Chapter 7 pt 2

Question 1

DTs occur in about what % of withdrawal and carries what mortality rate

Answer 1

5% of withdraws experience it

5% mortality rate

Question 2

attempted suicide is associated with what

Answer 2

mental illness, young females, and alcohol use

Question 3

what is confabulation

Answer 3

inventing sorties of events that never occurred

often associated with KORSAKOFF’S PSYCHOSIS or alcohol induced neurocognative disorder

patients unaware they are making things up

Question 4

how are DTs treated

Answer 4

benzos (chlordiazepoxide, diazepam, lorazepam)
antipsychotics (careful of lowering seizure threshold)
thaimine, folic acid, and multivitamins
electrolyte and fluids need to be managed
CIWA scale monitoring
check for hepatic failure (ascites, jaundice, caput medusa, coagulopathy)

Question 5

what is used to screen for alcohol use disorder

Answer 5

AUDIT-C

Question 6

what is at-risk or heavy drinking for men and women

Answer 6

men: over 4 drinks/day or over 14/week
women: over 3 drinks/day or 7/week

Question 7

what labs suggest alcohol use

Answer 7

AST:ALT ratio ≥2:1 and elevated GGT

MCV is also useful

Question 8

what are the 1st line mediations used to alcohol use disorder

Answer 8

naltrexone (revia, Vivitrol (IM))-opioid receptor blocker: reduces cravings

acamprostate (cameral): modulates GABA transmission

• started post detox for relapse prevention
• contraindicated in severe renal disease
• can be used in pt w/ liver disease

Question 9

what are the 2nd line mediations used to alcohol use disorder

Answer 9

disulfiram (antabuse): blocks aldehyde dehydrogenase in liver and causes adverse reaction to alcohol

• contraindicated in severe cardiac disease, pregnancy and psychosis
• monitor liver function

topiramate (topimax): potentiates GABA and inhibits glutamate receptors
-reduces cravings for alcohol and decreases alcohol use

Question 10

what is seen in DTs

Answer 10

disorientation
agitation
visual and tactile hallucionations
increased respiratory rate, HR, and BP

Question 11

what does and AUDIT-C score mean

Answer 11

0 means no alcohol use
4 or more in men is positive
3 or more in women is positive

Question 12

what is the major long term complication of alcohol intake

Answer 12

WERNICKE’S ENCEPHALOPATHY

Question 13

what is wernicke’s encephalopathy

Answer 13

caused by THIAMINE (B1) deficiency
acute and can be revered with thiamine therapy

ataxia (broad based)
confusion
ocular abnormalities (nystagmus, gaze palsys)

Question 14

what happens if wernicke’s encephalopathy is left untreated

Answer 14

chronic amnestic syndrome
reversible in only 20%

impaired recent memory
anterograde amnesia
compensatory confabulation

Question 15

cocaine overdose can cause death secondary to what

Answer 15

cardiac arrhythmias
MI
seizure
respiratory depression

Question 16

how does cocaine work

Answer 16

blocks the re-uptake of dopamine, epinephrine, and norepinephrine from the synaptic cleft, causing a stimulant effect

Question 17

what is seen in general intoxication with cocaine

Answer 17

euphoria
heightened self-esteem
nausea
DILATED PUPILs
chills 
sweating
weight loss
increased or decreased blood pressure
tachycardia or bradycardia
psychomotor agitation or depression

Question 18

what is seen in dangerous intoxication with cocaine

Answer 18

respiratory depression
seizures
arrhythmias
hyperthermia 
paranoia
hallucinations (tactile)
mimics fight or flight response

Question 19

what is seen in deadly intoxication with cocaine

Answer 19

vasoconstrictive effect may result in MI, intracranial hemorrhage, or stroke

Question 20

how is cocaine intoxication managed

Answer 20

reassurance of patient
benzos
symptomatic control (htn, arrhythmias)
if severe: antipsychotics

temp over 102 treat aggressively with ice bath, cooling blanket, and other measures

Question 21

how is cocaine use disorder treated

Answer 21

physiological interventions are efficacious and MAINSTAY of treatment
no FDA approved pharmacotherapy
off label use of: disulfiram, modafinil, topiramate)

Question 22

what is seen in cocaine withdrawal

Answer 22

post-intoxication depression (crash): malaise, fatigue, hypersomnolence, depression, anhedonia, hunger, constricted pupils, vivid dreams, psychomotor agitation or retardation

with mild to moderate use symptoms resolve within 72 hours
heavy chronic use may last for 1-2 weeks

Question 23

how is cocaine withdrawal treated

Answer 23

supportive

severe psychiatric symptoms may need hospitalization