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INTERNSHIP > Psychotropic > Flashcards

Psychotropic Flashcards

1
Q

Describe the role of multivitamins in patients with a history of heavy alcohol intake.

A

Multivitamins are often pre-emptively charted for patients with a history of heavy alcohol intake to manage alcohol withdrawal in hospital.

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2
Q

According to the National Health and Medical Research Council (NHMRC) guidelines, what level of daily alcohol consumption is a health risk for men and women?

A

Average daily consumption in excess of two standard drinks

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3
Q

According to the National Health and Medical Research Council (NHMRC) guidelines, on any given day, alcohol consumption should not exceed what amount?

A

Four standard drinks

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4
Q

How much alcohol does a standard drink contain?

A

10 grams

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5
Q

What volume of full-strength beer equates to one standard drink?

A

285 mL

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6
Q

What volume of wine equates to one standard drink?

A

100 mL

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7
Q

What volume of fortified wine equates to one standard drink?

A

60 mL

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8
Q

What volume of spirits equates to one standard drink?

A

30 mL

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9
Q

Significant alcohol dependence associated with a withdrawal syndrome on cessation is more likely in which individual?

A

Those whose regular consumption is greater than eight standard drinks per day, especially if they also use other sedatives

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10
Q

Describe the significance of alcohol overdose.

A

Alcohol overdose is potentially fatal

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11
Q

What usually leads to death in alcohol overdose?

A

Death is usually due to inhalation of vomit or to respiratory depression.

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12
Q

What is the average lethal blood alcohol concentration (BAC)?

A

Around 0.45% to 0.5% (450 to 500 mg/100 mL).

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13
Q

What is an important caveat to consider regarding blood alcohol concentration?

A

People who have developed high tolerance to alcohol will be able to cope with higher blood alcohol concentrations

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14
Q

What is a significant factor which may lead to death by alcohol overdose in patients with a relatively low blood alcohol concentration?

A

Death may result from a much lower blood alcohol concentration if other sedative drugs have been taken.

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15
Q

Describe the usefulness of clinical estimation in determining alcohol intoxication.

A

Clinical estimation grossly underestimates the prevalence and severity of alcohol intoxication so a breathalyser should be used routinely to estimate the blood alcohol concentration.

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16
Q

Patients with acute alcohol poisoning should be monitored until their blood alcohol concentration falls below what level?

A

0.2%, although ideally, monitoring should continue until the blood alcohol concentration has dropped to 0.05% and there is no evidence of the onset of a withdrawal syndrome.

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17
Q

Alcohol withdrawal may being at what blood alcohol concentration?

A

Withdrawal may begin at a blood alcohol concentration of 0.1% and usually starts before the blood alcohol concentration reaches zero.

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18
Q

At what rate does blood alcohol concentration normally decline?

A

Blood alcohol concentration normally declines at a rate of 0.015% to 0.02% per hour, although the rate of decline may be increased in heavy drinkers.

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19
Q

What should you always consider regarding falling blood alcohol concentrations?

A

Alcohol in the gastrointestinal tract may continue to be absorbed and hence the blood alcohol concentration could rise even if there is no further alcohol ingestion.

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20
Q

Describe the overall management of alcohol intoxication and overdose.

A

Treatment of intoxication and overdose is supportive and symptomatic, with careful monitoring of the blood alcohol concentration, airway, level of consciousness and responsiveness, and oxygen saturation.

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21
Q

Alcohol overdose may lead to what two major biochemical changes?

A

Alcohol overdose may cause hypoglycaemia and metabolic acidosis.

22
Q

Describe the role of stimulants in the management of alcohol overdose.

A

Stimulants should not be given.

23
Q

Alcohol withdrawal syndrome is characterised by what 9 symptoms?

A
  1. Anxiety
  2. Tremor
  3. Sweating
  4. Nausea/vomiting
  5. Agitation
  6. Headache
  7. Perceptual disturbances
  8. Seizures (occasionally)
24
Q

Describe the presentation of seizures in acute alcohol withdrawal.

A

Half of all patients who experience a seizure only suffer a single fit.

25
Q

What may occur to some highly dependent patients beyond alcohol withdrawal patients?

A

Some highly dependent patients will progress to an alcohol withdrawal delirium.

26
Q

Symptoms of alcohol withdrawal delirium usually appear how long after the consumption of alcohol?

A

Within 6 to 24 hours of the last consumption of alcohol

27
Q

How long do symptoms of alcohol withdrawal delirium typically persist?

A

For up to 72 hours (but may last for several weeks)

28
Q

Describe the general role of medication in alcohol withdrawal

A

Many alcohol-dependent people require no medication when withdrawing from alcohol.

29
Q

Describe the role of supportive care in alcohol withdrawal.

A

Supportive care including information on the withdrawal syndrome, monitoring, reassurance, and a low-stimulus environment are effective in reducing withdrawal severity.

30
Q

If medication is required to manage alcohol withdrawal what may be done?

A

A benzodiazepine loading dose technique may be used.

31
Q

Alcohol-dependent patients are usually deficient in what vitamin?

A

Thiamine

32
Q

What service should always be considered in the management of alcohol withdrawal?

A

Free telephone advice is available 24 hours a day from drug and alcohol specialist advisory services for all Australian states and territories.

33
Q

Is home treatment appropriate for alcohol withdrawal?

A

Patients with favourable home conditions can be treated at home without admission for residential care.

34
Q

What should be done to manage alcohol withdrawal in patients with severe liver disease?

A

A short-acting benzodiazepine without active metabolites should be considered (such as oxazepam). Specialist advice and hospitalisation would be preferred.

35
Q

What is alcohol withdrawal delirium also known as?

A

Delirium tremens

36
Q

What is the most severe manifestation of alcohol withdrawal?

A

Alcohol withdrawal delirium (delirium tremens)

37
Q

How long after the cessation of drinking does alcohol withdrawal delirium (delirium tremens) commence?

A

Usually 72 to 96 hours after cessation of drinking

38
Q

What is alcohol withdrawal delirium (delirium tremens) characterised by?

A

Gross tremors and fluctuating levels of agitation, hallucinations (usually tactile), disorientation and impaired attention. Fever, tachycardia and dehydration may be present.

39
Q

Describe the severity of alcohol withdrawal delirium (delirium tremens)

A

It is a medical emergency that always requires hospitalisation and, if inadequately treated, has a high mortality rate, mainly from heart failure.

40
Q

Describe the complexity of alcohol withdrawal delirium (delirium tremens).

A

Alcohol withdrawal delirium is rarely uncomplicated; it is usually associated with infections, anaemia, metabolic disturbances and head injury. It may be associated with a range of other disorders including Wernicke encephalopathy and hepatic encephalopathy.

41
Q

Describe the general principles of alcohol withdrawal delirium (delirium tremens).

A

The principles of treatment (including appropriate supportive care and the use of thiamine and diazepam) are the same as those for milder withdrawal syndromes. Use diazepam 20 mg orally, every 2 hours until symptoms subside.

42
Q

What should be done if an antipsychotic drug is required in alcohol withdrawal delirium (delirium tremens)?

A

Use haloperidol 0.5 to 2 mg orally, repeated every 2 hours and titrated to clinical response, up to 10 mg in 24 hours.

43
Q

What are 2 first line options for severe psychotic symptoms associated with alcohol withdrawal delirium (delirium tremens) when oral administration is not possible?

A

Cautiously use:
1. Droperidol 5 mg IM, as a single dose OR
1. Haloperidol 5 mg IM, as a single dose.

44
Q

Describe the difference between droperidol and haloperidol in the management of alcohol withdrawal delirium (delirium tremens).

A

Droperidol is similar to haloperidol but is more sedating; haloperidol is less likely to lower seizure threshold.

45
Q

Describe the role of cHLORPROMAZine in alcohol withdrawal delirium (delirium tremens).

A

Avoid cHLORPROMAZine as it lowers seizure threshold.

46
Q

What are 2 first line options if extrapyramidal adverse effects emerge with droperidol or haloperidol in the management of alcohol withdrawal delirium (delirium tremens)?

A
  1. Benzatropine 1 to 2 mg orally OR
  2. Benzatropine 1 to 2 mg IM.
47
Q

What are 4 examples of symptoms of alcohol withdrawal?

A
  1. Anxiety
  2. Irritability
  3. Insomnia
  4. Cravings
48
Q

What forms the basis of long-term management of alcohol dependence?

A

Group or individual support and counselling programs

49
Q

How should you choose the drug to use for the long-term management of alcohol dependence?

A

Choice of drug needs to be individualised, depending on the person’s circumstances.

50
Q

Describe the intended duration of pharmacotherapy in the long-term management of alcohol dependence.

A

Regardless of the medication, treatment duration of 6 months or more is recommended.

51
Q

Describe the emerging evidence in regard to pharmacotherapy for alcohol dependence.

A

Baclofen, ondansetron and topiramate have been shown to assist in reducing alcohol relapse but further research is needed before these more expensive drugs can be recommended for use as first-line treatments.

INTERNSHIP (189 decks)

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