Alcoholism

Question 1

Who is an alcoholic

Answer 1

Is a person who drinks so much that his drinking leads him to harming himself or other social problems

This can be done by binging or heavy daily use, other addictions may be present too.

DENIAL is a leading feature, question relatives!

Question 2

What is the CAGE questionnaire

Answer 2

Ever felt you want to:

Cut down on your drinking?

Annoyed by people criticising your drinking?

Guilty about your drinking?

Eye-opener in the morning? - important sign

Question 3

Other screening methods of alcoholism

Answer 3

TWEAK, AUDIT

Question 4

Which organs can alcohol affect

Answer 4

NEVER FORGET RISK OF TRAUMA WHILE INTOXICATED:

Liver

CNS

Gut

Blood

Heart

Question 5

What can alcohol do to the liver

Answer 5

Normal in 50%

Fatty liver - acute reversible but may progress to cirrhosis if drinking continues

Alcoholic hepatitis - 80% progress to cirrhosis and 10% to hepatic failure

Question 6

What is the prognosis of liver cirrhosis

Answer 6

5yr survival is 48%if drinking continues, if not its 77%

Question 7

What are the other causes of fatty liver disease

Answer 7

DM, Amiodarone, and obesity

Question 8

How is CNS affected with alcoholism

Answer 8

Self neglect

reduced memory/cognition

High potency IM vitancy can reverse it

fits

falls

neuropathy

Wernicke’s encephalopathy

Question 9

How is the gut affected with alcoholism

Answer 9

Obesity

D&V

Gastric erosions

Peptic ulcers

Varices (portal HTN)

Pancreatitis

cancer (many types)

Oesophageal rupture

Question 10

How is the heart affected with alcoholism

Answer 10

Arrhythmias

HTN

Cardiomyopathy

Sudden death if binge drinking

Question 11

How is the blood affected with alcoholism

Answer 11

Increased MCV

Anaemia from marrow depression

GI bleeding

Alcoholism-associated folate deficiency

Haemolysis

Sideroblastic anaemia - see in anaemia cards

Question 12

What is Wernicke’s encephalopathy

Answer 12

damage to mamillary bodies in the thalamus and adjacent areas

Thiamine deficiency if alcoholic and poor diet

nystagmus, ophthalmoplegia, ataxia and confusion

Question 13

Withdrawal symptoms for alcoholics

Answer 13

Starts 10-72hrs after last drink

Signs

tachycardia

HTN

tremor

confusion

fits

hallucinations - visual/auditory - delirium

Question 14

Alcohol contraindications

Answer 14

Driving

Hepatitis

Cirrhosis

Peptic Ulcer

Drugs (antihistamines, metronidazole)

Carcinoid

Pregnancy

Question 15

Management of Alcoholism

Answer 15

Alcohol withdrawal

Prevention

Habit suggestions

Question 16

How to treat alcohol withdrawl

Answer 16

Admit, do Obs/4hrs - caution if BP decreased

Give generous chlordiazepoxide (Benzodiazepine), weaning over 7-10 days. Alt –> diazepam

Vitamins may be needed

Encourage alcohol free beers, cheaper, difficult to prevent risk is always high

Treat people who are willing to be treated, this is more effective

Question 17

What habit attitudes you might suggest for people trying to abstinence

Answer 17

Graceful ways of declining drinks

Not buying for themselves when it is your turn

Dont lift your glass to your lips until slowest drinker starts

sip don’t gulp

Question 18

Relapsing in alcoholism

Answer 18

50% of alcoholics tend to relapse

Acamprosate

Disulfiram Rx chronic alcohol dependence - causes extreme effects when alcohol is taken - *confer with experts if considering this drugs

Question 19

What does acamprosate do

Answer 19

helps with intense anxiety, insomnia, and craving

should be started as soon as acute withdrawal is managed

Question 20

signs of alcohol dependence

Answer 20

nausea and retching