drugs in alcohol dependence

Question 1

2 long acting BZDPNs

Answer 1

diazepam
chlordiazepoxide

Question 2

what are long acting BZDPNs used for

Answer 2

to attenuate alcohol withdrawal symptoms

Question 3

this AED can be used as an alternative treatment to LA BZDPN for acute alcohol withdrawal

Answer 3

carbamazepine (unlicensed)

Question 4

this drug can be used as an alternative treatment to LA-BZDPN or carbamazepine for acute alcohol withdrawal, but only in an in patient setting and only if the patient is not liable to continue drinking

Answer 4

chlomethiazole

Question 5

why must chlomethiazole not be given to patients who are liable to continue drinking

Answer 5

Alcohol combined with clomethiazole, particularly in patients with cirrhosis, can lead to fatal respiratory depression even with short-term use.

Question 6

1st line and 2nd line for delirium tremens

Answer 6

oral lorazepam

if persists or oral treatment declined, IV lorazepam unlicensed or haloperidol unlicensed

Question 7

what is acamprosate used for

Answer 7

maintenance of abstinence in alcohol dependent patients

Question 8

dose of acamprosate depends on whether your weight is …

Answer 8

under 60kg, or 60kg and above

Question 9

doses for acamprosate for maintenance of abstinence in alcohol dependent patients

Answer 9

18-65, body weight up to 60kg: 666mg OD at breakfast, 333mg BD at midday and at night
18-65, 60kg and above: 666mg TDS

Question 10

naltrexone MOA

Answer 10

opioid receptor antagonist

Question 11

who can initiate naltrexone

Answer 11

specialist

Question 12

what is naltrexone indicated for

Answer 12

adjunct to prevent relapse in formerly alcohol dependent pt

Question 13

naltrexone is contraindicated in..

Answer 13

patients currently dependent on opioids

Question 14

naltrexone monitoring

Answer 14

LFTs before and during

Question 15

indication for disulfuram

Answer 15

adjunct in treatment of alcohol dependence under expert supervision

Question 16

important counselling info for disulfuram

Answer 16

disulfuram-alcohol reaction
may occur even following exposure to small amounts of alcohol e.g. perfume, aerosol sprays, low alcohol and non alcohol beers and wines
symptoms can be severe and life threatening

Question 17

what are some symptoms of alcohol-disulfuram reaction

Answer 17

can be severe and life threatening
nausea, flushing, palpitations, arrhythmias, hypotension, resp depression, coma

Question 18

which of the following is NOT a sign of alcohol-disulfuram reaction?
- nausea
- palpitations
- arrhtyhmias
- hypertension
- coma
- flushing
- respiratory depression

Answer 18

HYPERTENSION. it is hypotension that occurs

Question 19

disulfuram - pt and carer advice, hepatotoxicity

Answer 19

patients should discontinue treatment and seek immediate medical attention if they feel unwell or symptoms such as fever or jaundice develop.

Question 20

A patient comes in they look very yellow and say they feel unwell and that their stools are clay coloured. you look at their PMR and see they are taking disulfuram, lansoprazole and sertraline. which one is likely to have caused this and what is it

Answer 20

disulfuram, hepatotoxicity

Question 21

disfuluram contraindicated in

Answer 21

• cardiac failure
• coronary artery disease
• history of cerebrovascular accident
• hypertension
• psychosis
• severe personality disorder
• suicide risk

Question 22

disulfuram and metronidazole interact severely. what is it?
- increased risk of disulfuram-alcohol reaction
- increased risk of acute psychoses
- increased risk of blood disorder

Answer 22

increase risk of psychoses when given together

Question 23

disulfuram interaction with vit k antagonists

Answer 23

acenocoumarol, phenindione, warfarin
disulfuram increases the AC effect of these drugs - monitor and adjust dose

Question 24

these two AED interact with disulfuram. what are they and what is the interaction

Answer 24

phenytoin and fosphenytoin
disulfuram increases the conc of these drugs, monitor and adjust dose

Question 25

interaction between this ADHD med and disulfuram

Answer 25

Methylphenidate has been reported to cause psychotic symptoms when given with Disulfiram.

Question 26

when is nalmefene indicated

Answer 26

Reduction of alcohol consumption in patients with alcohol dependence who have a high drinking risk level without physical withdrawal symptoms, and who do not require immediate detoxification

Question 27

when should the dose for nalmefene be taken for reduction of alcohol consumption in patients with alcohol dependence who have a high drinking risk level without physical withdrawal symptoms, and who do not require immediate detoxification

Answer 27

18mg daily if requires
taken on each day there is a risk of drinking alcohol
preferable 1-2h before anticipated time drinking
if a dose has not been taken before drinking alcohol, take one ASAP
max 18mg per day

Question 28

nalfemene is contraindicated in (2)

Answer 28

Recent history of acute alcohol withdrawal syndrome; recent or current opioid use

Question 29

nalfeme should only be prescribed for patients who continue to have a high drinking risk level ….. weeks after initial assessment before initiating treatment

Answer 29

2 weeks

Question 30

nalfemene will decrease the efficacy of which drug class

Answer 30

it is an opioid receptor antagonist - reduced efficacy of opioids
avoid or only use in emergency

Question 31

if someone is suspected of having Wernicks encephalopathy, give them

Answer 31

parnteral thiamine followed by oral thiamine

Question 32

MHRA safety advice regarding thiamine parenterally

Answer 32

anaphylaxis rarely occur during, or shortly after
ensure facilities for treating anaphylaxis including resuscitation facilities are available when parenteral thiamine is administered

Question 33

if you are giving this drug parenterally, ensure there are facilities for treating anaphylaxis including resuscitation facilities

Answer 33

IV thiamine