Alcoholism

Question 1

Name 2 initial assessment screens for alcoholism

Answer 1

CAGE

AUDIT (Alcohol use disorders identification test

Question 2

What percentage of patients who are alcohol dependent will develop acute withdrawal symptoms?

Answer 2

6%

Ie DT, Wernicke - Korsakoff syndrome, seizures etc

Question 3

Name some biological dependence symptoms

Answer 3

Withdrawal symptoms - shakes, sweating etc if they dont drink

Tolerance to alcohol

Question 4

Name some psychological dependence symptoms

Answer 4

Overwhelming desire for alcohol
Out of control drinking
Reduced interest in other activities
Continuing to drink even after it has caused harm

Question 5

Management of harmful/mildly dependent drinking

Answer 5

Give advice on the dangers and info on local help
Identify precipitating factors and agree targets to reduce drinking
CBT etc may be useful

Question 6

Management of alcohol dependence syndrome - detoxification

When is inpatient care required?

Answer 6

If there is

1) a risk off suicide
2) no social support
3) a history of severe withdrawal reactions

Question 7

Management of alcohol dependence syndrome- detoxification

What does community support consist of?

Answer 7

Daily supervision for withdrawal symptoms (DT, GCS down Etc)
Vitamins
Benzodiazepines
MDT support - GP, community alcohol team etc

Question 8

Name some potential problems that can arise from acute alcohol withdrawal

Answer 8

Delirium tremens 
Wernicke-Korsakoff syndrome 
Seizures 
Depression 
Polysubstance abuse 
Electrolyte disturbance 
Liver disease complications

Question 9

The withdrawal process
When do symptoms appear?
When do they peak?
When do they mostly resolve by?

Answer 9

Appear after 8 hours
Peak after 2 days
Resolve after 4-5 days

Question 10

The withdrawal process
Mild symptoms of alcohol withdrawal can occur 6-12 hours after a drop in blood alcohol levels.
Name some of these symptoms

Answer 10

Insomnia 
Fatigue
Tremor
Anxiety, restlessness
Nausea
Headache 
Sweating, palpitations
Anorexia
Low mood 
Alcohol craving

Question 11

Alcoholic hallucinations can occur how many hours after a drop in blood alcohol levels?

Answer 11

12-24 hours

Question 12

Withdrawal seizures occur when after a drop in blood alcohol levels, and are what type of seizures?

Answer 12

24-48 hours

Generalised tonic clinic seizures

Question 13

Delirium tremens can occur after how many hours, post drop in blood alcohol levels?

Answer 13

48-72hours

Question 14

When would medications for acute alcohol withdrawal be indicated?

Answer 14

If a man had been drinking 15+units/day or female 10+/day

If symptoms were present

Question 15

What medications are indicated for acute alcohol withdrawal?

Answer 15

Chlordiazepoxide (a benzodiazepine)

Thiamine

Question 16

What is acamprosate

Answer 16

Used after a detox, it blocks GABA and reduces glutamate (via NMDA)
It reduces cravings and may be neuroprotective

Question 17

What is naltrexone?

Answer 17

Competitive antagonist of opioid receptors
Reduces the pleasure gained from drinking alcohol
Reduced relapse rate and amount of alcohol drunk

Question 18

What is nalmefene

Answer 18

Opioid antagonist

Helps to reduce alcohol consumption in those who dont need immediate detox and dont have withdrawal symptoms

Question 19

What is disulfiram

Answer 19

Acetaldehyde dehydrogenase inhibitor
Causes a build up of acetaldehyde if alcohol is drunk = instant bad hangover
Used as part of alcohol abstinence program

Question 20

Complications of alcohol drinking

Answer 20

Liver - fatty liver - cirrhosis - die
Heart - dilated cardiomyopathy, arrhythmias
Gut - peptic ulcers, pancreatitis, D&V
CNS - bad memory, fits, Wernicke encephalopathy
Cancers - GI, breast