Third Year

Question 1

What drug class is chlordiazepoxide?

Answer 1

Benzodiazepine

Question 2

When would we use chlordiazepoxide?

Answer 2

Acute moderate and severe alcohol dependency withdrawal

Question 3

What is the dose of chlordiazepoxide?

Answer 3

Moderate 10-30mg TD PO. Titrate down for 5-7 days.

Severe 10-50mg QDS PO and PRN for 2 days. Titrate down for 7-10 days.

Question 4

What is the maximum daily dose of chlordiazepoxide?

Answer 4

250mg

Question 5

What are important contraindications for chlordiazepoxide?

Answer 5

Respiratory depression/insufficiency
Psychosis
Myasthenia gravis

Question 6

What are the side effects of chlordiazepoxide?

Answer 6

Movement disorder
Drowsy
Confusion
Dizziness
Hypotension
Nausea

Question 7

What advice should you give patients on benzodiazepines?

Answer 7

Don’t drive or use heavy machinery as drowsiness can persist the next day

Question 8

What do we use in acute alcohol withdrawal?

Answer 8

Chlordiazepoxide or diazepam
Carbamazepine as an alternative
Clomethiazole if in patient as a third alternative

Question 9

What is the drug treatment for delirium tremens?

Answer 9

Oral lorazepam

Parenteral lorazepam or haloperidol as second line

Question 10

What is carbamazepine?

Answer 10

Anti convulsant/anti epileptic

Question 11

What is carbamazepine used for?

Answer 11

Epilepsy
Alcohol withdrawal
Mania
Neuropathic pain
Diabetic neuropathy

Question 12

What is the dose for carbamazepine in alcohol withdrawal?

Answer 12

800mg divided over the day

Titrate to 200mg over 5 days

Question 13

When should you be cautious with carbamazepine?

Answer 13

Blood, hepatic or skin disorders

Question 14

What are the side effects of carbamazepine?

Answer 14

Drowsiness
Dizziness
N/V
Diplopia

Question 15

Which drugs do we use for helping with alcohol cessation?

Answer 15

Acamprosate - prevents relapse by reducing insomnia, anxiety and craving
Disulfiram - causes bad things when drink alcohol
Naltrexone - opioid receptor antag, stops alc effects
Nalmefene - opioid receptor antag, stops craving

Question 16

What dose of thiamine do we give before WE and in WE?

Answer 16

25-100mcg OD

200-300mcg daily

Question 17

What is pabrinex?

Answer 17

Mix of vit B and vit C: thiamine, riboflavin, pyridoxine, nicotinamide and ascorbic acid

Question 18

How do we give pabrinex?

Answer 18

IV

Question 19

What are the SEs of pabrinex?

Answer 19

Tight chest and wheeze indicates sensitivity reaction.

Anaphylactic shock

Question 20

Which drug do we need to be aware of if someone is about to be prescribed pabrinex?

Answer 20

Levodopa

Question 21

What are the contraindications to acamprosate?

Answer 21

Pregnancy
Severe liver failure
Cr above 120

Question 22

What are the side effects of acamprosate?

Answer 22

D/V

reduced libido

Question 23

What is the dose of acamprosate?

Answer 23

666mg TD PO if over 60kg and under 65y/o

666mg OD PO and 333mgx2 BD PO if under 60kg or over 65

Continue for 1 year

Question 24

How does disulfiram work?

Answer 24

Causes acetaldehyde build up causing asian flush:
flushing
throbbing
headache
palpitations

Question 25

Why can’t you drink on metronidizole?

Answer 25

It give you asian flush bc acetaldehyde build up