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PHM701 - AUD/SUB ABUSE > ETOH Withdrawal > Flashcards

ETOH Withdrawal Flashcards

1
Q

When does minor withdrawal kick in?

A

5-10 hours after last drink

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2
Q

Symptoms of minor withdrawal

A

Autonomic hyperactivity: tremulousness, hyperhidrosis, tachycardia, HTN, GI upset, anxiety, insomnia, vivid dreams, diaphoresis, HA, palpitations, anorexia

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3
Q

When does minor withdrawal usually resolve?

A

24-48 hours

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4
Q

When does major withdrawal kick in?

A

12-72 hours after last drink

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5
Q

Symptoms of major withdrawal

A

Hallucinations, seizures

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6
Q

When does alcoholic hallucinosis occur?

A

Major withdrawal, usually 12-24 hours after last drink

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7
Q

When does alcoholic hallucinosis resolve?

A

24-48 hours

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8
Q

When do withdrawal seizures occur?

A

Major withdrawal, within 48 hours after last drink

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9
Q

What kind of seizures are withdrawal seizures?

A

Generalized tonic-clonic

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10
Q

When does delirium tremems occur?

A

48-96 hours- it’s a medical emergency!!!

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11
Q

Hallmarks of delirium tremens

A

Hallucinations
Disorientation
Tachycardia
HTN
Low grade fever
Agitation
Diaphoresis
Elevated cardiac indices, oxygen delivery, and oxygen consumption
Hyperventilation and respiratory alkalosis → reduced cerebral blood flow
Sensorium clouding

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12
Q

Mortality risk from delirium tremens is greater in what populations/disease states?

A

Elderly
Concomitant COPD (smokers)
Core body temperature >104º
Co-existing liver disease (cirrhosis)
Death is usually due to arrhythmia or secondary complications (pneumonia, liver failure)

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13
Q

True or false: ethanol withdrawal is clinically more serious than heroin withdrawal

A

True

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14
Q

Treatment of ethanol withdrawal (like an ER setting)

A

Thiamine 50-100mg QD- ADMINISTER FIRST!
D5W, 1/2 NS
Multivitamin
Standing orders for clonidine and a benzo

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15
Q

Symptom triggered regimens

A

Administer one of the following every hour when the CIWA-Ar ≥8-10:

Diazepam 10-20mg
Lorazepam 2-4mg

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16
Q

Alcohol withdrawal monitoring

A

Use the CIWA-Ar scoring system until score has been <8-10 for 24 hours q4-8h

Score <8-10: benzo may not be needed

Score 8-15: may need a benzo

Score ≥15: significant risk of major complications if left untreated

17
Q

Fixed schedule regimens

A

Diazepam 10mg q4h x4, then 5mg q6h x8

Lorazepam 2mg q4h x4, then 1mg q6h x8

Other benzos can be used but no short-acting benzos!

18
Q

Maintenance of sobriety

A

GROUP SUPPORT!!
Disulfiram, naltrexone, acamprosate

19
Q

Disulfiram MoA

A

Inhibits aldehyde dehydrogenase to build up acetaldehyde and punishes the patient for drinking cuz they feel like doo doo

20
Q

Disulfiram dosing

A

500mg PO QD x1-2wks, then 250mg PO QD

MDD is 500mg

21
Q

Drugs that can precipitate a disulfiram reaction

A

Nitroimidazoles (metronidazole)
First generation sulfonylureas (tolbutamide)
Cephalosporins that have an N-methylthio-tetrazole moiety (cefoperazone, cefotetan)
Griseofulvin

22
Q

CNS ADEs of disulfiram

A

drowsiness, HA, fatigue, polyneuritis, psychosis

23
Q

Dermatologic ADEs of disulfiram

A

rash, acneiform eruptions, allergic dermatitis

24
Q

GI ADEs of disulfiram

A

metallic/garlic-like taste

25
Q

Genitourinary ADE of disulfiram

A

impotence

26
Q

Hepatic ADEs of disulfiram

A

hepatitis, hepatitis failure

27
Q

Neuromuscular and skeletal ADEs of disulfiram

A

peripheral neuritis and neuropathy

28
Q

Ocular ADE of disulfiram

A

optic neuritis

29
Q

Use disulfiram with caution in these disease states:

A

DM, hepatic impairment, hypothyroidism, nephritis, seizures

30
Q

Naltrexone MoA

A

Acts as a competitive antagonist as opioid receptor sites (mu receptors especially)

31
Q

Naltrexone dosing

A

50mg PO QD or 380mg IM q4w

32
Q

Acamprosate MoA

A

Structurally similar to GABA; decreases the activity of the GABA-ergic system and decreases activity of glutamate within the CNS, including a decrease in activity at N-methyl D-aspartate (NMDA) receptors; may also affect CNS calcium channels

33
Q

Acamprosate dosing

A

666mg PO TID, 333mg PO TID in renal failure (<30ml/min)

34
Q

When should acamprosate be initiated?

A

ASAP following period of alcohol withdrawal when the patient has achieved abstinence

35
Q

When should you not use naltrexone?

A

If the patient is on opiate therapy for something else- using the opiate and naltrexone at the same time won’t make the opiate effective

PHM701 - AUD/SUB ABUSE (6 decks)

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