felt you should Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt bad or Guilty about your drinking?
Have you ever taken a drink first thing in the morning (Eye-opener) to steady your nerves or get rid of a hangover?

for men, a score of ≥2 is a positive screen; for women, a score of ≥1 is a positive screen

Question 5

First line treatment of alcohol use disorder?

Answer 5

1. Naltrexone (Revia*): opioid antagonist, shown to be successful in reducing the “high” associated with alcohol, moderately e ective in reducing cravings, frequency or intensity of alcohol binges
2. acamprosate (Campral®): NMDA glutamate receptor antagonist; useful in maintaining abstinence and decreasing cravings

Question 6

Side effects of naltrexone?

Answer 6

1. nausea, headache, and dizziness, which subside with continued use
2. Liver enzymes should be monitored periodically during naltrexone treatment.

Question 7

Naltrexone depot

Answer 7

Vivitrol (only approved in US)

Question 8

side effects of acamprosate.

Answer 8

The most prominent adverse events are diarrhea, nervousness, and fatigue, which usually subside with continued use. Because acamprosate is excreted mostly unchanged by the kidneys, rather than the liver, it can be used safely in severely alcohol-dependent individuals with liver disease. Acamprosate dosage needs adjustment for renal insufficiency and is contraindicated in patients with renal failure.

Question 9

Second line pharmacotreatment of alcohol use disorder?

Answer 9

1. Disulfram (Antabuse*)
2. Gabapentin,
3. Baclofen
4. Nalmefene (opioid antagonist)
5. Ondansetron