Substance misuse

Question 1

Drug management in alcohol withdrawal

Answer 1

Withdrawal: long-acting benzo e.g. diazepam (alternative: chlordiazepoxide)

Seizures: short-acting benzo e.g. lorazepam

Delirium tremens: oral lorazepam 1st line (then IV lorazepam/haloperidol if Sx persist/PO declined)

Also give: pabrinex IV/IM - prophylactic thiamine, folate and pyridoxine

Question 2

What is Wernicke’s encephalopathy caused by?

Answer 2

acute thiamine (B1) deficiency, usually related to alcohol abuse

Question 3

What is the classic triad in Wernicke’s encephalopathy?

Answer 3

1. confusion
2. wide-based gait ataxia
3. opthalmoplegia - nystagmus, conjugate gaze palsies (decreased ability to move both eyes in same direction), bilateral lateral rectus palsies

Question 4

Management for Wernicke’s encephalopathy

Answer 4

high dose IV/IM thiamine (Pabrinex) over 1 week then oral supplements

must be given BEFORE glucose/carbohydrates to prevent Wernicke’s being precipitated by glucose administration

Question 5

What is Korsakoff’s syndrome?

Answer 5

hypothalamic damage and cerebral atrophy due to thiamine deficiency
- causes (mostly) irreversible anteroretrograde amnesia (inability to form new memories), etc.

Question 6

What is acamprosate?

Answer 6

anti-craving drug for alcohol (unvalidated)

Question 7

What is disulfiram?

Answer 7

antabuse - an aversive, makes drinking alcohol unpleasant

Question 8

What does naloxone block?

Answer 8

opiates

Question 9

What does naltrexone block?

Answer 9

opiates and alcohol

Question 10

Timeframe for presentations of alcohol withdrawal

Answer 10

6-12h - Sx
36h - seizures
72h - delirium tremens