Alcohol Withdrawal

Question 1

True or false: Ethanol does not bind directly to GABA receptors but facilitates binding

Answer 1

True

Question 2

What are the receptors involved in the inhibitory pathway?

Answer 2

GABA

Question 3

What are the 2 excitatory pathway receptors?

Answer 3

1. NMDA
2. Glutamate

Question 4

True or false: Ethanol binds directly to the NMDA/GLUTAMATE receptors

Answer 4

False (reduces binding to receptors)

Question 5

What are two enzymes that metabolize ethanol?

Answer 5

1. Alcohol dehydrogenase
2. Aldehyde dehydrogenase

Question 6

What are 3 complications of alcohol withdrawal?

Answer 6

1. Uncomplicated symptoms
2. Alcoholic hallucinations
3. Alcohol withdrawal seizures

Question 7

What is a serious complication of alcohol withdrawal that is diagnosed by the presence of delirium and tremors?

Answer 7

Delirium Tremens

Question 8

What are 5 things that are seen with delirium tremens?

Answer 8

1. Agitation
2. Hallucinations
3. Tachycardia
4. Tachypnea
5. Hypertension

Question 9

What test is used for diagnosing alcohol withdrawal?

Answer 9

PAWSS

Question 10

What score on PAWSS shows a low likelihood of developing moderate to severe alcohol withdrawal?

Answer 10

<4

Question 11

What score on PAWSS shows a high likelihood of developing moderate to severe alcohol withdrawal?

Answer 11

> /= 4

Question 12

What diagnosis tool for alcohol withdrawal is the most commonly used?

Answer 12

CIWA-AR

Question 13

What are 7 supportive care treatments used for alcohol withdrawal?

Answer 13

1. Fluids
2. Antipyretics
3. Thiamine and multivitamins
4. Electrolyte replacement
5. Dextrose
6. Mechanical ventilation
7. Restraints

Question 14

What drugs increase the affinity of GABA to GABAA receptors leading to an inhibitory effect?

Answer 14

Benzodiazepines

Question 15

What are 4 benzodiazepines that can be used for alcohol withdrawal?

Answer 15

1. Diazepam
2. Lorazepam
3. Midazolam
4. Chlordiazepoxide

Question 16

What are 3 neurologic ADRS of benzos?

Answer 16

1. Sedation
2. Dizziness
3. Delirium

Question 17

What is a cardiovascular effect of benzos?

Answer 17

Hypotension

Question 18

What is a rare side effect of benzos?

Answer 18

Respiratory depression

Question 19

What benzodiazepine is very susceptible to 3A4 inhibitors?

Answer 19

Midazolam

Question 20

What may occur if lorazepam is infused at high doses?

Answer 20

Metabolic acidosis

Question 21

What drug class enhances GABA binding to the GABAA receptors and increases the duration of the Cl channel opening?

Answer 21

Barbiturates

Question 22

What are the barbiturates place in therapy?

Answer 22

Adjunct therapy to benzodiazepines

Question 23

What drug class treats the symptoms of alcohol withdrawal but not the underlying physiological source of the withdrawal?

Answer 23

Alpha 2 agonists

Question 24

What are the 2 alpha 2 agonists?

Answer 24

1. Precedex
2. Propofol

Question 25

What is a second line agent that can be used after benzodiazepines and barbiturates?

Answer 25

Ketamine

Question 26

What drug is a NMDA/Glutamate antagonist?

Answer 26

Ketamine

Question 27

What are 3 adverse effects of ketamine?

Answer 27

1. Hypertension
2. Dissociation
3. Respiratory depression

Question 28

How is ketamine given?

Answer 28

At a low dose or a bolus dose

Question 29

What drug class is used for sedation during hallucinations and DTs?

Answer 29

Antipsychotics

Question 30

What are the 2 antipsychotics that are used?

Answer 30

1. Haloperidol
2. Olanzapine

Question 31

True or false: antiepileptics should be used to treat alcohol withdrawal seizures

Answer 31

False (not very effective)

Question 32

When are antiepileptics used for alcohol withdrawal seizures?

Answer 32

If status epilepticus develops or suspicion of another cause