CIWA Flashcards
What drugs can people get for alcohol withdrawal?
Benzodiazepines
Barbiturates
Gabapentin
Adjuvant drugs
what are adjuvant drugs
anticonvulsants, neuroleptic agents, sedative-hypnotics, antipsychotics, alpha agonists
What is the MOA for benzos?
- increases GABA transmission and reduces CNS excitability, which decreases the risk for seizures and prevents the progression to DT
What is the medications considered first line therapy for treatment of alcohol withdrawal?
- Benzos
- they halt the progression to delirium tremens
- Lam and Pam
Which benzos are rapid acting?
- chlordiazepoxide
- diazepam (can be given to pts every 5-10min)
What should you be aware of in pts conditions when giving chlordiazepoxide and diazepam?
These meds undergo hepatic metabolism.
The active metabolite may accumulate in the liver in pts with hepatic disease if the dose of the drug is not adjusted
Which benzos are more appropriate for pts with liver dysfunction?
Alprzolam and lorazepam
Which medications should you avoid in pts with alcohol withdrawal?
- Avoid phenytoin
- use benzos over antipsychotics
- avoid ETOH or opioids (abuse and addiction potential, psychomotor slowing, increased risk of falls, cog impairment)
What additional drugs can be given in pts where benzos are contraindicated?
Phenobarbital
propofol
ketamine
dexmedetomidine
How frequently are diazepam and lorazepam given?
Route and dosage preferred?
Diazepam given every 5-10 min
Lorazepam given every 15-20 min
Diazepam 10mg
Lorazepam 4mg
IV is preferred, but oral can be given in non-emergent situations
What GABA (gamma-aminobutyric acid) have with alcohol withdrawal?
-reduce the production of GABA in the brain and throughout the body. When people do not have enough GABA to regulate their emotions, they often experience more mental health issues such as stress, depression, and paranoia
Chronic alcohol leads to downregulation of GABA receptors
During alcohol withdrawal, an acute reduction in alcohol use leads to decreased neurotransmission in GABA pathways and increased neurotransmission in NMDA pathways
What happens as a result of this decreased neurotransmission of GABA pathways and increased neurotransmission in NMDA pathways?
The resulting neuronal hyperexcitability lowers the threshold for seizures
Upregulation of noradrenergic and dopaminergic pathways induces the autonomic hyperactivity and hallucinations associated w/ alcohol withdrawal
What symptoms develop within several hours to a few days after cessation of or reduction in alcohol use
Autonomic hyperactivity (sweating or pulse rate greater than 100)
Increased hand tremor
Insomnia
N/V
transient visual, tactile hallucinations or illusions
psychomotor agitation
anxiety
grand mal seizures
*These symptoms are not d/t general medical conditions and are not better accounted for by another mental disorder, including intoxication or withdrawal from another substance.
What is delirium Tremens?
Alcohol withdrawal delirium; characterized by confusion and an alteration in consciousness. Often accompanied by severe autonomic changes and hallucinations.
usually manifested within 2-5 days after the last drink
What s/s might a pt with delirium tremens have?
fluctuating LOC
attention and cog deficits
hallucinations
confusion
HTN
If delirium tremens is poorly managed, what should the nurse be aware of?
CV or resp collapse
arrhythmia
dehydration
electrolyte imbalance
MODs
*no treatment=high mortality rate
What is the rationale to use various drugs in alcohol withdrawal?
- various drugs can manage severe withdrawal or delirium tremens
- also decreases the Length of stay and decreases admission and transfer to the ICU
What are symptoms of alcohol withdrawal 24hrs after the last intake of alcohol? Are they mild?
Mild
tremor
Anxiety
diaphoresis
tachycardia
sleep disturbances
What are progressive symptoms of alcohol withdrawal 12-24hrs after last intake?
fever
confusion
clouding of sensorium
hallucinations
seizures
*result of neuronal excitation
What are more severe and feared complications of alcohol withdrawal and about how many days is it manifested after the last drink?
2-5 days after last drink
delirium tremens - fluctuating LOC - attention and cog deficits - hallucinations - confusion HTN
CV and resp collapse, arrhythmias, dehydration, electrolyte imbalance, MODs
What is the key to managing alcohol withdrawal?
Early identification
obtain an ETOH hx!!
Interventions and management:
- measurement of BG and appropriate administration of dextrose as well as naloxone can be life-saving and produce immediate changes in mentation thus revealing the etiology of the presentation
- fluid resuscitation in pts w/ alcohol use disoreder requires close monitoring of serum sodium to avoid beer poromania (the rapid provision of intravenous solute prompts sudden diuresis and hyponatremia)
- thiamine (vit B1) should be administered empirically for prevention of wernickes encephalopathy and korsakoffs psychosis
What NMDA have with alcohol withdrawal?
- the upregulation of NMDA receptors
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