Substance abuse

Question 1

What are the symptoms of acute alcohol withdrawal?

When do these symptoms typically occur?

Answer 1

6-12 hours:

• Tremor
• Tachycardia
• Anxiety
• Sweating

36 hours:
- Seizures

48-72 hours:
- Delirium tremens (confusion, delusions, hallucinations, fever)

Question 2

i) What treatment is given in acute alcohol withdrawal?
ii) What other medications may be prescribed as part of an alcohol detoxification programme in chronic alcohol dependence?

Answer 2

i) Chlordiazepoxide (benzodiazepine)

ii)

• Acamprosate (reduces alcohol cravings)
• Disulfiram (unpleasant physical reactions if patient drinks alcohol)

Question 3

How do you calculate units of alcohol?

Answer 3

Units = Volume (L) x ABV (%)

Question 4

Describe the mechanism of action of benzodiazepines

Answer 4

Enhance the inhibitory effect of GABA, by increasing the frequency of chloride ion channels

Question 5

Describe the aetiology of Wernicke’s encephalopathy

Answer 5

Vitamin B1 (thiamine) deficiency

Question 6

Describe the clinical features of Wernicke’s encephalopathy

Answer 6

CAN OPEN

• Confusion
• Ataxia
• Nystagmus
• Ophthalmoplegia (weakness/paralysis of extraocular muscles)
• PEripheral
• Neuropathy

Question 7

Describe the prognosis of Wernicke’s encephalopathy

Answer 7

Reversible if treated

Question 8

How is Wernicke’s encephalopathy treated?

Answer 8

Pabrinex (Vitamin B1 + C)

Question 9

If Wernicke’s encephalopathy is not treated, it may progress to…

Answer 9

Korsakoff’s syndrome

Question 10

What are the clinical features of Korsakoff’s syndrome?

Answer 10

• Amnesia (retrograde and anterograde)

- Confabulation

Question 11

Describe the prognosis of Korsakoff’s syndrome

Answer 11

Chronic, irreversible

Question 12

What are the features of alcohol dependence?

Answer 12

CAN’T STOP

• Compulsion to drink alcohol
• Aware of the harms but persists
• Neglect of other activities
• Tolerance
• Stopping causes withdrawal
• Time preoccupied with alcohol
• Out of control use
• Persistent, futile effort to cut down

Question 13

Which tool can be used to screen for alcohol abuse?

Answer 13

CAGE questionnaire

• Cut down: have you thought you should cut down on the amount of alcohol you drink?
• Annoyed: do you feel annoyed if others suggest you drink too much?
• Guilty: do you feel guilty about how much you drink?
• Eye opener: do you ever have a drink first thing when you wake up?

Question 14

What is the weekly recommended number of units of alcohol for men and women?

Answer 14

14 units for men and women