drugs in alcohol dependence Flashcards
2 long acting BZDPNs
diazepam
chlordiazepoxide
what are long acting BZDPNs used for
to attenuate alcohol withdrawal symptoms
this AED can be used as an alternative treatment to LA BZDPN for acute alcohol withdrawal
carbamazepine (unlicensed)
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
chlomethiazole
why must chlomethiazole not be given to patients who are liable to continue drinking
Alcohol combined with clomethiazole, particularly in patients with cirrhosis, can lead to fatal respiratory depression even with short-term use.
1st line and 2nd line for delirium tremens
oral lorazepam
if persists or oral treatment declined, IV lorazepam unlicensed or haloperidol unlicensed
what is acamprosate used for
maintenance of abstinence in alcohol dependent patients
dose of acamprosate depends on whether your weight is …
under 60kg, or 60kg and above
doses for acamprosate for maintenance of abstinence in alcohol dependent patients
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
naltrexone MOA
opioid receptor antagonist
who can initiate naltrexone
specialist
what is naltrexone indicated for
adjunct to prevent relapse in formerly alcohol dependent pt
naltrexone is contraindicated in..
patients currently dependent on opioids
naltrexone monitoring
LFTs before and during
indication for disulfuram
adjunct in treatment of alcohol dependence under expert supervision
important counselling info for disulfuram
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
what are some symptoms of alcohol-disulfuram reaction
can be severe and life threatening
nausea, flushing, palpitations, arrhythmias, hypotension, resp depression, coma
which of the following is NOT a sign of alcohol-disulfuram reaction?
- nausea
- palpitations
- arrhtyhmias
- hypertension
- coma
- flushing
- respiratory depression
HYPERTENSION. it is hypotension that occurs
disulfuram - pt and carer advice, hepatotoxicity
patients should discontinue treatment and seek immediate medical attention if they feel unwell or symptoms such as fever or jaundice develop.
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
disulfuram, hepatotoxicity
disfuluram contraindicated in
- cardiac failure
- coronary artery disease
- history of cerebrovascular accident
- hypertension
- psychosis
- severe personality disorder
- suicide risk
disulfuram and metronidazole interact severely. what is it?
- increased risk of disulfuram-alcohol reaction
- increased risk of acute psychoses
- increased risk of blood disorder
increase risk of psychoses when given together
disulfuram interaction with vit k antagonists
acenocoumarol, phenindione, warfarin
disulfuram increases the AC effect of these drugs - monitor and adjust dose
these two AED interact with disulfuram. what are they and what is the interaction
phenytoin and fosphenytoin
disulfuram increases the conc of these drugs, monitor and adjust dose
interaction between this ADHD med and disulfuram
Methylphenidate has been reported to cause psychotic symptoms when given with Disulfiram.
when is nalmefene indicated
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
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
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
nalfemene is contraindicated in (2)
Recent history of acute alcohol withdrawal syndrome; recent or current opioid use
nalfeme should only be prescribed for patients who continue to have a high drinking risk level ….. weeks after initial assessment before initiating treatment
2 weeks
nalfemene will decrease the efficacy of which drug class
it is an opioid receptor antagonist - reduced efficacy of opioids
avoid or only use in emergency
if someone is suspected of having Wernicks encephalopathy, give them
parnteral thiamine followed by oral thiamine
MHRA safety advice regarding thiamine parenterally
anaphylaxis rarely occur during, or shortly after
ensure facilities for treating anaphylaxis including resuscitation facilities are available when parenteral thiamine is administered
if you are giving this drug parenterally, ensure there are facilities for treating anaphylaxis including resuscitation facilities
IV thiamine
