Substance Misuse - BB Flashcards
Formula for working out how many units patient is drinking?
(ml x abv%) / 1000
What do you need to demonstrate in history taking to show that patient is alcohol dependent?
If three or more of the following have been present together at some time during previous year:
* Strong desire or sense of compulsion to take substance
* Difficulties in controlling substance taking behaviour in terms of its onset, termination or levels of use
* Physiological withdrawal state when substance ceased/reduced
* Evidence of tolerance - increased doses needed to achieve original effects by lower doses
* Progressive neglect of alternative pleasures or interests, increased amount of time to obtain or take substance or recover from efefcts
* Persisting with substance despote clear evidence of overtly harmful consequences (eg liver, depression, impaired cognition)
Medications for alcohol withdrawal - how long for, purpose and route
- Chlordiazepoxide - benzo, high dose, oral, gradually reduced and stopped over 10 days
- Pabrinex - IV/IM - b vitamin compound, oral thiamine and multivitamins after course
- Diazepam 10mg PR - consider PRN in case of seizure
Cause and symptoms of Wernickes encephalopathy
Thiamine deficiency, life threatening:
* Nystagmus
* Ataxia
* Confusion
Medication to treat and prevent wernickes encepalopathy
- Pabrinex IM/IV
- Then oral thiamine and multivitamins after
Consequency of not providing treatment for WE and symptoms of this
Korsakoff psychosis, permanent has no cure:
* Retrograde amnesia - loss previous memories
* Anterograde amnesia - unable to make new memories
* Confusion
* Behavioural changes
Alcohol detox guidelines UHL
- Screen for all substances on admission as part of MHA
- Complete severity of alcohol dependence questionaire (SADQ)
- Before prescribing withdrawal meds - contact turning point to check if known to services and already prescribed something
- Specialist advice from Addiction consultant if necessary
- Investigations - baseline
- Observe at regular intervals - at least 6 hourly - inc temp, pulse, RR and BP for first 24hrs
- Prescribe
- Assess for Wernickes encephalopathy
- Discharge - cautious, not while undergoing detox, referred to substance misuse services after detox for relapse prevention
Investigations done for someone presenting with alcohol withdrawal
Bedside:
* Full set obs
* ECG
* Urine drug test
* Breathalyser test
Bloods:
* Full blood count
* INR
* U&E
* LFT inc GGT
* Amylase
* TFT
* Lipid profile
* Vitamin B12 and folate
* Bone profile
* Glucose
When is alcohol detoxification not suitable to be undertaken in community and needs inpatient management?
- Severe alcohol dependence with risk of severe withdrawal symptoms
- Poor/no social support
- Medical or psychiatric co-morbidities eg epilepsy, severe liver impairement
- Risk of harm to self and others
- PMH withdrawal complicated by seizures or delirium tremens
- Evidence of cognitive impairment
- May be needed if 15 units daily
Alcohl withdrawal syndrome symptoms
Can manifest as early as 6-12hrs
Peak between 10-30hrs, subside by 40
* Tachycardia
* Hypertension
* Tremor
* Sweating
* Pyrexia
* Nausea
* Retching
* Insomnia
* Hyperactivity
* Anxiety
* Transient visual and auditory hallucinations - can last for 5-6 days
–> LRI
Withdrawal seizures
- Occur in first 12-48hrs
- After this occurance is rare
- More likely if previous seizures on withdrawal or epilepsy
- Generalised usually
- Can be episodic
Delirium tremens - symptoms
- Uncommon medical emergency
- Impaired consciousness
- Confusion
- Hallucinations
- Agitation
- Marked tremor
- Paranoid ideation
- Insomnia
- Autonomic hyperactivity (tachycardia, hypertension, pyrexia and sweating)
Cause of death from delirium tremens
- Hyperpyrexia
- Ketoacidosis
- Profound circulatory collapse
Preventing relapse of alcohol dependence
- Disulfiram
- Acamprosate
- Naltrexone
Initiated by turning point
Alcohol withdrawal assessment scoring
- CIWA-Ar tool - questionaire, assess withdrawal
Scoring system for liver disease
- Child-Pugh
