SUBSTANCE ABUSE- ALCOHOL

Question 1

ALCOHOL DEPENDENCE;

What can alcohol withdrawal lead to?

Answer 1

In severely dependent;
alcohol withdrawal syndrome
leading to seizures, delirium tremens and death.

Question 2

ALCOHOL DEPENDENCE;
What is treatment of alcohol withdrawal syndrome?

Answer 2

Long acting benzodiazepine
chlordiazepoxide or diazepam

Question 3

ALCOHOL DEPENDENCE;
what are the different dose regimens for treatment of alcohol withdrawal symptoms?

When are they used?

Answer 3

Fixed dose reducing regimens- using a standard initial dose followed by dose reduction to zero, usually over 7-10 days

used in primary care

inpatient or residential- fixed dose of symptoms triggered regimen is used.

Tailors the drug regimen according to the severity of withdrawal and complications

Question 4

ALCOHOL DEPENDENCE;
What drugs can also be used in acute alcohol withdrawal?

Answer 4

Carbamazepine (unlicensed)
Clomethiazole

Question 5

ALCOHOL DEPENDENCE;
What dangerous interaction can occur with clomethiazole?

Answer 5

alcohol and clomethiazole especially in patients with cirrhosis can lead to fatal respiratory depression even with short term use.

Question 6

ALCOHOL DEPENDENCE;
What should be given if alcohol withdrawal seizures occurs?

What should be given if seizures develop during treatment?

Answer 6

A fast acting benzodiazepine (lorazepam)

Review withdrawal drug regimen

Question 7

ALCOHOL DEPENDENCE;
What is given if patient experienced delirium tremens?

Answer 7

Medical emergency

should give lorazepam oral or

lorazepam OR haloperidol IV if symptoms persist

Question 8

ALCOHOL DEPENDENCE;
What are treatment options for alcohol dependence?

Answer 8

Psychological treatment;
CBT

Pharmacological treatment;
acamprosate
naltrexone
Both are recommended for relapse prevention in patients with moderate and severe dependence used alone side psychological intervention

Disulfiram

Question 9

ALCOHOL DEPENDENCE;
what is given for alcohol related pancreatitis ?

Answer 9

pancreatic enzyme supplements

given to patients who have symptoms of steatorrhea or have poor nutritional status due to exocrine pancreatic insuffiencieny.

Question 10

ALCOHOL DEPENDENCE;
What is treatment for alcohol related hepatitis?

Answer 10

If they have a discriminant function of 32 or more a corticosteroid can be given only after active infection or GI bleeding is treated and renal impairment is controlled.

Only short term use

Question 11

ALCOHOL DEPENDENCE;
ACRAMPOSATE
what is it and what is it used for?

Answer 11

used with counselling

used for maintaining absitenence
Initated after abstinence has been achieved and continued for 1 year

Treatment can be maintained if the patient has temp relapse but stopped if regular/excessive drinking.

Question 12

Naltrexone;
what is it and what is it used for?

Answer 12

An opioid receptor antagonist
useful as adjunct in the treatment of alcohol dependence after successful withdrawal.

Stopped after 4-6 weeks after starting treatment.

Question 13

DISULFUIRAM;
what is it used for?

What are side effects?

Answer 13

Extremely unpleasant reaction if taken with alcohol after ingestion of even small amount(mouthwashes, toiletries, medicines).

Only effective taken daily

flushing face, throbbing headache, nausea and vomiting

Question 14

NALMEFENE;
what is it and what is it used for?

Answer 14

Used in patients with dependence without physical withdrawal symptoms and who do not require immediate detoxification.
Not for immediate abstinence

Question 15

WERNICKES ENCEPHALOPATHY;
Which patients are at increased risk of developing it?

Answer 15

Malnourished or at risk of malnourishment
decompensated liver disease

alcohol dependent patients

Question 16

WERNICKES ENCEPHALOPATHY;
What is treatment?

Answer 16

If suspected;
parenteral thiamine followed by oral thiamine

Prophylactic oral thiamine should also be given to harmful or dependent drinkers if they are in acute withdrawal or before and during assisted alcohol withdrawal.