CASC Stations 3 Flashcards
Legal questions to ask in alcohol use
- Have you actually had an accident or hurt yourself?
- Have you ever been convicted of drink driving?
- Have you ever been arrested because of your dinking?
What is detox
Detoxification is a treatment designed to control both the medical
and psychological complications that may occur temporarily after
a period of sustained alcohol misuse
What does detox involve
• It usually involves chlordiazepoxide at diminishing doses over 7 to
10 days with thiamine supplementation
• The doses of medication should be titrated against withdrawal
symptoms.
Indications for prescribing a reducing regime of CPZ
– Clinical evidence of alcohol withdrawal features
– History of alcohol dependence syndrome
– Consumption of alcohol is greater than 10 units per day over the
last 10 days
Indications of inpatient detox
– Symptoms of Wernicke-Korsakoff syndrome
– Past history of seizures or delirium during withdrawals
– Acute confusional presentation
– High risk of suicide
– History of poly drug misuse
– Co-morbid mental health illness, e.g., depression, psychosis
– Lack of stable support in the community, e.g., homelessness
– Severe malnutrition/severe physical health conditions.
SEs of disulfiram
Headache
Halitosis
Hepatotoxicity
Psychosis
How does disulfiram work
Irreversible inhibitor of acetaldehyde dehydrogenase
Acts as adjunct to therapy and prescribed once abstinence is achieved
How does acamprosate work
Enhances GABA transmission in the brain
Diminishes alcohol craving
SEs of acamprosate
Pruritis
GI upset
Rash
How does naltrexone work
Antagonizes effect of endorphins released by alcohol consumption
Reduces total alcohol consumed and number of drinking days
SEs of acamprosate
Anxiety Headache Fatigue Flu-likw sx GI sx Sleep disturbance
Describe supportive psychotherapy in alcohol use
Education
Advice and counselling on physical and psychosocial complications of alcohol use and problem solving approach to normal day-to-day difficulties
Describe CBT in alcohol use
Education and improvement of social and interpersonal skills
Relapse prevention including identifying situational or interpersonal triggers than result in excessive drinking, suggestions to change social milieu to get away from drinking and developing new interests and planning and rehearsing new methods of coping
Adopting behavioural approaches - self-monitoring, diary keeping
What does motivational interviewing involve
Feedback of personal risk or impairment
Emphasis on personal responsibility for change
Clear advice to change
Menu of alternative change options
Therapeutic empathy as a counselling style
Enhancement of patient self-efficacy or optimism
Duration of alcohol hallucinosis
Begins 12-24 hours after last drink
Resolves after 24-48 hours
What makes alcohol hallucinosis different from DT
Develops and resolves rapidly
Limited set of hallucinations - auditory and visual, usually accusatory or threatening voices
No other physical sx
What increases risk of alcohol hallucinosis
Long-term heavy alcohol abuse
Use of other illicit drug use
Questions to ask about needle usage in drug use
Where are they obtained?
Are they shared?
What sites are used for injection?
Risks to ask about in drug use
Sharing needles
Unsafe sex
Sex of drugs
Financing of drugs
Features of dependence syndrome in drug use
Compulsion
Tolerance
Withdrawal sx
Treatment and re-instatement
Timeframe of opioid withdrawal
Appear 6-24 hours after last dose
Last 5-7 days
Peak on 2nd or 3rd day
Pharmacological options for opioid use
Methadone
Buprenorphine
Lofexamine
Symptomatic treatment
What is methadone
Long acting, synthetic opioid
Long half-life of 24 hours
Prescribed as a liquid
What happens in rapid reduction regime of methadone
Reduce dose over 14-21 days using symptomatic drugs as adjuncts