Thera 2 ETOH disorder

Question 1

NIAA definition of ETOH abuser for males is:

Answer 1

> 7 drinks in 2 hrs
14 drinks / week

Question 2

NIAA definiton of ETOH abuser for females is:

Answer 2

> 3 drinks in 2 hrs
7 drinks/week

Question 3

Biological markes for ETOH

Answer 3

AST 2x>ALT
GGT >30
dCDT >1.7
BAC >1.5
EtG+

Question 4

ETOH Neuro effects are:

Answer 4

Enhances GABA–> Feel relax
NMDA Glutamate receptor antagonism–>Don’t feel pain
Mild opiate agonism
5-HT3 augmentation–> Vomiting
Vasodilation
Increase in gastric secretions
Diuresis–> ADH is inhibited by alcohol so pee more

Question 5

Treatment for ETOH withdrawal:

Answer 5

1-Benzodiazepines is the prefer option
2-Can use Barbiturates like phenobarbital if the benzodiazepines are not effective
3-Propofol –> Is a GABA agonist and a NMDA receptor antagonist so decreases the glutamate activity–> Is useful in ICU but Benzos are still prefered

Question 6

Treatment for alcohol withdrawal autonomic manifestation if the pt has high BP

Answer 6

Clonidine or dexmedetomidine a alpha 2 agonist

Question 7

treatment for alcohol withdrawal Neuroleptics to reduce agitation:

Answer 7

Haloperidol
-Block dopamine so reduces agitation
-Give by IV

Question 8

Wernicks encephalopathy symptoms

Answer 8

Ataxia–> poor coordination
Confusion
Ocular muscle disturbances
due to low thiamine
pt is ETOH problem need to give Thiamine (B1) supplement

Question 9

Thiamine dose is

Answer 9

200-500mg IV TID until symptoms resolve
Can give Mg2+ and glucose supplement 20mins after

Question 10

Korsakoff syndrome
Symptoms

Answer 10

Irriversible brain damage due to chronic thiamine (Vitamin B1) deficiency + pt is alcoholic
Symptoms:
Amnesia–> memory loss
Poor recall
Confabulation–> Pt will make fake memories

Question 11

Drugs to treat Alcohol use disorder after withdrawal symptoms have been resolved:

**Disulfiram **

Answer 11

Antabuse
Inhibits Aldehyde dehydrogenase which lead to increase acetaldehyde levels
If the pt drink they will suffer from: Intense nausea, vomiting, tachycardia, hypotension, flushing
-Cannot give if pt has cardiac conditions like angina, MI, severe liver damage
-Cannot give if pt lives alone

Question 12

Drugs to treat Alcohol use disorder after withdrawal symptoms have been resolved:
Naltrexone

Answer 12

PO is Revia
Injection is vivitrol
is a MU antagonist
It has anticraving effects, negative effects in the nucleus of accumbus
AE: Nausea, HA, dizziness
-Cannot give if pt has increase LFT so high AST/ALT high GGT and is HepC+ has sever liver hepatitis cirrhosis
-Pregnancy category C
-Conjugated and then renally excreted –> Is metabolize to 6-betanaltrexol

Question 13

Drugs to treat Alcohol use disorder after withdrawal symptoms have been resolved:
**Acamprosate **

Answer 13

Campra
MOA: Enhances GABA, Ca2+ blockade, Decreases glutamate activity, may increase taurine
-Is excreted unchange so is safe to give to pt with elevated LFT levels
AE: Diarrhea, HA

Question 14

Drugs to treat Alcohol use disorder after withdrawal symptoms have been resolved:
Topiramate

Answer 14

Topomax
MOA: Enhances GABA ; reduces glutamate signaling
Useful if Naltrexone and acamprosate have failed
AE:
-paresthesia
-HA
-Loss of taste
-Anorexia

Question 15

Gabapentin

Answer 15

can be use in patient with high withdrawal symptoms
-has a abuse risk so shouldn’t be use in pt with substance abuse disorder