Alcohol Use Disorders? Flashcards
What is one unit equal to?
10ml of alcohol
What is higher risk drinking defined as?
regularly consuming over 35 units per week
Which gender is more prone to chronic consequences of alcohol?
womrn
What is carbohydrate deficient transferin?
identifies men drinking 5 or more units per day fro 2 weeks or more
What is the most common cause of raised MCV?
alcoholism
What is FRAMES brief intervention?
FEEDBACK- problems due to alcohol RESPONSIBILITY- pt is responsible for change ADVICE- reduction/abstinence MENU-options for changing behaviour EMPATHY SELF-EFFICACY-optimism
When should patients be referred for speciliast tx for alcohol dependence?
signs of mod or severe alcohol dependence; no benefit from brief intervention and want more help; signs of severe alcohol-related impairment or related condition
How does alcohol work at a molecular level?
inihibits action of excitatry NMDA-glutamate channels and potenetiates actions of inhibitory GABAA channels
What does alcohol withdrawal lead to?
excess glutamate activity and reduced GABA activity leading to excessive glutamate which is toxic to nerve cells
What are the molecular consequences of chrnoic alcohol use?
upregulation of excitatry NMDA channels and downregulation of inhibitory GABAa receptors
What are the symptoms of alcohol withdrawal syndrome?
restlessness; tremor; sweating; anxiety; N&V; loss of appetite and insomnia; tachy; HT; seiures and delitium tremens
When do seizures and delirium tremens normally occur?
first 24 hours
When do symptoms of alcohol withdrawal syndrome normally resolve?
5-7days
What are the features of delirium tremens?
confusion- often insidious onset at night; disorientation; agitiation; HT; fever; visual and auditory hallucinations and paranoid ideation
What causes mortality in delirium tremens?
assoc. with CVS collapse and infection
What is the function of BZDs in alcohol withdrawal?
cross tolerant with alcohol (als oact on GABAa receptors)
what type of BZD should be used in alcohol withdrawal?
long -acting as short-acting can get peaks and troughs of drug in system with breakthrough symptoms
What should be used as prophylaxis against Wernicke’s in alcohol withdrawal?
thiamine
How should thiamine be given?
parental as alcohol reduces ability of stomach to abrosrb
Who should have inpatient detoxes?
severe dependence; hx of delirium tremens or seizures; hx of failed community detox; poor social support; cognitive impairment; psych co-morbid; poor physical health
What 3 psychosocial interventions are equally effective in relapse prevention?
CBT; 12 step’ MET
How does disulfiram (antabuse) work?
inhibits acetaldehyde dehydrogenase leading to accumulation of acetaldehyde (flushing; tachy; N&V; arrhythmias and hypotension) if alcohol is ingested
How does acamprosate wotk?
acts centrally on glutamate and GABA systems to reduce craving
What is the first line agent for relapse prevention?
naltrexone
How does naltrexone work?
opioid antagonist and reduces reward from alcohol
