Alcoholic hepatitis (alcohol dependence drugs)

Question 1

Acamprosate MOA

Answer 1

• Weak NMDA receptor antagonist and upregulates GABA receptors (which have been downregulated due to chronic alcohol abuse) and prevents withdrawal symptoms
• used in protracted alcoholic withdrawal
• reduces cravings, increased first-time-to-drink

Question 2

Acamprosate S/E and CI

Answer 2

S/E
	• Rash 
	• Diarrhoea/vomiting/nausea
	• Change in libido 
	• Urticaria, angioedema, anaphylaxis 

CI
• impaired renal function – dose must be adjusted
• pregnancy

Question 3

Naltrexone MOA

Answer 3

• Miu opioid receptor antagonist

* reduces the pleasurable effects of alcohol, leading to fewer cravings

Question 4

Naltrexone S/E and CI

Answer 4

S/E
	• Nausea, dizziness, headache 
	• Hepatotoxicity at high doses
	
CI
	• chronic opioid therapy (e.g. methadone treatment)
	• recent opioid use
	• acute hepatitis
liver failure

Question 5

Disulfiram MOA

Answer 5

• blocks acetaldehyde dehydrogenase (2nd step in alcohol metabolism) and causes the accumulation of acetaldehyde
• increases the negative symptoms of alcohol i.e. headache, nausea, vomiting, confusion, tachycardia, flushing
• only works when patients are compliant with medication
• does not reduce cravings, reduces pleasurable effects of alcohol

Question 6

Disulfiram S/E and CI

Answer 6

S/E
• Headache
• metallic taste
• hepatitis

CI
• severe myocardial disease
• psychosis, advanced renal/hepatic disease