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Adult Years > Clinical Assessment and Management of Alcohol Use Disorder > Flashcards

Clinical Assessment and Management of Alcohol Use Disorder Flashcards

1
Q

What are the first 5 members of the alcohol family?

A
  • CH3OH (methanol) - ‘wood alcohol’
  • C2H5OH (ethanol) - ‘booze’
  • C3H7OH (propanol) - ‘rubbing alcohol’
  • C4H9OH (butanol)
  • C5H11OH (pentanol)
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2
Q

What are the factors which affect alcohol metabolism?

A
  • Site of absorption
  • Rate of absorption
  • Rate of metabolism
  • Alcohol dehydrogenase
  • Acetaldehyde dehydrogenase
  • Micosomal ethanol-oxidising system (MEOS)
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3
Q

What are the neurological effects of alcohol consumption?

A
  • Potentiates GABA
  • Affects glutamate and NMDA receptor system
  • 5HT (reduced function
  • Dopamine (pleasurable effect)
  • Noradrenaline
  • Opioid system
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4
Q

Describe the relationship between the severity of alcohol problems and the type of intervention needed.

A
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5
Q

What is a unit of alcohol?

A

One unit of alcohol is equivalent to 10mLs (0.01L) of pure alcohol

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6
Q

How do you calculate units of alcohol?

A
  • In order to work out how many units of alcohol are in the drink, simply multiply the ABV (alcohol by volume) of the drink by the volume of the glass, can or bottle in litres.
  • For a pub measure of 40% ABV spirit, 0.025L (25mLs) x 40 (%) = 1 unit.
  • For a can of 9% ABV super strength lager or cider, 0.44 litres (440mLs) x 9 (%) = 3.96 units.
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7
Q

What are the WHO categories of alcohol use disorders?

A
  • Hazardous - above recommended limits, but not yet experiencing harm.
  • Harmful - above recommended limits and experiencin physical or psychological harm from drinking.
  • Dependent - above the recommended limits and experiencing physical or psychological harm from drinking where a central characteristic is the strong, and sometimes overpowering desire to drink alcohol.
  • Binge drinking - originally episodic heavy drinking, but now heavy drinking in a single session i.e. twice the daily limit.
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8
Q

What are the physical signs and symptoms of alcohol dependence?

A
  • Recurrent intoxication, nausea, sweating, tachycardia, hypertension.
  • Dyspepsia, diarrhoea, bloating, haematemesis, jaundice.
  • Poor nutrition, poor immunity and personal neglect.
  • Anxiety, insomnia, chronic fatigue, anmesic episodes.
  • Paraesthesia, neuropathy, tremor, unsteady gait, memory loss, erectile dysfunction.
  • Seizures, hallucinations, delirium, tremens.
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9
Q

What are the other harms (aside from signs and symptoms) caused by alcohol dependence?

A
  • Mood swings, depression, anxiety, suicide
  • Accidents
  • Drink driving
  • Poor pregnancy outcomes
  • Loss of employment
  • Domestic violence
  • Crime:
    • 60% of homicides
    • 75% of stabbings
    • 70% of beatings
    • 50% of fights / domestic disturbances
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10
Q

Describe the social problems caused by heavy alcohol consumption.

A
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11
Q

What are the effects of 20-50mg % blood alcohol level?

A

Affects fine motor skills

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12
Q

What are the effects of 50-100mg % blood alcohol level?

A

Mood and behavioural changes

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13
Q

What are the effects of 100-150mg % blood alcohol level?

A

Ataxia and loss of self control

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14
Q

What are the effects of 300mg % blood alcohol level?

A

Can cause coma in novice drinker

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15
Q

What are the effects of 400mg % blood alcohol level?

A

Respiratory depression

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16
Q

What are the effects of 500mg % blood alcohol level?

A

Fatal

17
Q

Describe the assessment of someone who is ?dependent upon alcohol.

A
  • Alcohol consumption in units (how much?)
  • When, where, with whom, why, what happens afterward?
  • Established alcohol use disorder
  • Treat complications
  • Don’t forget to ask about driving
18
Q

What are the screening tools which can be used to identify alcohol dependence?

A
  • CAGE (see lecture for more detail)
  • AUDIT (see lecture for more detail)
  • Bloods
    • MCV
    • GGT
    • ALT
  • FAST
19
Q

What are the CVS and respiratory system complications of alcohol dependence?

A
  • Arrhythmias: AF & SVT
  • Hypertension
  • CVA
  • CHD
  • Cardiomyopathy
  • Strep pneumoniae, TB, klebsiella infection
  • CA lung
20
Q

What are the GI and hepatic complications of alcohol dependence?

A
  • Gastritis
  • Fatty liver
  • Alcoholic hepatitis
  • Alcoholic liver cirrhosis
  • Acute pancreatitis
  • Chronic pancreatitis
  • Mallory Weiss syndrome
21
Q

What is Mallory Weiss syndrome?

A
  • One of the withdrawl features is vomiting.
  • Mallory Weiss is when you develop a tear resultant from the vomiting and bleeding associated.
  • Patients can also have varices which can lead to serious GI bleeds. The reason they are bleeding is also becuase their platelet count is very low so they are not clotting.
22
Q

What are the CNS complications of alcohol dependence?

A
  • Head injuries and subdural haemorrhages
  • Hepatic encephalopathy
  • Peripheral neuropathy
  • Cerebellar degeneration
  • Central pontine myelinosis
    • Affects white matter in brain stem, leading to pseudobulbar palsy, quadriplegia and resulting in death.
  • Marchiafava-Bignami disease
    • Demyelination of corpus callosum
23
Q

What are the GU complications of alcohol dependence?

A
  • Impotence
  • Renal failure
  • Infertility
  • STI
24
Q

What are the subtypes of alcohol withdrawl syndrome (AWS)?

A
  • Uncomplicated alcohol withdrawl syndrome (AWS)
  • AWS with seizures
  • Delirium tremens
25
Q

Describe uncomplicated AWS.

A
  • Occurs 4-12 hours after the last alcoholic drink.
  • Coarse tremor, sweating, insomnia, nausea and vomiting.
  • Increased craving.
  • Increase in severity in rought proportion to habitual consumption.
  • Peak at 48 hours, lasts 2-5 days.
26
Q

Describe AWS with seizures.

A
  • 5-15% of cases of withdrawls are complicated by grand mal seizures.
  • If seizures occur only in withdrawl they do not signify the development of idiopathic epilepsy.
  • Predisposing factors:
    • Previous hx of withdrawal seizures
    • Idiopathic epilepsy
    • Head injury
    • Hypokalaemia and hypomagnesaemia
27
Q

Describe delirium tremens.

A
  • Acute confusional state. Medical emergency.
  • Occurs in 5% of withdrawls.
  • Onset 1-7 days after last drink.
  • Peaks at 48 hours.
  • Risk increased by:
    • Severe dependence
    • Co-morbid infection
    • Pre-existing liver damage
  • In addition to AWS symptoms:
    • Marked psychomotor agitation
    • Hallucinations
      • Visual
      • Auditory
      • Tactile
      • Lilliputian
    • Persecutory delusions
    • Febrile
  • If you do not intervene, mortality rate is high.
  • Mostly, these patients do not have the capacity to make decisions in the best interest of their health. You must work under the mental health act.
28
Q

Describe the pathology of Wernicke-Korsakoff syndrome.

A
  • Haemorrhages and secondary gliosis in periventricular and periaqueductal grey matter involving the mamillary bodies, hypothalamus, mesodorsal thalamic nucleus, colliculi and tegmentum of the midbrain.
29
Q

What are the treatments for Wernicke-Korsakoff syndrome?

A
  • High potency parenteral vitamins
  • Prophylaxis in detox
30
Q

Describe Wernicke-Korsakoff syndrome.

A
  • Acute and chronic phases of a single disease process.
  • Neuronal degeneration secondary to thiamine deficiency.
  • Wernicke encephalopathy tetrad:
    • Acute confusional state
    • Ophthalmoplegia
    • Nystagmus
    • Ataxic gait
31
Q

What are the pharmacological treatments for alcohol use disorders?

A
  • Medically assisted withdrawal from alcohol ‘DETOX’
  • Naltrexone
  • Baclofen
  • Medication for relapse prevention
    • Acamprosate
    • Disulfiram
32
Q

What are the psychosocial treatments for alcohol disorders?

A
  • AA / Mutual aid
  • CBT
  • MET
33
Q

What are the pharmacological methods of relapse prevention in alcohol use disorder?

A
  • Disulfiram (antabuse)
    • Causes irreversible inhibition of acetaldehyde dehydrogenase (ALDH) which converts alcohol to CO2 and H2O.
  • Build up of acetaldehyde causes:
    • Flushing
    • Headache
    • Nausea
    • Vomiting
34
Q

What are the effects of acamprosate?

A
  • Anti-craving drugs
  • Enhances GABA transmission in the brain. Has been found to reduce alcohol consumption in animal models of alcohol addiction and patients taking it report diminished alcohol craving.
  • NMDA antagonist.
  • RCT cohort showed people on acamprosate increased staying abstained and doubling of time to first relapse.
35
Q

What is the dosage of acamprosate?

What are the side effects?

A
  • Dose
    • ​Depends on weight, once abstinence achieved usually 666mg tds.
  • Side effects
    • ​GI upset, pruritis, rash, altered libido.
  • No role in controlled drinking
  • No aversive action
  • No addictive potential
36
Q

What is the mechanism of action of Naltrexone?

Describe the effect of Naltrexone on the reward pathway.

A
  • Opioid antagonist
  • Modulating euphoric effect
  • Nalmefene

Adult Years (27 decks)

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