Alcohol Withdrawal Flashcards
Ethanol is primarily metabolized via (oxidative/non-oxidative) metabolsim
Oxidative
Examples of screening tools for assessing alcohol use
. CAGE questionnaire
. AUDIT
. AUDIT-PC (shorter AUDIT)
. PAWSS
Acute alcohol ingestion (inc/dec) GABA activity and (inc/dec) glutamate activity
Inc, dec
Chronic alcohol ingestion (up/down) regulates GABA receptors and (up/down) regulates NMDA receptors
Down, up
Abrupt alcohol cessation (inc/dec) GABA pathway activity and (inc/dec) NMDA pathway activity
Dec, inc
Onset of alcoholic hallucinosis can be seen at what time frame?
a. 8 hours
b. 12 hours
c. 24 hours
d. 72 hours
a. 8 hours
Onset of alcohol withdrawal seizures can be seen at what time frame?
a. 8 hours
b. 12 hours
c. 24 hours
d. 72 hours
b. 12 hours
What is regarded as the most serious complication of alcohol withdrawal?
Delirium tremens
True or false: Delirium tremens is not seen 7-10 days after last drink
False. Can still occur7-10 days after last drink
True or false: The CIWA-Ar Scale assesses severity of withdrawal and is used for diagnosis of AWS
False. NOT used for diagnosis
What CIWA-Ar score indicates severe symptoms?
19+
What CIWA-Ar score indicates mild symptoms?
Less than 10
Which class of medications is considered first line treatment for AWS?
Benzodiazepines
Benzodiazepine MOA in AWS
Stimulate GABAa receptors which increases influx of chloride ions and provide inhibitory effects
Which 2 benzodiazepines used in AWS do not have any active metabolites?
Lorazepam and oxazepam
Benzodiazepine selection considerations for elderly patients or those with liver dysfunction. Which agents?
. Shorter duration of action
. Lack of active metabolites
. Lorazepam or oxazepam
Benzodiazepine selection considerations for healthy patients. Which agents?
. Longer duration of action
. Chlordiazepoxide or diazepam
True or false: Oxazepam is only available PO
True
Characteristics of a front-loading benzodiazepine dosing strategy
. Moderate-high dose of long acting benzo
. Recommended for severe (CIWA-Ar 19+)
Characteristics of a symptom-triggered benzodiazepine dosing strategy
. Benzo only administered when patient is experiencing symptoms (CIWA-Ar 8-10)
Which benzodiazepine is usually preferred for alcohol withdrawal seizures?
Lorazepam (next line can be diazepam)
True or false: Oral or IV alcohol may be used for the prevention or treatment of alcohol withdrawal
False
What deficiency results in Wernicke’s encephalopathy?
Thiamine
