Alcoholism Flashcards
How can tolerance be described?
The person will have a reduced response to alcohol so they need more to produce the same effect. This is increased tolerance.
Tolerance stays for a long time even after abstinence.
What causes withdrawal symptoms?
The body increases HR, BP etc to counteract the depression of alcohol.
If the person doesn’t drink, the bodies anticipatory actions will cause them to feel awful.
What is dependence?
When the person needs alcohol just to feel normal.
What is the main effect of alcohol?
Depressant.
Reduces HR, BP, wakefulness.
What are the withdrawal symptoms?
Anxiety depression irritability fatigue vomit seizures tremors palpitations clammy skin dilated pupils sweating headache difficulty sleeping delirium tremens.
What withdrawal symptoms occur after 6-12 hours?
Nausea Shaking Insomnia Clammy Anxiety
What withdrawal symptoms haven after 12-24hrs?
Hallucinations.
What withdrawal symptoms happen after 48-72hrs?
Delirium tremens
Agitation
Confusion
Low grade fever
What is delirium tremens?
Rapid onset confusion caused by alcohol withdrawal. Confusion Tremor Sweating Seizures (rarely) Hypertension Hallucinations (visual and tactile)
What is a common tactile hallucination seen in delirium tremens?
Feeling of insects crawling on or under the skin.
Which reinforcements lead to alcohol addiction?
Positive reinforcement = drinking more to feel euphoria.
+
Negative reinforcement = drinking more to prevent negative withdrawal symptoms
What gives a diagnosis of harmful alcohol use?
A pattern of use causing physical or mental damage.
The use lasting >1 month or repeatedly over 12 months.
What gives a diagnosis of alcohol dependence?
3 or more of the following:
- Cravings/compulsions to take
- Difficulty controlling use
- Primacy
- Increased tolerance
- Physiological withdrawal or reduction/cessation
- Persistence despite harmful consequences
What is the recommended maximum units to be consumed per week by both male and female?
14 units
Spaced out over 3 days.
Which alcohol screening test should be used in pregnant women?
TWEAK Tolerance Worrying about drinking Eye opener Amnesia (blackouts) K/cut down
What is a physical sign that can be tested which shows alcohol misuse?
Asterixis
What are the long term conditions caused by alcohol dependence?
Dilated cardiomyopathy Arrhythmias Irregular heart beat Strokes Cirrhosis Pancreatitis Hypertension Anxiety Depression Morbid jealousy
What other questionnaires can be done when assessing someones alcohol intake?
Audit CAGE (cut down, annoyed, guilty, eye opener).
What type of cancers does alcohol dependence increase the chance of?
Mouth Oesophagus Throat Liver Breast
How does alcohol most commonly cause death?
By cardiovascular or respiratory depression.
What is the treatment for withdrawal?
Long acting Benzodiazepines - diazepam, chlordiazepoxide.
What medication can be given as an anti-convulsant?
Carbamazepine
Which medications can be given as an anti-craving drug?
Naltrexone
Acamprosate
Which drug can be given to produce aversion of alcohol? How does it work?
Disulfiram - blocks the enzyme which breaks down alcohol. Leads to hangover symptoms like nausea instantly.
Which medication should be given if the patient is having an alcohol withdrawal seizure?
Rapid acting benzodiazepines - IV lorazepam.
Which medication can be given to prevent wernicke’s encephalopathy?
Pabrinex (vitamin B and C).
What are the main symptoms of drinking too much alcohol?
Slurred speech Incoordination Unsteady gait Nystagmus Stupor Gona Over emotional responses Impaired judgement
What are the risk factors for substance misuse?
Family history
Neglect
Abuse
What brain damage can occur after alcohol dependence?
Short term memory Long term recall New skills acquisition Language decline Ventricular enlargement
What is the cause of wernicke’s encephalopathy?
Thiamine or vitamin B1 deficiency.
Which triad of symptoms are seen in wernicke’s encephalopathy?
Confusion
Ataxia
Nystagmus
If untreated, what can wernicke’s encephalopathy develop into?
Korsakoff’s syndrome.
What is the treatment for wernicke’s encephalopathy?
Urgent IV infusion thiamine replacement over a couple of days.
Given alongside glucose.
Give thiamine first or glucose will turn to lactic acid.
What is korsakoffs syndrome?
A form of dementia caused by long term drinking.
What are the symptoms of Korsakoff’s syndrome?
Anterograde amnesia Retrograde amnesia Confabulation Behavioural changes Confusion (ataxia) that can cause leg tremor. Nystagmus Double vision Eyelid drooping
Alcohol withdrawal.
What is FAST?
A screening test used to identify how much alcohol is being consumed.
What are the main points when thinking about delirium tremens?
Complication of acute alcohol withdrawal Fluctuating confusion Disorientation in time and place Memory impairment Psychotic symptoms - hallucination, delusion Treated with benzodiazepines
