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Psychiatry > Alcohol Use Disorders > Flashcards

Alcohol Use Disorders Flashcards

1
Q

Give examples of high risk occupations for alcohol misuse.

A

Bartenders.
Itinerant workers.
Professional autonomy ie. doctors

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2
Q

Who do the highest rates of drinking occur in?

A

Adolescents and those in their 20’s

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3
Q

1 unit =

A

10 ml

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4
Q

How are number of units calculated?

A

(% x volume) / 10.

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5
Q

How many units of alcohol are in 750ml of 40% ABV vodka?

A

(0.4 x 750)/10 = 300/10 = 30 units

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6
Q

What is ‘high risk’ drinking defined as?

A

Regularly consuming over 35 units per week.

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7
Q

What is ‘increased risk’ drinking defined as?

A

Regularly consuming between 15 and 35 units per week.

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8
Q

What are the UK guidelines for low risk drinking?

A

Men and women should not regularly drink more than 14 units of alcohol a week. Ideally, this should be spread evenly over three days or more

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9
Q

According to F10, what can harmful use for alcohol be described as?

A

A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (as in cases of hepatitis from the self-administration of injected psychoactive substances) or mental (e.g. episodes of depressive disorder secondary to heavy consumption of alcohol).

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10
Q

Outline the diagnostic criteria for alcohol dependence syndrome according to F10.2

A
  • Strong desire or sense of compulsion to take drug
  • Difficulty in controlling use of substance in terms of onset, termination or level of use
  • Physiological withdrawal state
  • Evidence of tolerance
  • Progressive neglect of other pleasures /interests because of use /effects of substance
  • Persistence with use despite clear evidence of harmful consequences
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11
Q

AUDIT

A

Alcohol users disorder identification test

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12
Q

CAGE

A

Cut dow, annoyed, guilt, eye opener

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13
Q

TAGE

A

Tolerance, annoyed, guilt, eye opener

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14
Q

What is lab testing not useful in?

A

Screening for alcohol disorders

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15
Q

What may lab testing have a role in?

A

Monitoring a patients response to treatment

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16
Q

What is GGT an indicator of?

A

Liver injury

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17
Q

Measuring what can allow identification of men drinking 5 or more units per day for 2 weeks or more?

A

Carbohydrate deficient transferrin

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18
Q

Alcoholism is the most common cause of raised what?

A

MCV (mean corpuscular volume)

- causes a macrocytosis

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19
Q

Who are the target audience for brief interventions?

A
  • Adults who have been identified via screening as drinking a hazardous or harmful amount of alcohol.
  • Attending NHS, or NHS-commissioned services or services offered by other public institutes.
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20
Q

What is the duration of a brief intervention?

A

5-15 mins

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21
Q

Outline the FRAMES framework.

A

Feedback - review problems experienced because of alcohol.

Responsibility – patient is responsible for change.

Advice – advise reduction or abstinence.

Menu – provide options for changing behaviour.

Empathy – use empathic approach.

Self-efficacy –encourage optimism about changing behaviour.

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22
Q

What model is used for brief interventions?

A

FRAMES

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23
Q

What does alcohol inhibit?

A

The action of excitatory NMDA-glutamate controlled ion channels (chronic use leads to upregulation of receptors).

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24
Q

What does alcohol potentiate the actions of?

A

Inhibitory GABA type A controlled ion channels

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25
Q

What is the effect of chronic use of alcohol on GABA-A channels?

A

Chronic use leads to downregulation of receptors

26
Q

What does alcohol withdrawal lead to excess activity of?

A

Glutamate and GABA activity

27
Q

What is the effect of excessive glutamate activity on the nerve cell?

28
Q

What does acute withdrawal of alcohol in the dependent subject lead to?

A

CNS excitability + neurotoxicity

29
Q

When do symptoms of alcohol withdrawal occur?

A

Within hours

30
Q

When do symptoms of alcohol withdrawal peak?

A

24-48 hours

31
Q

List the symptoms of alcohol withdrawal syndrome.

A

Restlessness, tremor, sweating, anxiety, nausea and vomiting, loss of appetite and insomnia

Tachycardia + systolic hypertension.

32
Q

What else can occur in the first 24 hours of alcohol withdrawal syndrome?

A

Delirium tremens

Generalised seizure

33
Q

In most people, when do symptoms of alcohol withdrawal resolve?

34
Q

In what % of cases of people with alcohol withdrawal foes delirium tremens occur?

35
Q

When is the peak onset of delirium tremens?

A

2 days post abstinence

36
Q

How does delirium tremens present?

A

Presents insidiously, with night-time confusion

(ask about drug/alcohol dependency in confused pt!!!!)

Sx: confusion, disorientation, agitation, hypertension, fever, visual and auditory hallucinations, paranoid ideation.

37
Q

What causes death in delirium tremens?

A

CVS collapse and infection

38
Q

What are the 3 main areas of management of delirium tremens?

A
  • General support.
  • Benzodiazepines.
  • Vitamin supplementation.
39
Q

What drug is cross-tolerant with alcohol?

40
Q

Why are BZD’s cross-tolerant with alcohol?

A

They both act on GABA-A receptors

41
Q

What should the duration of action of the benzos used be like? Give egs.

A

Long-acting – ie. diazepam, chlordiazepoxide

42
Q

What should BZD’s be titrated against?

A

Severity of withdrawal symptoms

43
Q

After how many days can BZD’s be reduced for treatment of alcohol withdrawal?

44
Q

What vitamin should be given in the management of alcohol withdrawal?

45
Q

Why is thiamine given?

A

As a prophylaxis against Wernicke’s Korsacoff

46
Q

Via what route is thiamine given?

A

Parenteral

47
Q

If you suspect Wernicke’s encephalopathy, what should you do?

A

Increase dose of thiamine

48
Q

What is the classic triad of symptoms in Wernicke’s?

A

Ocular findings,
Cerebellar dysfunction
Confusion

i.e nystagmus, ataxia and confusion

49
Q

When should someone be considered as an inpatient for detox?

A

Severe dependence
A history of Delirium Tremens or alcohol withdrawal seizures
A history of failed community detoxifications
Poor social support
Cognitive impairment
Psychiatric co-morbidity
Poor physical health

50
Q

What does delirium tremens require?

A

Prompt transfer to general medical ward.

51
Q

What is there no need for beyond the detox period i.e only needed acutely?

52
Q

Name 3 drugs that are used in relapse prevention.

A

Disulfiram (antabuse)
Acamprosate
Naltrexone

53
Q

What is the mode of action of disulfiram?

A

Inhibits acetaldehyde dehydrogenase, leading to accumulation of acetaldehyde if alcohol is ingested.

54
Q

What are some side effects of disulfiram?

A

Flushed skin, tachycardia, n+v, arrhythmias and hypotension, depending on the volume consumed

55
Q

Where does acamprosate act?

A

Centrally on glutamate and GABA systems

56
Q

What does acamprosate do?

A

Reduces cravings with a modest treatment effect.

57
Q

When should acamprosate be started?

A

As soon as detox is done

58
Q

What are the side effects of acamprosate?

A

Headache, diarrhoea, nausea

59
Q

What is the first line agent for relapse prevention?

A

NALTREXONE

60
Q

What type of drug is naltrexone?

A

An opioid antagonist

61
Q

What does naltrexone do?

A

Reduces the reward from alcohol

Psychiatry (31 decks)

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