Alcohol Use Disorder Flashcards
How is alcohol metabolized
Alcohol is converted to acetaldehyde by alcohol dehydrogenase then water and carbon dioxide by aldehyde dehydrogenase
What is the rate-limiting step of metabolizing alcohol
Aldehyde dehydrogenase availability
What are the alcohol test that measure the amount
Blood alcohol level and carbohydrate-deficient transferrin
T/F: To tell if someone has liver damage due to alcohol AST is twice as much as ALTs
True
What is the pathophysiology of alcohol
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
What is a unique sign of alcohol withdrawal, most dangerous
Hand tremor, seizures
When do seizures usually happen
1-2 days later but they usually wont happen if not present in first two days
What is dellirium tremens
Disturbance of consciousness and cognition seen 48 to 72 hours later (Fatal)
What are the two types of Wernicke-Korsakoff
Wernicke’s Encephalopathy: Confusion, ataxia (impaired coordination), mystagmus
Korsakoff Psychosis: Retrograde/anterograde, amnesia, confabulations, hallucinations (May be permanent)
How is Wernicke-Korsakoff prevented
Thiamine 100 mg daily for 3 to 5 days FOR ALL ALCOHOLICS or Thiamine 100-500 mg for high risk individuals
How is Wernicke-Korsakoff treated
Thiamine 500 mg IM/IV TID for 3 to 5 days
What scale is used to measure the alcoholism of a patient, what score allows for medication
CIWA-Ar scale, greater than 8 (15 gives scheduled medication)
What are the options for acute treatment of Alcoholism
BZDs, Anticonvulsants, adjunctive treatment
What are the first line options for maintenance treatment, 2nd/last line option
Campral and Naltrexone/ Disulfram
What is the drugs of choice for acute alcholholism, which ones specifically
Benzodiazepines (only inpatient)/ Chlordiazepoxide, Diazepam, Lorazepam, Oxazepam
What is are the contraindications for BZDs
Alcohol intoxication, Hepatic impairment, History of substance abuse, pregnancy unless she is seizing than benefit is higher than risk, elderly
Which BZDs are not hepatically metabolized, reversible agent
Lorazepam, Oxazepam, and Temazepam, Flumenazil
What are the cons of BZDs
Prolong hospitaliztion and overmedicating
Which anticonvulsants are used for acute treatment of alcoholism
Carbamazepine, valproic acid, gabapentin, phenobarbital
What is the supportive treatment for acute alcoholism
Thiamine (prior to giving glucose), folic acid, clonidine, Monitor electrolytes
What are medications that should be avoided
Antipsychotics (reduce hallucinations) , Ethanol, Phenytoin
What is the MOA of naltrexone in alcoholism
attenuates the pleasurable response, decreases heavy drinking, decreases cravings
What are the Naltrexone contraindications/ monitoring
Current opioid use, opioid withdrawal, hepatic impairment/ LFTs and Opioid withdrawal
What are the side of effects of Naltrexone
Nausea abdoimal pain, headache, site reaction injections
How does Acamprosate work,dose
Enhances GABA neurotransmission and antagonizes glutamate (mimics alcohol) decreases cravings (most effective if sober greater than 4 days)/ 333 TID
What patients cant have acamprosate
CrCl less than 30 ml/min
How does Disulfram work, how long after last sip of alcohol should it be taken
inhbits aldehyde dehydrogenase causes increased amounts of acetahydelyhde, 12 hours post
Side effects of disulfram
Heptotoxicity, Headache, fatigue, garlic taste
T/F: Disulfram can cause nausea in people with perfume and moutwash due to alcohol concentration
True
Which anticonvulsant is not FDA approved but is effective
Gabapentin (improve sleep too)
T/F: Non phamracolgic treatments are the most effective to help with alcoholism
True
T/F: Relapse is not failure an happens to everyone
True
