Dr.Ott alcohol

Question 1

DSM-5 substance use disorder

Answer 1

two of the following Symptoms for at least 12 months

larger amounts that needed, cannot cut down use, great deal of time spent, craving, taking up time of day, use even with problems in social life, important activities are given up, continued use despite knowing its bad, tolerance, withdrawal

Question 2

Stages of withdrawal

Answer 2

Stage 1 - 6-8 hours
Stage 2 - 24 hours
Stage 3 - 1-2 days
Stage 4 - 3-5 days
- this stage is where we are concerned about delirium tremens but around 96 hours if patient hasn’t experienced it they usually are ok moving forward

Question 3

RISK FACTORS FOR DELIRIUM TREMENS - EXAM Q

Answer 3

prior history of DT
consuming the equivalent of 1 pint of wishkey per day for 10 of 14 days prior to admission

Question 4

Treating alcohol withdrawal
prophylaxis dosing

Answer 4

When a patient is at risk of DT or has had previous DT
Prophylaxis/ fixed dosing
- chlordiazepoxide 25mg TID x 2 days, BID x 2 days, daily x 2 days then D/C

Question 5

TREATING ALCOHOL WITHDRAWAL WITH CIWA SCALE

Answer 5

CIWA <8 - NONPHARMACOLOGIC TREATMENT (cold compress, fluids)
CIWA 8-15 - medicate (lorazepam, diazepam)
CIWA >15 - risk of complications if untreated

Question 6

Treatment consideration - EXAM Q

Answer 6

always give patient Thiamine

Wrenicke’s encephalopathy is a result of thiamine deficiency, give before destrose containing fluid

Question 7

Acamprostate (Campral)

Answer 7

Renal elimination, monitor renal function

suicidality warning, side effects include diarrhea, nausea, depression, anxiety

Question 8

Naltrexone

Answer 8

elevated LFTs is common so monitor
Warning for Inj site reaction

Question 9

Opioid withdrawal treatment

Answer 9

Acetaminophen for muscle aches
Hydroxyzine for agitation
Ondansetron for cramping
Loperamide for diarrhea
Clonidine for sweating

Question 10

Maintenance treatment of opioid use disorders

Answer 10

Bupenorphine is usually given in combo with naloxone - must be sublingual

methadone must be given in a licensed treatment program

Question 11

Methadone - EXAM Q

Answer 11

Used for maintenance treatment
Methadone should not be given with 3A4 inhibitor - also substrate of many other cyps -exam Q

QTc prolongation

Question 12

Naltrexone long acting injection

Answer 12

Good for patient that has opioid use disorder and alcohol use disorder