Substance misuse Flashcards
What blood alcohol concentration does acute toxicity occur at ?
300mg%
What are the ways in which to measure alcohol consumption
- Blood alcohol concentration- breathalyser
2. Blood tests- raised MCV (2-3 months), GGT (2-3 weeks), CDT (2-3 weeks)
What is the management of alcohol misuse?
When is abstinence vs controlled drinking preferred?
- Motivational intervewing- helps moves through stage
- Planning intervention- ie carry on with pattern, reduce dose or abstinence (detox)
Controlled drinking preferred when psych co-morbidity and friends and family don’t drink
What are the three alcohol withdrawal disorders?
State when they all occur after withdrawal
- Uncomplicated withdrawal syndrome, 4-12 hours
- Alcoholic withdrawal syndrome with seizures 6-48 hours (grand mal)
- Delerium tremens 1-7 days
What are the features of uncomplicated alcoholic withdrawal disorder?
Tachycardia >100 Sweating Nausea and vomiting Insomnia COARSE TREMOR Psychomotor agitiation Hallucinations (derogatory auditory typically) and illusions
What are the features of delerium tremens (acute confusional state)
Same as withdrawal disorder plus
Clouding of conciousness Disorientation Amnesia Marked psychomotor agitation Hallucinations- visual, auditory, tactile classic Lilliputian hallucinations Paranoid delusions Seizures Sudden cardiovascular collapse
When is prophylaxis for withdrawal required in alcoholics?
- > 10 units for 10 days
2. Previous history of withdrawal, dependence or current withdrawal symptoms
What is the drug management of withdrawals ie Detox?
- Benzodiazepenes- Diazepam
- Outpatient- chlordiazepoxide (type of BZ)
- Parenteral B vitamins
What is the psychological therapy of maintenance of alcohol abstinence
- Individual psychotherapy
2. Group therapy AA
What is the pharmacological therapy of maintenance of alcohol withdrawal?
- Aversion- Disulfiram (inhibits acetaldehyde dehydrogenase)
- Anticraving drugs:
- Naltrexone
- Acomprostate
What is Wernicke’s encephalopathy?
Tetrad of:
- Acute confusional state
- Occular signs-opthalmoplegia, nystagmus
- Ataxia
- Other features: peripheral neuropathy, resting tachycardia, evidence of nutritional deficiency
How do you treat wernicke’s encephalopathy?
IV thiamine replacement- pabrinex
Avoid carbohydrate load until thiamine replacement is complete
What is Korsakoff’s syndrome?
Inability to lay down new memories
Retrograde amnesia
Confabulation (filling in memories)
How do you manage Korsafoff’s syndrome?
Oral thiamine replacement and multivitamin replacement for up to 2 years
OT assessment, cognitive rehabilitation
What is the management of opoids abstinence?
- Methadone Linctus- to reduce withdrawal symptoms in community is buprenorphine
- Clonidine and Naltrexone
