Alcoholism

Question 1

How can tolerance be described?

Answer 1

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.

Question 2

What causes withdrawal symptoms?

Answer 2

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.

Question 3

What is dependence?

Answer 3

When the person needs alcohol just to feel normal.

Question 4

What is the main effect of alcohol?

Answer 4

Depressant.

Reduces HR, BP, wakefulness.

Question 5

What are the withdrawal symptoms?

Answer 5

Anxiety
depression
irritability
fatigue
vomit
seizures
tremors
palpitations
clammy skin
dilated pupils
sweating
headache
difficulty sleeping
delirium tremens.

Question 6

What withdrawal symptoms occur after 6-12 hours?

Answer 6

Nausea
Shaking
Insomnia
Clammy
Anxiety

Question 7

What withdrawal symptoms haven after 12-24hrs?

Answer 7

Hallucinations.

Question 8

What withdrawal symptoms happen after 48-72hrs?

Answer 8

Delirium tremens
Agitation
Confusion
Low grade fever

Question 9

What is delirium tremens?

Answer 9

Rapid onset confusion caused by alcohol withdrawal.
Confusion
Tremor
Sweating
Seizures (rarely)
Hypertension
Hallucinations (visual and tactile)

Question 10

What is a common tactile hallucination seen in delirium tremens?

Answer 10

Feeling of insects crawling on or under the skin.

Question 11

Which reinforcements lead to alcohol addiction?

Answer 11

Positive reinforcement = drinking more to feel euphoria.
+
Negative reinforcement = drinking more to prevent negative withdrawal symptoms

Question 12

What gives a diagnosis of harmful alcohol use?

Answer 12

A pattern of use causing physical or mental damage.

The use lasting >1 month or repeatedly over 12 months.

Question 13

What gives a diagnosis of alcohol dependence?

Answer 13

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

Question 14

What is the recommended maximum units to be consumed per week by both male and female?

Answer 14

14 units

Spaced out over 3 days.

Question 15

Which alcohol screening test should be used in pregnant women?

Answer 15

TWEAK
Tolerance
Worrying about drinking
Eye opener 
Amnesia (blackouts)
K/cut down

Question 16

What is a physical sign that can be tested which shows alcohol misuse?

Answer 16

Asterixis

Question 17

What are the long term conditions caused by alcohol dependence?

Answer 17

Dilated cardiomyopathy
Arrhythmias 
Irregular heart beat
Strokes
Cirrhosis
Pancreatitis 
Hypertension
Anxiety
Depression
Morbid jealousy

Question 18

What other questionnaires can be done when assessing someones alcohol intake?

Answer 18

Audit 
CAGE (cut down, annoyed, guilty, eye opener).

Question 19

What type of cancers does alcohol dependence increase the chance of?

Answer 19

Mouth
Oesophagus 
Throat
Liver 
Breast

Question 20

How does alcohol most commonly cause death?

Answer 20

By cardiovascular or respiratory depression.

Question 21

What is the treatment for withdrawal?

Answer 21

Long acting Benzodiazepines - diazepam, chlordiazepoxide.

Question 22

What medication can be given as an anti-convulsant?

Answer 22

Carbamazepine

Question 23

Which medications can be given as an anti-craving drug?

Answer 23

Naltrexone

Acamprosate

Question 24

Which drug can be given to produce aversion of alcohol? How does it work?

Answer 24

Disulfiram - blocks the enzyme which breaks down alcohol. Leads to hangover symptoms like nausea instantly.

Question 25

Which medication should be given if the patient is having an alcohol withdrawal seizure?

Answer 25

Rapid acting benzodiazepines - IV lorazepam.

Question 26

Which medication can be given to prevent wernicke’s encephalopathy?

Answer 26

Pabrinex (vitamin B and C).

Question 27

What are the main symptoms of drinking too much alcohol?

Answer 27

Slurred speech
Incoordination
Unsteady gait
Nystagmus
Stupor
Gona 
Over emotional responses 
Impaired judgement

Question 28

What are the risk factors for substance misuse?

Answer 28

Family history
Neglect
Abuse

Question 29

What brain damage can occur after alcohol dependence?

Answer 29

Short term memory
Long term recall
New skills acquisition
Language decline
Ventricular enlargement

Question 30

What is the cause of wernicke’s encephalopathy?

Answer 30

Thiamine or vitamin B1 deficiency.

Question 31

Which triad of symptoms are seen in wernicke’s encephalopathy?

Answer 31

Confusion
Ataxia
Nystagmus

Question 32

If untreated, what can wernicke’s encephalopathy develop into?

Answer 32

Korsakoff’s syndrome.

Question 33

What is the treatment for wernicke’s encephalopathy?

Answer 33

Urgent IV infusion thiamine replacement over a couple of days.
Given alongside glucose.

Give thiamine first or glucose will turn to lactic acid.

Question 34

What is korsakoffs syndrome?

Answer 34

A form of dementia caused by long term drinking.

Question 35

What are the symptoms of Korsakoff’s syndrome?

Answer 35

Anterograde amnesia
Retrograde amnesia
Confabulation 
Behavioural changes
Confusion 
(ataxia) that can cause leg tremor.
Nystagmus
Double vision
Eyelid drooping

Alcohol withdrawal.

Question 36

What is FAST?

Answer 36

A screening test used to identify how much alcohol is being consumed.

Question 37

What are the main points when thinking about delirium tremens?

Answer 37

Complication of acute alcohol withdrawal
Fluctuating confusion
Disorientation in time and place
Memory impairment 
Psychotic symptoms - hallucination, delusion
Treated with benzodiazepines