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Substance Use Disorders > Alcohol Withdrawal Syndrome > Flashcards

Alcohol Withdrawal Syndrome Flashcards

1
Q

The DSM-5 describes alcohol withdrawal syndrome (AWS) as…

A

2+ symptoms after a decrease in heavy + prolonged drinking, causing significant distress or impairment in social, occupational, or other important areas of functioning

Not attributable to another medical condition

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2
Q

A mnemonic for the symptoms of alcohol withdrawal symptom is…

A

HAS A PINT
H - hallucinations/illusions/DTs
A - autonomic hyperactivity (sweats, HR)
S - seizures

A - anxiety

P - psychomotor agitation
I - insomnia
N - N/V
T - tremor of the hand

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3
Q

AWS symptoms can manifest as early as…

A

4-12 hours after the last drink, usually around 6-24h. Peaks on day 2-3.

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4
Q

Seizure risk with AWS is greatest…

A

In the first 72 hours

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5
Q

Symptoms of delirium tremens (DTs) involves…

A

Severe confusion, disorientation, and/or hallucinations, with clouding of global sensorium and severe autonomic hyperactivity

Loss of consciousness
Severe autonomic hyperactivity = tachycardia, HTN, hyperthermia, agitation, sweating

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6
Q

DTs is the most serious complication of alcohol withdrawal since its mortality rate is…

A

~5%

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7
Q

DTs usually begins after ____ and lasts for _____

A

48-96hr after the last drink, lasts for 1-5 days

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8
Q

The two notable neurotransmitters involved in AWS is…

A

GABA (inhibitory) and Glutamate (excitatory)

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9
Q

The balance between inhibitory and excitatory states in a non-alcoholic is…

A

Balanced

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10
Q

The balance between inhibitory and excitatory states in intoxication in an occasional user is…

A

Increased inhibitory - GABA + alcohol

Relaxed, sleepy state

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11
Q

The balance between inhibitory and excitatory states in someone with chronic and regular alcohol use is…

A

Balanced - glutamate is upregulated to compensate for inhibitory effect of alcohol

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12
Q

The balance between inhibitory and excitatory states in someone in alcohol withdrawal is…

A

Excitatory - glutamate is upregulated

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13
Q

Risk factors for AWS include…

A

Increased quantity, frequency, and duration lf alcohol use
Previous/family hx of alcohol withdrawals
Concurrent medical conditions
Consumption of sedatives/hypnotics/anxiolytics

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14
Q

Complications of AWS include…

A

Relapse
Aspiration
Arrhythmias
Seizures, DTs
Prolonged hospitalization
Brain damage
Death

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15
Q

The most useful screening tool for predicting a patient’s risk of developing severe complications related to alcohol withdrawal is…

A

PAWSS - Prediction of Alcohol Withdrawal Severity Scale

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16
Q

The most commonly used medications for AWS are…

A

Benzodiazepines

Reduce risk of seizure and DTs

17
Q

This medication is often used in addition to benzos, because…

A

Clonidine - suppress noradrenergic symptoms that do resolve with benzos (anxiety, HTN, tachycardia)

“symptomatic relief”

18
Q

Adjunctive/alternative therapies for AWS may include…

A

Carbamazepine
Gabapentin
Baclofen
Beta-blockers
Haloperidol

GABA activity
CNS depression
Helping with withdrawal activity

19
Q

BZD’s are most effective for AWS due to their MOA, which involves…

A

Binding to BZD binding site on GABA receptors, increasing GABA binding affinity and increase inhibitory action of GABA

20
Q

The BZD’s used for AWS are ____, and the difference between them is…

A

Lorazepam and diazepam; difference in their half-life. Lorazepam is shorter and has inactive metabolites

21
Q

This scale measures the severity of alcohol withdrawal symptoms:

A

CIWA - Clinical institute Withdrawal Assessment for Alcohol

22
Q

The purpose of CIWA is to measure severity of…

A

Withdrawal symptoms, and give certain dose of BZD to balance treating sx’s and avoiding too much CNS depression

Often used with an order set to help with dosing

23
Q

Lorazepam can be given…

A

PO, IM, SC, or IV

24
Q

Diazepam can be given…

A

PO or IV

25
Q

o

Supportive care that is given for AWS patients include…

A

Thiamine
Folate
Multivitamin
Electrolyte (if needed for correction)
Fluids

26
Q

Thiamine is given to AWS patients to help with…

A

Preventing Wernicke-Korsakoff’s syndrome, peripheral neuropathy, and cardiomyopathy

27
Q

Folate is given to AWS patients to help with…

A

Preventing and correcting anemia

28
Q

Multivitamins are given to AWS patients to help with…

A

Preventing and correcting micronutrient deficiency

29
Q

Electrolytes may be given to AWS patients to help with…

A

Preventing electrolyte imbalances and life-threatening complications (such as arrhythmia, coma)

30
Q

Fluids are given to AWS patients to help with…

A

Correcting hypovolemia and dehydration from sweating, vomiting, diarrhea, and fever

31
Q

Evidence for supportive care in AWS is…

A

Limited/RCT data insufficient, but is often the standard of care

Substance Use Disorders (6 decks)

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