Treatments for alcohol misuse

Question 1

Indications for inpatient alcohol detoxification instead of outpatient

Answer 1

Past or current DTs
Past or current seizures
Psychiatric morbidity with risk of suicide
Poor physical health
Wernicke’s or Korsakoff’s
Homelessness
Social situation where outpatient detox might not be completed successfully

Question 2

Most suitable benzodiazepines for alcohol detox in a patient with liver failure

Answer 2

Lorazepam
Oxazepam

Question 3

Reason why lorazepam or oxazepam are more suitable for alcohol detox in patients with liver failure

Answer 3

They do not have phase 1 metabolism

Question 4

Description of front loading benzodiazepine detox regime

Answer 4

Loading dose of diazepam is given
Further doses are given every 90 minutes until the patient is lightly sedated
No further medication is given
The long half life of diazepam covers the withdrawal

Question 5

Disadvantages of using chlormethiazole for an alcohol detox

Answer 5

Variable oral bioavailability
Higher risk of respiratory depression
Higher addictive potential
Higher street value

Question 6

Mechanism of action of acamprosate

Answer 6

Inhibits glutamatergic NMDA receptor function
Balances the GABA glutamate imbalance seen in alcoholism

Question 7

Most common side effects with acamprosate

Answer 7

GI disturbance

Question 8

Number needed to treat with acamprosate to prevent one relapse

Answer 8

11

Question 9

Mechanism of action of naltrexone

Answer 9

Opioid antagonist

Question 10

Mechanism of action of nalmefene

Answer 10

Opioid receptor modulator

Question 11

Benefits to prescribing nalmefene against other medications used to prevent relapse of alcohol abuse

Answer 11

Can be prescribed PRN
No requirement for blood monitoring
Can be used in a community setting

Question 12

Mechanism of action of disulfiram

Answer 12

Blocks aldehyde dehydrogenase, results in the accumulation of acetaldehyde leading to signs and symptoms of nausea, vomiting, headache etc. if alcohol is drunk

Question 13

Contraindications to disulfiram

Answer 13

Impulsivity
Suicidality
Psychosis
Severe hepatic dysfunction
Peripheral neuropathy
Cardiac disease

Question 14

Treatments included in the Project MATCH study

Answer 14

CBT
Twelve step programme
Motivational enhancement therapy

Question 15

Most effective treatment according to Project MATCH in patients with low psychiatric comorbidity

Answer 15

Twelve step programme

Question 16

Treatments included in the UK Alcohol Treatment Trial (UKATT)

Answer 16

Motivational enhancement therapy
Social behaviour and network therapy

Question 17

Main components in behavioural self-control training

Answer 17

Limiting number of drinks
Using a drink diary
Using food and non-alcoholic drinks as spacers
Slowing down rate of drinking
Using assertiveness to refuse drinks

Question 18

Components of the FRAMES approach to alcohol abuse

Answer 18

Feedback of risks
Responsibility heightened
Advised to cut down or abstain
Menu of alternative options offered
Empathetic interviewing
Self-efficacy enhanced

Question 19

Four principles of motivational interviewing

Answer 19

Express empathy
Develop attitude-behaviour discrepancy
Roll with resistance
Support self-efficacy for change

Question 20

The idea that focusing entirely on abstinence makes relapses feel more catastrophic

Answer 20

Abstinence violation effect

Question 21

Concepts used within the Minnesota rehab model

Answer 21

4 week stay in a ward
Detoxification
Psychoeducation
AA attendance
Aftercare

Question 22

Concepts used within the Phoenix house model

Answer 22

Therapeutic community
Slightly confrontational style
Firm feedback
Emphasis on personal responsibility

Question 23

Length of time a benzodiazepine reducing regime usually lasts for alcohol detoxification

Answer 23

5-7 days

Question 24

Starting dose of acamprosate in adults >60kg

Answer 24

666mg three times daily

Question 25

Length of time acamprosate should be given

Answer 25

6 months - 1 year

Question 26

Age range which acamprosate is licensed for

Answer 26

18-65

Question 27

Neurotransmitter system which acamprosate acts on

Answer 27

GABA

Question 28

Benzodiazepine used for alcohol detoxification in a patient with a history of seizures

Answer 28

Diazepam

Question 29

Common side effects of disulfiram

Answer 29

Halitosis
Headache

Question 30

Medication used for delirium tremens which may increase the risk of seizures

Answer 30

Haloperidol

Question 31

Opioid receptor antagonist which can be used to block the ‘high’ from alcohol

Answer 31

Naltrexone

Question 32

First symptom to resolve when a patient with Wernicke’s encephalopathy is given thiamine

Answer 32

Ophthalmoplegia

Question 33

Drug used in alcohol treatment which should be supervised by someon

Answer 33

Disulfiram

Question 34

Mechanism of action of disulfiram

Answer 34

Aldehyde dehydrogenase inhibitor

Question 35

First line antipsychotic for hallucinations associated with DTs

Answer 35

Haloperidol

Question 36

Percentage of people undergoing alcohol withdrawal who develop delirium tremens

Answer 36

5%