Alcoholism and withdrawal Flashcards
Why does alcohol withdrawal occur?
Decreased inhibitory GABA and increased NMDA glutamate transmission
When do symptoms of alcohol withdrawal start?
6-12 hours after last drink
What are the first symptoms of alcohol withdrawal?
Tremor
Anxiety
Sweating
Tachycardia
When is the peak incidence of seizures after alcohol withdrawal?
36 hours
When does delirium tremens occur after alcohol withdrawal?
48-72 hours after last drink
What is delriuim tremens?
The rapid onset of confusion precipitated by alcohol withdrawal
What are the symptoms of delirium tremens?
Confusion and disorientation
Hallucinations
Sweating
Tachycardia
Hypertension
Seizures (rarely)
What is the first line management of delirium tremens?
Oral lorazepam
What is the second line management of delirium tremens?
Pareneteral lorazepam or haloperidol
What questionnaires can be used to assess alcoholism?
AUDIT questionnaire
SADQ questionnaire
What are the indications for inpatient withdrawal from alcohol?
Drinking > 30 units per day
Scoring over 30 on the SADQ questionnaire
High risk of alcohol withdrawal seizures
Concurrent withdrawal from benzodiazepines
Significant medical or psychiatric comorbidity
Patients under 18
Vulnerable patients
What is the medical management of alcoholism?
Assisted withdrawal with chlordiazepoxide
What other medical options are available for alcoholism?
Acamprosate
Naltrexone
What is acamprosate used for?
Acamprosate is used to help maintain abstinence from alcohol
What is the first line psychological management for alcoholism and withdrawal?
CBT
