Pharmacology: Alcohol Withdrawal/Intoxication + Addiction Rehabilitation

Question 1

In general: What is the treatment for

• Alcohol Intoxication
• Alcohol Withdrawal
• Alcohol Addiction Rehabilitation

Answer 1

Alcohol Intoxication
- give “Banana bag” and supportive therapy

Alcohol Withdrawal
- Benzodiazepine

Alcohol Addiction Rehabilitation
- MUST HAVE desire to quit and use non-pharmacologic therapy. In addition: Naltrexone/Disulfiram/Acamprosate.

Question 2

Patient walks in with slurred speech, nystagmus, facial flushing, irritability, ataxia, and mood changes. What kind of alcoholic state is he in? And what are the major effects of long term intoxication

Answer 2

Alcoholic Intoxication
- Hepatic damage and Thiamine (B1) deficiency (which can lead to Wernicke’s Encephalopathy and and hen Korsakoff’s Psychosis.

Question 3

A chronic alcoholic walks in with ataxia but then also has acute confusion and opthalmoplegia. What is he presenting with?

Answer 3

Wernicke’s Encephalopathy

Question 4

A chronic alcoholic walks in anterograde and retrogate amnesia, and confabulation. What is he most likely presenting with?

Answer 4

Korsakoff’s Psychosis

Question 5

What is in the banana bag and what is it used for?

Answer 5

Used for Alcohol Intoxication

• Thiamine (B1), Folic Acid (B9), Multivitamin, Fluid, and possibly Magnesium.

Question 6

A patient walks into the ED with confusion, hallucinations, agitation, tachycardia, and eventually tonic-clonic seizures and hyperthermia… what is he presenting with and what is his main treatment?

Answer 6

Alcohol Withdrawal: Delirium Tremens (3-5 days onset)

- Tx: Benzodiazepines (1st line)

Question 7

Types of Benzodiazepines to know: for Alcohol Withdrawal.

- two general groups and associated names.

Answer 7

Short acting: Does not go through Phase 1 Metabolism
- Lorazepam and Oxazepam

Longer Acting: Can accumulate in hepatic impairment
- Diazepam (very fast acting), Chloridiazepoxide, and Clonazepam

Question 8

What is the prerequisites for starting Alcohol Addiction Rehabilitation?

Answer 8

They have to want to quit and be willing to also use a non-pharmacologic therapy.

Question 9

What are the FDA approved drugs for the maintenance of abstinence?

Answer 9

Naltrexone, Disulfiram, Acamprosate

Question 10

Naltrexone: MOA

Answer 10

Reversible Opioid antagonist

Question 11

Naltrexone: FDA approved indications

Answer 11

Alcohol and Opioid dependence (since it’s a reversible opioid antagonist)
- Note: Patients using opioids as pain control may not get pain relief while on Naltrexone.

Question 12

Disulfiram: MOA

Answer 12

Aldehyde dehydrogenase antagonist

Question 13

Disulfiram: FDA approved indication

Answer 13

Maintenance of alcohol abstinence: via ADVERSIVE therapy, makes patient sick when they drink alcohol.

Therefore: Preferred to be given to highly motivated people who will actually stop when they get sick OR for high temptation situations.

Question 14

Disulfiram: Adverse Effects

Answer 14

Metallic taste, drowsiness, visual changes, etc.

ACETALDEHYDE TOXICITY

• Flushing, Nausea/Vomiting
• Rare: CV collapse, Death

Question 15

Acamprosate: MOA

Answer 15

Unknown: Likely blockade of NMDA receptor

Question 16

Acamprosate: FDA approved indication

Answer 16

Maintenance of alcohol abstinence

Question 17

Acamprosate: Important Fact

Answer 17

• Caution in severe renal impairment (Disulfiram and Naltrexone are more hepatic related but Acamprosate is renal)
• Patient needs to currently be abstinent before starting.