Chapter 7 pt 2 Flashcards
DTs occur in about what % of withdrawal and carries what mortality rate
5% of withdraws experience it
5% mortality rate
attempted suicide is associated with what
mental illness, young females, and alcohol use
what is confabulation
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
how are DTs treated
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)
what is used to screen for alcohol use disorder
AUDIT-C
what is at-risk or heavy drinking for men and women
men: over 4 drinks/day or over 14/week
women: over 3 drinks/day or 7/week
what labs suggest alcohol use
AST:ALT ratio ≥2:1 and elevated GGT
MCV is also useful
what are the 1st line mediations used to alcohol use disorder
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
what are the 2nd line mediations used to alcohol use disorder
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
what is seen in DTs
disorientation
agitation
visual and tactile hallucionations
increased respiratory rate, HR, and BP
what does and AUDIT-C score mean
0 means no alcohol use
4 or more in men is positive
3 or more in women is positive
what is the major long term complication of alcohol intake
WERNICKE’S ENCEPHALOPATHY
what is wernicke’s encephalopathy
caused by THIAMINE (B1) deficiency
acute and can be revered with thiamine therapy
ataxia (broad based)
confusion
ocular abnormalities (nystagmus, gaze palsys)
what happens if wernicke’s encephalopathy is left untreated
chronic amnestic syndrome
reversible in only 20%
impaired recent memory
anterograde amnesia
compensatory confabulation
cocaine overdose can cause death secondary to what
cardiac arrhythmias
MI
seizure
respiratory depression
how does cocaine work
blocks the re-uptake of dopamine, epinephrine, and norepinephrine from the synaptic cleft, causing a stimulant effect
what is seen in general intoxication with cocaine
euphoria heightened self-esteem nausea DILATED PUPILs chills sweating weight loss increased or decreased blood pressure tachycardia or bradycardia psychomotor agitation or depression
what is seen in dangerous intoxication with cocaine
respiratory depression seizures arrhythmias hyperthermia paranoia hallucinations (tactile) mimics fight or flight response
what is seen in deadly intoxication with cocaine
vasoconstrictive effect may result in MI, intracranial hemorrhage, or stroke
how is cocaine intoxication managed
reassurance of patient
benzos
symptomatic control (htn, arrhythmias)
if severe: antipsychotics
temp over 102 treat aggressively with ice bath, cooling blanket, and other measures
how is cocaine use disorder treated
physiological interventions are efficacious and MAINSTAY of treatment
no FDA approved pharmacotherapy
off label use of: disulfiram, modafinil, topiramate)
what is seen in cocaine withdrawal
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
how is cocaine withdrawal treated
supportive
severe psychiatric symptoms may need hospitalization
