DELIRIUM TREMENS Flashcards

1
Q

DTs - Incidence and mortality

A

5% DTs (35% mortality if untreated)

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2
Q

Why to DTs occur?

A

ETOH is a depressant. When ETOH withdrawn, excitability increases and inhibition decreases = overactive CNS

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3
Q

Approach to treatment - DTs

A
IV fluids
vitamins? (B1 - thiamin, B9 - folic acid, B12 - cobalamin)
fix lytes? (mag, ca…)
Benzos (loading dose if acute)
Barbituates if refractory
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4
Q

Benzos vs Barbituates for DTs

A

1st Benzos - high TI (high doses before resp depression)

2nd Barbituates - narrow TI (more resp depression)

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5
Q

Midazolam (Versed), Oxazepam (Serax) and Triazolam (Halcion) - class?

A

Benzodiazepines (short acting <10 hrs)

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6
Q

Alprazolam (Xanax), Clonazepam (Klonopin), Lorazepam (Ativan) - class?

A

Benzodiazepines (intermittent 10-24 hrs)

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7
Q

Clorazepate (Tranxene), Chlordiazepoxide (Librium), Diazepam (Valium) - class?

A

Benzodiazepines (long acting >24 hrs)

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8
Q

Which long acting Benzo is good for acute DTs (because rapid) and self tapering (because long acting) but DDI may be of concern because inhibitor of 2C19 and 3A4?

A

Diazepam (Valium)

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9
Q

Treatment options if DTs are refractory to Benzos?

A

Barbituates (phenobarb or pentobarb)
Propofol (if intubated)
MgSO4 if hypoMg
alpha 2 receptor agonists (Clonidine, guanfesine, methydolpa b/c decrease sympathetic tone)
Beta Blocker (metoprolol or propranolol - want lipophilic to penetrate CNS)
CCB if hyper reactive airway disease (b/c no BB)

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10
Q

Phenobarbital and Pentobarbital - class?

A

Barbiturates

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