Treatments for alcohol misuse Flashcards
Indications for inpatient alcohol detoxification instead of outpatient
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
Most suitable benzodiazepines for alcohol detox in a patient with liver failure
Lorazepam
Oxazepam
Reason why lorazepam or oxazepam are more suitable for alcohol detox in patients with liver failure
They do not have phase 1 metabolism
Description of front loading benzodiazepine detox regime
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
Disadvantages of using chlormethiazole for an alcohol detox
Variable oral bioavailability
Higher risk of respiratory depression
Higher addictive potential
Higher street value
Mechanism of action of acamprosate
Inhibits glutamatergic NMDA receptor function
Balances the GABA glutamate imbalance seen in alcoholism
Most common side effects with acamprosate
GI disturbance
Number needed to treat with acamprosate to prevent one relapse
11
Mechanism of action of naltrexone
Opioid antagonist
Mechanism of action of nalmefene
Opioid receptor modulator
Benefits to prescribing nalmefene against other medications used to prevent relapse of alcohol abuse
Can be prescribed PRN
No requirement for blood monitoring
Can be used in a community setting
Mechanism of action of disulfiram
Blocks aldehyde dehydrogenase, results in the accumulation of acetaldehyde leading to signs and symptoms of nausea, vomiting, headache etc. if alcohol is drunk
Contraindications to disulfiram
Impulsivity
Suicidality
Psychosis
Severe hepatic dysfunction
Peripheral neuropathy
Cardiac disease
Treatments included in the Project MATCH study
CBT
Twelve step programme
Motivational enhancement therapy
Most effective treatment according to Project MATCH in patients with low psychiatric comorbidity
Twelve step programme
Treatments included in the UK Alcohol Treatment Trial (UKATT)
Motivational enhancement therapy
Social behaviour and network therapy
Main components in behavioural self-control training
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
Components of the FRAMES approach to alcohol abuse
Feedback of risks
Responsibility heightened
Advised to cut down or abstain
Menu of alternative options offered
Empathetic interviewing
Self-efficacy enhanced
Four principles of motivational interviewing
Express empathy
Develop attitude-behaviour discrepancy
Roll with resistance
Support self-efficacy for change
The idea that focusing entirely on abstinence makes relapses feel more catastrophic
Abstinence violation effect
Concepts used within the Minnesota rehab model
4 week stay in a ward
Detoxification
Psychoeducation
AA attendance
Aftercare
Concepts used within the Phoenix house model
Therapeutic community
Slightly confrontational style
Firm feedback
Emphasis on personal responsibility
Length of time a benzodiazepine reducing regime usually lasts for alcohol detoxification
5-7 days
Starting dose of acamprosate in adults >60kg
666mg three times daily
Length of time acamprosate should be given
6 months - 1 year
Age range which acamprosate is licensed for
18-65
Neurotransmitter system which acamprosate acts on
GABA
Benzodiazepine used for alcohol detoxification in a patient with a history of seizures
Diazepam
Common side effects of disulfiram
Halitosis
Headache
Medication used for delirium tremens which may increase the risk of seizures
Haloperidol
Opioid receptor antagonist which can be used to block the ‘high’ from alcohol
Naltrexone
First symptom to resolve when a patient with Wernicke’s encephalopathy is given thiamine
Ophthalmoplegia
Drug used in alcohol treatment which should be supervised by someon
Disulfiram
Mechanism of action of disulfiram
Aldehyde dehydrogenase inhibitor
First line antipsychotic for hallucinations associated with DTs
Haloperidol
Percentage of people undergoing alcohol withdrawal who develop delirium tremens
5%
