Drugs and Alcohol Flashcards
When is the peak incidence of seizures in alcohol withdrawal?
At 36 hours post-withdrawal
When is the peak incidence of delirium tremens in alcohol withdrawal?
At 48-72 hrs (day 2-3) post withdrawal
What is the max number of recommended units of alcohol per week nationally?
Max 14 units of alcohol per week for BOTH men and women
Which drugs of abuse stay in a urine drug screen for a long time after usage has stopped?
Cannabis - remains in the urine for 7-30 days
Benzos - remain in the urine for 3-6 weeks
How should a structured benzodiazepine withdrawal programme be planned?
Should switch to diazepam from which long-term benzo they’re on as diazepam has a longer half life so is less likely to cause withdrawal symptoms.
You then reduce the dose by about 1/10th to one-quarter every 2 weeks with an aim to totally stop
What are the contraindications for the use of Bupropion for smoking cessation support (reduces cravings for nicotine and reduces withdrawal symptoms)?
History of eating disorder, bipolar disorder, seizures or pregnancy
what are the contraindications for the use of disulfiram for alcohol abstinence?
(Disulfiram causes a reaction when you drink alcohol on it - flushing, palpitations, tachycardia)
Hx of coronary artery disease, congestive cardiac failure, history of CVA/stroke, hypertension, psychosis and suicide risk
What are the contraindications for the use of acomprosate to prevent alcohol relapse?
(Acomprosate helps prevent relapse by reducing alcohol cravings)
Pregnancy
Severe hepatic or renal impairment
What screening tool is recommended by NICE to screen for alcohol dependence and what score would suggest dependence / merit onward referral to alcohol specialist service?
AUDIT - 10 part WHO approved screening tool for alcohol dependence
Score < 8 low risk
Score > 8 may be harmful drinking, consider brief intervention to try and reduce alcohol harm
Score > 20 suggests alcohol dependence, consider referral to alcohol specialist team
What screening tools can be used to assess the severity of dependence in alcohol dependence according to NICE?
SADQ or LDQ score
What is the mechanism of action for Naltrexone and which group of patients is it important NOT to take Naltrexone?
Naltrexone works to block the endorphin release from alcohol (ie making drinking less enjoyable) and can be used to prevent relapse after a detox programme OR to reduce drinking in harmful drinkers
It is important that you don’t give Naltrexone to those on regular opioids (e.g for pain relief) as it will induce an opioid withdrawal presentation in them!!)
Usually given for at least 6 months but can be given longer if good response.
Sometimes given together with Acamprosate but NOT together with Disulfiram due to concerns re liver toxicity
If a patient taking Naltrexone or Acamprosate continues drinking, after how many weeks of this should the medications be stopped?
After 4-6 weeks of ongoing drinking on Acamprosate or Naltrexone, stop these medications
How does Disulfiram work in the prevention of relapse in alcohol dependence?
Disulfiram provokes an unpleasant reaction if you drink while taking it - including flushing, nausea, palpitations
What is the minimum time that you must wait after a person’s last alcoholic drink before starting Disulfiram?
Must wait at least 24 hours after their last drink before starting Disulfiram
Which patients should be offered an assisted alcohol withdrawal programme (either in the community or inpatient)?
Those who regularly drink > 15 units per day OR those with an AUDIT score 20+
Which patients should be admitted for inpatient detoxes?
- Drink > 30 units per day
- Score > 30 on SADQ
- History of epilepsy, withdrawal-associated tremors or previous delirium tremens
- Those with a concurrent alcohol and benzodiazepine addiction
- Those that drink between 15-30 units per day but have a significant psychiatric or physical comorbidity a significant learning disability or cognitive impairment
