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Phar 507 > Alcohol Use Disorder > Flashcards

Alcohol Use Disorder Flashcards

1
Q

How is alcohol metabolized

A

Alcohol is converted to acetaldehyde by alcohol dehydrogenase then water and carbon dioxide by aldehyde dehydrogenase

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2
Q

What is the rate-limiting step of metabolizing alcohol

A

Aldehyde dehydrogenase availability

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3
Q

What are the alcohol test that measure the amount

A

Blood alcohol level and carbohydrate-deficient transferrin

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4
Q

T/F: To tell if someone has liver damage due to alcohol AST is twice as much as ALTs

A

True

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5
Q

What is the pathophysiology of alcohol

A

Acute:Binds to GABA primarily in CNS, Chronic: Lowers GABA and lower receptor response

Acute: Inhibition of Glutamate NMDA receptors, Chronic: Upregulation of NMDA receptors

Dopamine: Release of endogenous opioids and dopamine causing euphoria

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6
Q

What is a unique sign of alcohol withdrawal, most dangerous

A

Hand tremor, seizures

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7
Q

When do seizures usually happen

A

1-2 days later but they usually wont happen if not present in first two days

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8
Q

What is dellirium tremens

A

Disturbance of consciousness and cognition seen 48 to 72 hours later (Fatal)

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9
Q

What are the two types of Wernicke-Korsakoff

A

Wernicke’s Encephalopathy: Confusion, ataxia (impaired coordination), mystagmus

Korsakoff Psychosis: Retrograde/anterograde, amnesia, confabulations, hallucinations (May be permanent)

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10
Q

How is Wernicke-Korsakoff prevented

A

Thiamine 100 mg daily for 3 to 5 days FOR ALL ALCOHOLICS or Thiamine 100-500 mg for high risk individuals

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11
Q

How is Wernicke-Korsakoff treated

A

Thiamine 500 mg IM/IV TID for 3 to 5 days

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12
Q

What scale is used to measure the alcoholism of a patient, what score allows for medication

A

CIWA-Ar scale, greater than 8 (15 gives scheduled medication)

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13
Q

What are the options for acute treatment of Alcoholism

A

BZDs, Anticonvulsants, adjunctive treatment

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14
Q

What are the first line options for maintenance treatment, 2nd/last line option

A

Campral and Naltrexone/ Disulfram

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15
Q

What is the drugs of choice for acute alcholholism, which ones specifically

A

Benzodiazepines (only inpatient)/ Chlordiazepoxide, Diazepam, Lorazepam, Oxazepam

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16
Q

What is are the contraindications for BZDs

A

Alcohol intoxication, Hepatic impairment, History of substance abuse, pregnancy unless she is seizing than benefit is higher than risk, elderly

17
Q

Which BZDs are not hepatically metabolized, reversible agent

A

Lorazepam, Oxazepam, and Temazepam, Flumenazil

18
Q

What are the cons of BZDs

A

Prolong hospitaliztion and overmedicating

19
Q

Which anticonvulsants are used for acute treatment of alcoholism

A

Carbamazepine, valproic acid, gabapentin, phenobarbital

20
Q

What is the supportive treatment for acute alcoholism

A

Thiamine (prior to giving glucose), folic acid, clonidine, Monitor electrolytes

21
Q

What are medications that should be avoided

A

Antipsychotics (reduce hallucinations) , Ethanol, Phenytoin

22
Q

What is the MOA of naltrexone in alcoholism

A

attenuates the pleasurable response, decreases heavy drinking, decreases cravings

23
Q

What are the Naltrexone contraindications/ monitoring

A

Current opioid use, opioid withdrawal, hepatic impairment/ LFTs and Opioid withdrawal

24
Q

What are the side of effects of Naltrexone

A

Nausea abdoimal pain, headache, site reaction injections

25
Q

How does Acamprosate work,dose

A

Enhances GABA neurotransmission and antagonizes glutamate (mimics alcohol) decreases cravings (most effective if sober greater than 4 days)/ 333 TID

26
Q

What patients cant have acamprosate

A

CrCl less than 30 ml/min

27
Q

How does Disulfram work, how long after last sip of alcohol should it be taken

A

inhbits aldehyde dehydrogenase causes increased amounts of acetahydelyhde, 12 hours post

28
Q

Side effects of disulfram

A

Heptotoxicity, Headache, fatigue, garlic taste

29
Q

T/F: Disulfram can cause nausea in people with perfume and moutwash due to alcohol concentration

A

True

30
Q

Which anticonvulsant is not FDA approved but is effective

A

Gabapentin (improve sleep too)

31
Q

T/F: Non phamracolgic treatments are the most effective to help with alcoholism

A

True

32
Q

T/F: Relapse is not failure an happens to everyone

A

True

Phar 507 (33 decks)

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