Substance use disorder Flashcards
What is the mechanism of alcohol withdrawal?
Chronic alcohol consumption enhances GABA mediated inhibition in the CNS and inhibits NMDA-type glutamate receptors. Alcohol withdrawal leads to decreased inhibitory GABA and increased NMDA glutamate transmission.
When do symptoms of alcohol withdrawal typically start?
Symptoms start at 6-12 hours after the last drink.
What are common symptoms of alcohol withdrawal?
Tremor, sweating, tachycardia, and anxiety.
When is the peak incidence of seizures during alcohol withdrawal?
The peak incidence of seizures is at 36 hours.
When does delirium tremens peak during alcohol withdrawal?
The peak incidence of delirium tremens is at 48-72 hours.
What are the symptoms of delirium tremens?
Coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, and tachycardia.
What is the management for patients with a history of complex alcohol withdrawals?
Patients should be admitted to the hospital for monitoring until withdrawals stabilize.
What is the first-line treatment for alcohol withdrawal?
Long-acting benzodiazepines such as chlordiazepoxide or diazepam.
Which benzodiazepine is preferable in patients with hepatic failure?
Lorazepam is often preferred in patients with hepatic failure.
Why is lorazepam preferred in patients with liver cirrhosis?
Lorazepam is metabolised through glucuronidation, which is less affected by liver function.
What is the risk of using chlordiazepoxide in patients with liver cirrhosis?
Chlordiazepoxide undergoes hepatic oxidation via the cytochrome P450 system, which can lead to prolonged drug accumulation and increased risk of toxicity.
Is carbamazepine effective in treating alcohol withdrawal?
Yes, carbamazepine is also effective in the treatment of alcohol withdrawal.
Is phenytoin effective for alcohol withdrawal seizures?
Phenytoin is said not to be as effective in the treatment of alcohol withdrawal seizures.
