NS: Alcohol dependence

Question 1

A long-acting benzodiazepine, such as what?, is recommended to attentuate alcohol withdrawal symptoms.

Answer 1

Chlordiazepoxide hydrochloride or diazepam.

Question 2

Dose reduction to zero of long-acting benzos in treating alcohol withdrawal symptoms usually takes place over what lenght of time?

Answer 2

7-10 days in primary care

Question 3

What drug typically used for partial seizure or trigeminal neuralgia treatment can be used as an alternative ti a long-acting benzodiazepin in treating alcohol withdrawl symptoms?

What type of use is this?

Answer 3

Carbmazepine

Unlicensed indication use so Off-label.

Question 4

What drug can be used an alternative to a benzodiazepine or carbamazepine in treating alcohol withdrawal symptoms? When can this be used?

Answer 4

Clomethiazole, in an inpatient setting and not if the patient is liable to continue drinking alcohol as it can lead to fatal respiratory depression even with short-term use if mized with alcohol.

Question 5

If alcohol withdrawal seizures occur, what should be prescribed for the patient to reduce the likelihood of further seizures?

Answer 5

A fast acting benzo such as lorazepam (unlicensed use)

Question 6

What are the characteristic symptoms of delirium tremens?

Answer 6

Agitation
Confusion
Paranoia
Visual and auditory hallucinations.

Question 7

What is the first-line treatment of delirium tremens?

Answer 7

Oral lorazepam.

Question 8

If first-line therapy of delirium tremens with oral lorazepam is declined or does not work, what can be given instead? (2)

Answer 8

Parenteral lorazepam or haloperidol as adjunctive therapy.

Question 9

What drugs, in combination with a psychological intervention are recommended for relapse prevention in patients with moderate and severe alcohol dependence?

Answer 9

Acamprosate calcium or oral naltrexone hydrochloride.

Question 10

When would disulfiram be used?

Answer 10

As an alternative to acamprosate calcium and oral naltrexone hydrochloride are not suitable, or if the patient prefers disulfiram and understands the risks of taking the drug.

Question 11

When is nalmefene recommended for the reduction of alcohol consumption?

Answer 11

In patients with alcohol dependence who have a high drinking risk level, without physical withdrawal symptoms, and who do not require immediate detoxification.

Question 12

What is Wernicke’s encephalopathy?

Answer 12

The presence of neurological symptoms caused by biochemical lesions of the central nervous system after exhaustion of B-vitamin reserves, in particular thiamine (vitamin B1).

Question 13

Prophylactic supplementation of what vitamin should be considered in people who are harmful or dependent drinkers?

Answer 13

Thiamine, vitamin B1 due to risk of Wernicke’s encephalopathy