B6-041 CBCL Fractured Ribs Secondary to Alcohol Flashcards
what is considered at risk drinking for a male
> 4 drinks per occasion, >14/week
what is considered at risk drinking for a female
> 2 drinks per occasion, >7 per week
[…] grams of ethanol per standard drink
14
alcohol is primarily absorbed in the
duodenum
characteristic response to alcohol consumption
euphoria, impaired thoughts
alcohol increases […] in the mesocorticolimbic system
dopamine
alcohol activates the […] peptide system
opioid
alcohol facilitates […] transmission and blocks […] receptors
GABA
NMDA
increased dopamine and opioids cause
euphoria/pleasure
increased GABA signaling causes
anxiolysis, ataxia
increased GABA + decreased NMDA signaling causes
sedation, amnesia
decreased GABA and increased NMDA signaling causes
withdrawal
decreased opioid signaling causes
craving
withdrawal symptoms of tremor, anxiety, and insomnia can persist up to […]
two weeks
withdrawal symptom of hallucinations can occur for […]
one week
seizures occur [….] in the withdrawal period
early
alcohol use disorder is more prevalent in [males/females]
males
describe the CAGE questionnaire
have you ever felt you should Cut down?
have people Annoyed you by criticizing your drinking?
have you ever felt Guilty about your drinking?
Eye-opener (drink first thing in the morning)
[…] yes responses to the CAGE questionnaire indicate risk of AUD
two
ALT/AST will be elevated in […] withdrawal/early AUD and […] in chronic AUD
acute
lowered
what liver enzymes would you expect to see elevated with AUD (in general)
GGTP
AST
ALT
2:1 AST/ALT ratio indicates
individual in “at risk” drinking category
why is MCV elevated in AUD?
nutritional deficiency
what medication class is used for acute alcohol withdrawal syndrome?
benzodiazepines (taper)
what medication classes are used for cardiac management of alcohol withdrawal syndrome? [2]
beta blockers
alpha agonists
what medication classes are used for promotion of sobriety? [3]
disulfiram
naltrexone
acamprosate
5 As
Ask
Advise
Assess
Assist
Arrange
OARS of motivation interviewing
Open Ended
Affirming
Reflective
Summarizing
promotes noxious effects of etoh breakdown
disulfiram
blocks craving and rewards
opioid antagonists
reduces drinking; modulates GABA and NMDA activity [2]
acamprosate
anticonvulsants
Wernicke-Korsakoff is caused by lack of vitamin
B1
confusion, ataxia, abnormal eye movement seen in the context of AWS
Wernicke encephalopathy (acute)
confabulation, memory loss, inability to form new memories, hallucinations
Korsakoff syndrome (chronic)
caused by changes to the thalmus and hypothalmus
Wernicke-Korsakoff
2nd line option for AUD
disulfiram
1st line options for AUD [2]
naltrexone
acamprosate
inhibits ALDH preventing the conversion for acetaldehyde to acetate
disulfiram
patients must abstain for alcohol for at lead […] prior to dosing with disulfiram
12 hours
disulfiram is absolutely contraindicated in patients with
myocardial disease (causes cardio toxicity)
[…] is available the form of injectable IM suspension given every 4 weeks
naltrexone (vivitriol)
most concerning side effect of naltrexone
hepatotoxicity
**should be avoided in patients with active liver disease
[…] has the side effect of opioid overdose
naltrexone
not metabolized by the liver, and therefore safe for patients with liver disease
acamprosate
can be used in patients receiving opioid maintenance or pain therapy
acamprosate
[…] standard drinks per day is considered hazardous for men
4
[…] standard drinks per day is considered hazardous for women
2
[males/females] demonstrate the highest incidence of AUD
males
increased […] and […] activity is associated with euphoria and pleasure
dopamine and opioid
inhibitory neurotransmitter associated with anti-anxiety effects produced by alcohol
GABA
amino acid that binds to glutamate receptors involved in memory and learning
NMDA
how does alcohol induce “blackouts”?
acute decreased NMDA activity causes memory lapses
indirectly increased in the mesocorticolimbic system by alcohol
dopamine
during withdrawal NMDA activity is […]
increased
during withdrawal opioid activity is […]
decreased
opioid activity is acutely […] by alcohol use
increased
what causes craving?
decreased opioid activity during withdrawal
increased […] and […] activity is associated with euphoria and pleasure
dopamine and opioid
elevation of MCV and mild anemia are consistent with
folate deficiency
shown to reduce craving and relapse drinking and promotes sustained abstinence from chronic, severe drinking
acamprosate
psychological symptoms of AWS
anxiety
psychomotor agitiation
hallucinations
insomnia
physiological symptoms of AWS
tremor
autonomic hyperactivity (sweating, tachycardic)
nause
vomiting
seizures
first line treatment to decreases severity of AWS
benzodiazepines
why is disulfiram contraindicated in acute withdrawal?
it interferes with the metabolism of alcohol leading to accumulation of acetylaldehyde
**need to abstain for at least 12 hrs
supplemental thiamine can be administered to alleviate risk of
Wernicke’s encephalopathy
alcoholism is commonly associated with deficiency of […] vitamins
B
[…] deficiency can precipitates central and peripheral neurodegeneration
thiamine
associated with CNS symptoms such as confusion, visual and tactile hallucinations, and tremors but not peripheral and optical disturbances
delirium tremens
indirectly elevates dopamine levels in the nucleus accumbens
alcohol
[…] is associated with microencephaly and intellectual disability
fetal alcohol exposure
what percentage of death from external causes is due to alcohol?
45%
standard drinks are […] grams of pure alcohol
14
screening instrument designed to be developmentally appropriate for teens
CRAFFT
has high sensitivity in detecting both alcohol and substance abuse disorders in teens
CRAFFT
general alcohol screening questionnaire designed for adults
CAGE
used to screen for risk drinking in pregnancy
TWEAK
risk drinking in pregnancy is defined as
1 oz or more of alcohol per day
synthetic compound shown to reduce craving and encourage abstinence
acamprosate
used to mitigate AWS but has no effect on craving
diazepam
creates aversive reaction to alcohol but has no direct effect on craving
disulfiram
mu opioid receptor antagonist used to help reduce relapse in the treatment of AWS
naltrexone
what form is naltrexone (reVia) administered in?
pill once per day
what form is naltrexone (vivitrol) administered in?
IM injection 1x per month
taurine analog
acamprosate
what class of medications are first line for AWS?
sedative hypnotics
reduced […] in women concentrates alcohol within the blood relative of men the same size
body water
what neural system mediates the rewarding properties of abused drugs?
mesocorticolimbic pathway
toxic metabolite of alcohol
acetylaldehyde
reinforcing effects of alcohol occur through action on opiate receptors in the
ventral tegmental area